SOCIAL CLASS AND MENTAL ILLNESS

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SOCIAL RESPONSE TO MENTAL ILLNESS
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FINDINGS FROM COMMUNITY STUDIES

• I. ONLY ABOUT 20 OF PEOPLE DIAGNOSED WITH M.I.
  SEEK HELP UNMET NEED
• II. ABOUT 50 OF PEOPLE WHO ARE IN TREATMENT GET
  A DIAGNOSIS OVERMET NEED
• HAVING A M.I. AND GETTING TREATMENT FOR IT 2
  DIFFERENT PROCESSES

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STAGES OF HELP-SEEKING

• RECOGNITION FROM VERY LIKELY TO VERY UNLIKELY
• SELF OR OTHER RECOGNIZES
• INFORMAL CONSULTATION
• CHOICE OF PRACTITIONER
• ADHERENCE TO TREATMENT
• HUGE VARIATION AT EACH STAGE

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SOURCES OF VARIATION

• STRATIFICATION MORE POWER AND RESOURCES GET
  WHAT THEY WANT (INCOME)
• CULTURE VALUES AND ATTITUDES TOWARD TREATMENT
  (ETHNIC, GENDER, EDUCATION)
• INTEGRATION MORE INTEG. LESS TREATMENT
  (CONNECTEDNESS)

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FOCUS HERE

• SOCIAL CLASS COMBINATION OF INCOME AND
  EDUCATION (RESOURCES AND CULTURE)
• GENDER

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SOCIAL CLASS AND TREATMENT
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SOCIAL CLASS AND TREATMENT

• HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN
  1950s
• INCIDENCE NEW CASES
• PREVALENCE ALL CASES
• PREVALENCE INCIDENCE REENTRY CONTINUOUS

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TREATMENT OF PSYCHOSES
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TREATMENT OF PSYCHOSES

• NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER
  CLASS HAS MORE
• STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND
  PREVALENCE OF PSYCHOSES

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EXPLANATIONS

• WORSE PSYCHIATRIC TREATMENT FOR LOWER CLASS
• MORE CONTINUING STRESSORS FOR LOWER CLASS
• MORE COMMUNITY SUPPORT FOR HIGHER CLASSES
• LONGER DURATION AND WORSE PROGNOSIS FOR LOWER
  CLASSES

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TREATMENT OF NEUROSES
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TREATMENT OF NEUROSIS

• NO DIFFERENCE IN NEW CASES
• HIGHER CLASSES HAVE MUCH GREATER TREATED
  PREVALENCE
• HIGHER CLASSES STAY MUCH LONGER IN TREATMENT
• RELATIONSHIP FOR PREVALENCE OPPOSITE FOR NEUROSES
  AND PSYCHOSES

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REASONS

• ABILITY TO PAY FOR TREATMENT
• MORE FAVORABLE ATTITUDES TOWARD TREATMENT
• LESS STIGMA FOR HIGHER CLASSES
• RESPONSE OF M.H. PROFESSIONALS

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CHANGES OVER TIME

• LOWEST INCOME STILL MOST LIKELY TO BE IN PUBLIC
  MENTAL HOSPITALS
• EMERGENCE OF INSURANCE AND MEDICAID FOR
  OUTPATIENT
• WEALTHIEST AND POOREST MOST LIKELY
• NEAR-POOR LEAST LIKELY TO USE

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USE OF OUTPATIENT

• COLLEGE GRADUATES MUCH MORE THAN OTHERS
• EDUCATION MORE IMPORTANT THAN INCOME
• WHITES 2 3 X MORE LIKELY THAN OTHERS
• DIVORCED/SEPARATED 2 X MORE THAN SINGLE 3X THAN
  MARRIED

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GENDER AND TREATMENT
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TYPES OF ILLNESS

• LITTLE GENDER DIFFERENCE FOR PSYCHOSES
• WOMEN 2/3 OF DEPRESSION, ANXIETY, DISTRESS,
  SUICIDE ATTEMPTS, ALMOST ALL EATING DISORDERS
• MEN 2/3 OF ALCOHOL AND DRUG PROBLEMS, 4X
  SUICIDES, ALMOST ALL GAMBLING
• OVERALL RATES EQUAL

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REASONS

• CULTURAL EXPECTATIONS ABOUT GENDER ROLES
• WOMEN INTERNALIZE
• WOMEN EXPECTED NOT TO EXTERNALIZE
• MEN EXTERNALIZE
• MEN EXPECTED NOT TO INTERNALIZE

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TREATMENT DIFFERENCES

• MEN ABOUT 60 OF INPATIENTS
• WOMEN ABOUT 2/3 OF OUTPATIENTS

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INPATIENT TREATMENT

• MEN MORE LIKELY TO BE INPATIENTS
• MENS SYMPTOMS MORE TROUBLESOME AND VIOLENT
• MALE ROLE INCONGRUENT WITH HELP-SEEKING
• MEN DELAY TREATMENT UNTIL MORE SEVERE
• OTHERS INITIATE TREATMENT

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OUTPATIENT TREATMENT

• WOMEN MORE LIKELY TO DEFINE SELVES AS HAVING
  PROBLEMS
• WOMEN MORE LIKELY TO SEEK MENTAL HEALTH TREATMENT
• WOMEN MORE LIKELY TO REMAIN IN TREATMENT -
  PATIENT ROLE

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MEDICATION
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MEDICATION

• GREAT VARIATION IN WILLINGNESS TO USE
• WOMEN 2x MORE LIKELY THAN MEN

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GREATEST UNMET NEED

• LOW (BUT NOT LOWEST) INCOME
• NO INSURANCE
• ELDERLY
• RACIAL/ETHNIC MINORITIES
• RURAL

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SUMMARY

• GREAT SOCIAL VARIATION IN RESPONSE TO M.I.
• SOCIAL CLASS VERY IMPORTANT
• EDUCATION
• INSURANCE
• GENDER VERY IMPORTANT
• ALSO ETHNICITY, MARITAL