2. 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

3. 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

4. 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)

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

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

8. TREATMENT OF PSYCHOSES

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

10. 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

11. TREATMENT OF NEUROSES

12. 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

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

14. 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

15. 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

17. 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

18. REASONS CULTURAL EXPECTATIONS ABOUT GENDER ROLES WOMEN INTERNALIZE WOMEN EXPECTED NOT TO EXTERNALIZE MEN EXTERNALIZE MEN EXPECTED NOT TO INTERNALIZE

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

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

21. 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

25. MEDICATION GREAT VARIATION IN WILLINGNESS TO USE WOMEN 2x MORE LIKELY THAN MEN

26. GREATEST UNMET NEED LOW (BUT NOT LOWEST) INCOME NO INSURANCE ELDERLY RACIAL/ETHNIC MINORITIES RURAL

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