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Managing Madness in the Community

Managing Madness in the Community: The Challenge of Contemporary Mental Health Care

Kerry Michael Dobransky
Copyright Date: 2014
Published by: Rutgers University Press
Pages: 190
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  • Book Info
    Managing Madness in the Community
    Book Description:

    While mental illness and mental health care are increasingly recognized and accepted in today's society, awareness of the most severely mentally ill-as well as those who care for them-is still dominated by stereotypes.Managing Madness in the Communitydispels the myth. Readers will see how treatment options often depend on the social status, race, and gender of both clients and carers; how ideas in the field of mental health care-conflicting priorities and approaches-actually affect what happens on the ground; and how, amid the competing demands of clients and families, government agencies, bureaucrats and advocates, the fragmented American mental health system really works-or doesn't.In the wake of movies likeOne Flew Over the Cuckoo's NestandShutter Island, most people picture the severely or chronically mentally ill being treated in cold, remote, and forbidding facilities. But the reality is very different. Today the majority of deeply troubled mental patients get treatment in nonprofit community organizations. And it is to two such organizations in the Midwest that this study looks for answers. Drawing upon a wealth of unique evidence-five months of ethnographic observations, 91 interviews with clients and workers, and a range of documents-Managing Madness in the Communitylays bare the sometimes disturbing nature and effects of our overly complex and disconnected mental health system.Kerry Michael Dobransky examines the practical strategies organizations and their clients use to manage the often-conflicting demands of a host of constituencies, laws, and regulations. Bringing to light the challenges confronting patients and staff of the community-based institutions that bear the brunt of caring for the mentally ill, his book provides a useful broad framework that will help researchers and policymakers understand the key forces influencing the mental health services system today.

    eISBN: 978-0-8135-6310-7
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Tables
    (pp. ix-x)
  4. Preface and Acknowledgments
    (pp. xi-xvi)
  5. Chapter 1 Introduction
    (pp. 1-18)

    Jabar Jones was pretty content with life at Suburban, a multiservice mental health care organization outside a midwestern US city. With an official diagnosis of schizoaffective disorder, he had spent the previous three decades involved with the mental health system in one form or another, including more than twenty hospitalizations. Had he been born a couple of decades earlier, Jabar could easily have spent those decades in a state hospital. Instead, coming of age and becoming ill in the era of deinstitutionalization, he fell into the all-too-familiar pattern of contemporary community care for people diagnosed with severe mental illness: residential...

  6. Chapter 2 Logic and Constraint
    (pp. 19-52)

    Four institutional logics were dominant organizing features of day-to-day life in the mental health system in which Urban and Suburban operated, shaping how workers interpreted situations and what they did in them. However, the meanings and behavioral imperatives of the logics did not always line up. Each had its own history, stakeholders, and set of priorities in relation to client care. This chapter examines each of the logics and how they are experienced by frontline workers.

    The logics varied in how and to what degree they were embedded in organizational life. Though all were to some degree institutionalized in regulation,...

  7. Chapter 3 Diagnosis, Labeling, and Social Control
    (pp. 53-76)

    Though you would never know it by interacting with him, Frankie Young has been involved with the mental health system on and off for decades. In fact, he met his now-deceased wife of twenty-five years through this involvement—they met when they were both residents in a “halfway house” for people with mental illness. His wife’s death threw his life into upheaval, both emotionally and financially. “I wanted to kill myself. . . . I had a gun to my head,” he said. He lost his home and lived on the street for several years. Outreach workers for Urban encountered...

  8. Chapter 4 Empowerment Practice, Practical Empowerment
    (pp. 77-100)

    The two vignettes above highlight how client preferences were key concerns in the work staff members at Urban and Suburban did with clients. They also illustrate that other forces shaped how workers attended to those client preferences. In this chapter, we focus on two components of the empowerment logic,self-determinationandprovision of resources, as workers attempted to implement them within the organizational context (versus broader empowerment in the clients’ lives outside the organizations). We do this for a couple of reasons. First, self-determination inside the organization was viewed by staff as necessary preparation for broader self-determination outside the bounds...

  9. Chapter 5 The Realities of Community Integration
    (pp. 101-120)

    Unlike state mental hospitals, community mental health care organizations have semi-permeable boundaries with the communities that surround them. Though confidentiality regulations assured that not just anyone could enter Urban or Suburban, clients could and did spend time in the surrounding community, especially those at Urban. The amount of time spent in the community and how far into the community they traveled varied greatly, however. Consistent with the community logic, workers generally saw the ultimate ideal goal of the services they provided as reducing client dependence on the organization and helping them live in the surrounding community (Bond 2004; Gulcur 2007)....

  10. Chapter 6 The Right Person for the Job: Fragmentation in Staffing and Worker-Client Interaction
    (pp. 121-144)

    Two short months into his tenure as an employee in the day program at Urban, Emmanuel Short had already dealt with a number of incidents that even a veteran worker would find notable. He had broken up a fight between two clients, actually grabbing a chair out of the hands of a client who was the size of an NFL lineman—two to three times Emmanuel’s own slender size. He had also confronted a client he witnessed selling drugs in the bathroom and was, as a result, threatened by that same client when he left work later that day. Add...

  11. Chapter 7 Conclusion
    (pp. 145-152)

    A patient or worker entrenched in the mental health system of the early twentieth century would be astounded by what they would find in today’s system. Instead of a field dominated by state hospitals, they would find hospitals an increasingly small component of the mental health care sector. Instead, with the ascent of the community logic, community care is now the preferred site of services. As a result, a progressively dizzying array of community organizations—not only behavioral, but also housing, public welfare, and other providers—offer services that were once centralized in the hospital setting. The logics guiding the...

  12. Notes
    (pp. 153-156)
  13. References
    (pp. 157-166)
  14. Index
    (pp. 167-170)
  15. Back Matter
    (pp. 171-174)