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

STAGES OF HELP-SEEKING RECOGNITION – FROM VERY LIKELY TO VERY UNLIKELY SELF OR OTHER RECOGNIZES CHOICE OF PRACTITIONER ADHERENCE TO TREATMENT HUGE VARIATION AT EACH STAGE

SOURCES OF VARIATION RESOURCES – MORE RESOURCES GET DESIRED TREATMENTS CULTURE – VALUES AND ATTITUDES TOWARD TREATMENT (EDUCATION, GENDER, ETHNICITY)

FOCUS HERE SOCIAL CLASS – COMBINATION OF INCOME AND EDUCATION (RESOURCES AND CULTURE) GENDER

SOCIAL CLASS AND TREATMENT HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN 1950s INCIDENCE = NEW CASES PREVALENCE = ALL CASES PREVALENCE = INCIDENCE + REENTRY + CONTINUOUS

TREATMENT OF PSYCHOSES

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

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

TREATMENT OF NEUROSES

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

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

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 IN OUTPATIENT NEAR-POOR LEAST LIKELY TO BE IN OUTPATIENT

USE OF OUTPATIENT EDUCATION MORE IMPORTANT THAN INCOME COLLEGE GRADUATES MUCH MORE THAN OTHERS WHITES 2 – 3 X MORE LIKELY THAN OTHERS

PSYCHOTHERAPY WHITES FAR MORE LIKELY TO BE IN P.T. EVEN MORE LIKELY TO STAY IN P.T. BLACKS ESPECIALLY UNLIKELY

TREATMENT DIFFERENCES MEN ABOUT 60% OF INPATIENTS WOMEN ABOUT 2/3 OF OUTPATIENTS

INPATIENT TREATMENT MEN MORE LIKELY TO BE INPATIENTS MEN’S SYMPTOMS MORE TROUBLESOME AND VIOLENT MALE ROLE INCOMPATIBLE WITH HELP- SEEKING MEN DELAY TREATMENT UNTIL MORE SEVERE OTHERS INITIATE TREATMENT

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

GREATEST UNMET NEED LOW (BUT NOT LOWEST) INCOME NO INSURANCE LESS EDUCATION MEN RACIAL/ETHNIC MINORITIES ELDERLY RURAL