Mental Health and Social Policy: The Emergence of Managed Care

Abstract

1.Mental Health and the Mental Health Professions. Symptoms, Diseases, and Reaction Patterns. Disease, Personality Disturbance, or Problem in Living. Social Adjustment. Patterns of Mental Health Utilization. The Mental Health Professions. Mental Health Personnel and Work Patterns. Trends in Mental Health Care. Changing Inpatient Care. 2.What Are Mental Health and Mental Illness? Psychiatric Diagnostic Models. Varieties of Mental Illness. Schizophrenia: An Example in Psychiatric Conceptualization. Varying Conceptions of Mental Illness. Developmental Models. Changing Conceptions of Mental Illness. Social Conceptions of Mental Illness. Views of Mental Illness in Relation to Social Policy. The Patient and the Society: An Insoluble Dilemma. Social Problem or Mental Illness? 3.Psychological Disorder and the Flow of Patients into Treatment: The Study of Psychiatric Epidemiology. Identifying Psychological Problems in Community Populations. Estimates of Prevalence of Disorder in Community Populations. The Epidemiological Catchment Area Program and the National Comorbidity Survey. Psychological Disorder and Utilization of Care. Social Factors Associated with Psychiatric Conditions in the Community. The Epidemiology of Antisocial Behavior and Behavior Disorders. 4.Conceptions of the Causes of and Means of Controlling Mental Illness. The Impact of Environment on Mental Illness. The Question of Inheritance and Environment. A Note on Psychiatric Drugs. The Psychosocial-Development Perspective. The Learning Perspective: Behavior Therapy. The Social-Stress Perspective. The Labeling Perspective. Collective Mobilization. 5.The Development of Mental Health Policy in the United States. The Early History of Worcester State Hospital. More Recent Developments in Mental Health Policy. Post-World War II Developments in Mental Health Policy. Postwar Psychiatry. The Organization of State Mental Hospitals. Programs of Community Care. The Composition of the Seriously Mentally Ill Population. Homelessness and Mental Illness. 6.The Recognition of Mental Disorders. Mental Illness, Illness Behavior, and Entry into Psychiatric Care. Community Definitions of Mental Illness. The Course of Schizophrenia. 7.The Financing and Delivery of Mental Health Services. Mental Health Coverage and Expenditures. The Pattern of Inpatient Services. Utilization of Services and Financing Patterns. The Economics of Mental Health Care. Psychiatric Care Under Prepayment Plans. The Structure of Insurance and Needed Mental Health Benefits. An Epidemiological Approach to Psychiatric Need. The Role of Primary Medical Care. The Management of Psychological Distress. 8.Managed Mental Health Care. Basic Mechanisms of Managed Care. Types of Managed Care Organizations. Managed Care for Persons with Mental Illness. Opportunities and Special Problems in Managed Mental Health Care. Performance of Managed Care. Some Unresolved Issues in Managed Care. 9.Central Perspectives in Formulating Mental Health Policies. Concepts of Severe and Persistent Mental Illness. Criteria for Evaluation. The Processes of Deinstitutionalization. Environmental Factors Promoting Effective Performance. Implications of Community Institutional Placement. Models for Community Care. Points of Leverage. The Case Management Approach. Organizational Barriers. Absence of a Clear Focus of Responsibility and Authority. 10.Innovations in Mental Health Services. Maintenance of Patients with Persistent Disorders. A Further Note on Employment. Problems in the Diffusion of Mental Health Innovations. Innovations in Housing. Changing Roles of the Mental Health Professions. Future Trends in Innovative Mental Health Services. 11.The Social Context of Mental Health Practice: Foundations of Trust. Social Influences on Psychiatric Judgment. Personal and Social Biographies. The Sociocultural Context. Constraints of Practice Organization and Settings. Competition in the Allocation of Care. 12.Mental Illness, the Community, and the Law. Involuntary Hospitalization. Outpatient Commitment. A Note on Dangerousness and the Relationship between Mental Illness and Violence. The Right to Treatment. Right to Refuse Treatment. The Social Context of Legal Reform in Mental Health.

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