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This paper examines the process of psychiatric diagnosis in a community mental health center walk-in clinic. The results indicate a great deal of conflict and contradiction in the psychiatric evaluation. This is discussed in light of several tensions: (1) mixed agendas surrounding diagnosis; (2) conflict between training and professional practice; (3) conflict created when a public facility is staffed by an elite medical school; (4) conflict between providing mental health services while serving the needs of other public agencies and mandates; and (5) conflict between an ascendant biopsychiatric model and the daily work of clinical therapeutic service. [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services. [ABSTRACT FROM AUTHOR]

In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005-2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity. [ABSTRACT FROM AUTHOR]

Research on disparities in health and services should include a critical examination of how social cultural and contextual factors affect the connection between symptoms and psychiatric disorders. Systematic differences in this connection by these factors will mean that clinicians using a universalist approach to disorders may make more diagnostic errors for certain patients (e.g., ethnic minorities, the poor). Based on the literature on normative clinical decision-making, this study tests for whether the effect of specific psychiatric disorders on key symptoms is the same for certain groups of the population. The data come from the National Comorbidity Survey. Conditional probabilities of disorders and symptoms, the elements feeding into clinical decision-making, are calculated and tested for equivalence across various racial/ethnic, educational income, and gender groups. We find some significant differences in the relation of key symptoms to disorders across groups. These findings should encourage testing relativistic frameworks in diagnostic nosology as a step to improve clinical decision-making and reduce diagnostic and treatment disparities in mental health services. [ABSTRACT FROM AUTHOR]

We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed "successful" by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness. [ABSTRACT FROM AUTHOR]

Numerous studies have demonstrated a strong connection between the experience of stigma and the well-being of the stigmatized. But in the area of mental illness there has been controversy surrounding the magnitude and duration of the effects of labeling and stigma. One of the arguments that has been used to downplay the importance of these factors is the substantial body of evidence suggesting that labeling leads to positive effects through mental health treatment. However, as Rosenfield (1997) points out, labeling can simultaneously induce both positive consequences through treatment and negative consequences through stigma. In this study we test whether stigma has enduring effects on well-being by interviewing 84 men with dual diagnoses of mental disorder and substance abuse at two points in time--at entry into treatment, when they were addicted to drugs and had many psychiatric symptoms and then again after a year of treatment, when they were far less symptomatic and largely drug- and alcohol-free. We found a relatively strong and enduring effect of stigma on well-being. This finding indicates that stigma continues to complicate the lives of the stigmatized even as treatment improves their symptoms and functioning. It follows that if health professionals want to maximize the well-being of the people they treat, they must address stigma as a separate and important factor in its own right. [ABSTRACT FROM AUTHOR]

Collecting three waves of panel data offered an unusual opportunity to examine the long-term outcomes of the use of mental health services. Data are drawn from a panel study of autoworkers. Waves 1, 2, and 3 consisted of 1,597, 1,288, and 1,136 workers, respectively, from four closing and 12 non-closing plants in Southeastern Michigan. Our results revealed a surprising finding: use of mental health services, whether in the general or specialty sectors, had a negative impact on the subsequent mental health of autoworkers in our sample. The use of mental health services is associated with increased levels of psychological distress. Further, we show that the negative association between use of mental health services and distress was greater for certain demographic groups, notably Blacks, men, older workers, the poorly educated, and the unemployed, depending upon the type of service used. Finally, we sought to uncover the reasons for the negative impact of services use. Results suggest that self-blame, for one, contributed to the negative impact of using mental health services. [ABSTRACT FROM AUTHOR]

In this study we re-examine the issue of gender differences in the use of mental health services by asking (1) whether gender differences in use depend upon the specific services studied; and (2) whether statistical models which are aligned closely to help-seeking theory can explain such differences better than previously used approaches. Our analyses are drawn from two waves of data collected from a representative sample of 3,921 respondents of the Epidemiologic Catchment Area study at the Yale University site. Results indicate that although women are more likely than men to consult a physician in the general medical sector about mental health-related problems, there are no gender differences in use of the mental health specialty sector. The relationship between gender and use of the general medical sector for mental health problems also varies by psychiatric status and by attitudes toward mental health services. In the presence of a psychiatric disorder determined by the Diagnostic Interview Schedule, the likelihood of using services is highest for women with positive attitudes and for men with negative attitudes. [ABSTRACT FROM AUTHOR]

The present study reports comparative male-female vulnerability to several stressed life circumstances that have been implicated in the development of depression. My analysis, which draws on data from a 1978 survey of 1,026 adults in central Wisconsin who were administered the Psychiatric Evaluation Research Instrument (PERI) Depression Scale, is based on a structural modeling approach that controls for the confounding of dysphoric mood and other forms of distress with a depressive syndrome. Findings show that women are more likely than men to suffer hardships associated with the absence of a spouse, social isolation, financial difficulties, and chronic health problems. However, none of these hardships has a significantly greater impact on depressive syndrome levels for women than for men. [ABSTRACT FROM AUTHOR]

The buffering hypothesis suggests that social support can moderate the impacts of life events upon mental health. However, several problems have yet to be resolved in tins literature. Social support has been inadequately conceptualized and operationalized therefore, the specific dimensions of support that reduce event impacts cannot be identified. The direct effect of events upon support and the interactive (buffering) effect of events with support have been confounded in many studies, such that results may have been biased in favor of the hypothesis. The relationships between events, support, and psychological disturbance have not been clarified theoretically; thus, the possibility that support itself is an etiological factor has beet: overlooked. This article reviews empirical work on the buffering hypothesis, outlines alternate conceptualizations and operationalizations of support, presents a refined hypothesis and model for analysis, and suggests three theoretical approaches that may be used to explain the interrelationships between support, events, and disturbance. [ABSTRACT FROM AUTHOR]

In this report we test several hypotheses on the different pathways through which men and women enter psychiatric treatment: women in treatment should have been more likely than men to recognize perceived psychiatric problems, to discuss these problems with other people, and to enter treatment voluntarily. Data from interviews with 120 patients at a community mental health center are consistent with each hypothesis. Several implications of the findings for theories of help-seeking behavior and social control are discussed. [ABSTRACT FROM AUTHOR]

The emergence of community mental health as an important system of mental health care delivery has presumably put into practice an ideology that results in what Dinitz and Beran have referred to as "boundary busting." In a previous article (1971), Dinitz and Beran have asserted that community mental health--unlike previously-established systems--has a greatly expanded domain. They conclude that this will erode the boundaries of systems such as traditional mental health and legal systems. This research is an attempt to assess empirically the existence, extent and variations in boundary busting in the role definition of community mental health workers. In a nation-wide sample of community mental health workers, it was found that considerable boundary busting existed from a personal-professional perspective, but was relatively restricted when organizational factors and medical training were taken into account. The analysis suggests both some support for, and some qualification upon, the conclusions of Dinitz and Beran. [ABSTRACT FROM AUTHOR]