Mental Health and Social Policy: Beyond Managed Care Book

Preface     xi
Mental Health and the Mental Health Professions     1
Symptoms, Diseases, and Reaction Patterns     3
Disease, Personality Disturbance, or Problem in Living     3
Social Adjustment     4
Concepts of Severe and Persistent Mental Illness     5
Patterns of Mental Health Utilization     6
The Mental Health Professions     9
Mental Health Personnel and Work Patterns     12
Trends in Mental Health Care     17
Changing Inpatient Care     20
What Are Mental Health and Mental Illness?     23
Psychiatric Diagnosis Guidelines     23
Varieties of Mental Illness     27
Schizophrenia: An Example in Psychiatric Conceptualization     28
Varying Conceptions of Mental Illness     32
Developmental Models     37
Changing Conceptions of Mental Illness     39
Social Conceptions of Mental Illness     41
Views of Mental Illness in Relation to Social Policy     43
The Patient and the Society: An Insoluble Dilemma     46
Social Problem or Mental Illness?     47
Psychological Disorder and the Flow of Patients into Treatment: The Study of Psychiatric Epidemiology     50
Identifying Psychological Problems in Community Populations     51
Estimates of Prevalence of Disorder in Community Populations     54
The Epidemiological Catchment Area Program and the National Comorbidity Survey     55
Psychological Disorder and Utilization of Care     57
Social Factors Associated with Psychiatric Conditions in the Community     61
Race and Ethnic Disparities     64
The Epidemiology of Antisocial Behavior and Behavior Disorders     66
Conceptions of the Causes of and Means of Controlling Mental Illness     68
The Impact of Environment on Mental Illness     68
The Question of Inheritance and Environment     69
A Note on Psychiatric Drugs     73
The Psychosocial-Development Perspective     80
The Learning Perspective: Behavior Therapy     86
The Social-Stress Perspective     88
The Labeling Perspective     93
Collective Mobilization     95
The Development of Mental Health Policy in the United States     96
The Early History of Worcester State Hospital     99
More Recent Developments in Mental Health Policy     100
Post-World War II Developments in Mental Health Policy     101
Postwar Psychiatry      102
The Organization of State Mental Hospitals     113
Programs of Community Care     117
The Composition of the Seriously Mentally Ill Population     117
Homelessness and Mental Illness     119
The Recognition of Mental Disorders     124
Mental Illness, Illness Behavior, and Entry into Psychiatric Care     126
Community Definitions of Mental Illness     132
The Course of Schizophrenia     137
The Financing and Delivery of Mental Health Services     140
Mental Health Coverage and Expenditures     140
The Pattern of Inpatient Services     144
Utilization of Services and Financing Patterns     146
The Economics of Mental Health Care     148
Psychiatric Care Under Prepayment Plans     149
The Structure of Insurance and Needed Mental Health Benefits     152
The Role of Primary Medical Care     158
The Management of Psychological Distress     162
Some Promising Signs     166
Managed Mental Health Care     167
Basic Mechanisms of Managed Care     167
Types of Managed Care Organizations     170
Managed Care for Persons with Mental Illness     171
Opportunities and Special Problems in Managed Mental Health Care     175
Performance of Managed Care     177
Some Unresolved Issues in Managed Care     181
Institutionalism and Deinstitutionalization: Building an Effective Community Services System     185
Criteria for Evaluation     185
Understanding the Processes of Deinstitutionalization     192
Environmental Factors Promoting Effective Performance     194
Implications of Community Institutional Placement     200
Models for Community Care     201
Points of Leverage     211
Modifying State Mental Health Systems     211
Medicaid Reform     213
Improving Disability Determination     214
The Case Management Approach     217
Organizational Barriers     219
The Absence of a Clear Focus of Responsibility and Authority     220
Innovations in Mental Health Services     222
Maintenance of Patients with Persistent Disorders     225
A Further Note on Employment     229
The Special Case of Children with Severe Emotional Disturbance     231
Problems in the Diffusion of Mental Health Innovations     233
Innovations in Housing     234
Changing Roles of the Mental Health Professions      235
Future Trends in Innovative Mental Health Services     236
The Social Context of Mental Health Practice: Foundations of Trust     238
Social Influences on Psychiatric Judgment     241
Personal and Social Biographies     242
The Sociocultural Context     244
Constraints of Practice Organization and Settings     248
Competition in the Allocation of Care     249
A Note on the Care of Patients Who Have Chronic Impairment     251
Mental Illness, the Community, and the Law     252
Involuntary Hospitalization     253
Outpatient Commitment and Mental Health Courts     258
Criminalization of Persons with Mental Illness     262
A Note on Dangerousness and the Relationship Between Mental Illness and Violence     265
The Right to Treatment     270
Right to Refuse Treatment     273
The Americans with Disabilities Act and the Supreme Court Decision in Olmstead v. L.C.     275
The Social Context of Legal Reform in Mental Health     277
References     279
Name Index     304
Subject Index     308