In this study, we build on previous work by developing and estimating a model of the relationships between causal attributions (e.g., controllability, responsibility), familiarity with mental illness, dangerousness, emotional responses (e.g., pity, anger, fear), and helping and rejecting responses. Using survey data containing responses to hypothetical vignettes, we examine these relationships in a sample of 518 community college students. Consistent with attribution theory, causal attributions affect beliefs about persons' responsibility for causing their condition, beliefs which in turn lead to affective reactions, resulting in rejecting responses such as avoidance, coercion, segregation, and withholding help. However, consistent with a danger appraisal hypothesis, the effects of perceptions of dangerousness on helping and rejecting responses are unmediated by responsibility beliefs. Much of the dangerousness effects operate by increasing fear, a particularly strong predictor of support for coercive treatment. The results from this study also suggest that familiarity with mental illness reduces discriminatory responses.

An attribution model of public discrimination towards persons with mental illness

Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

We test whether significant differences in mental illness exist in a matched sample of Mental illness and the criminal justice system. In T. L. Scheid T. N. Brown (Eds.), A handbook for the study of mental health: Social contexts, theories. Find 9780521567633 A Handbook for the Study of Mental Health : Social Contexts, Theories, and Systems by Horwitz et al at over 30 bookstores. Buy, rent. A review of mental health problems in fathers following the birth of a child. for the study of mental health:Social contexts, theories, and systems (2nd ed., pp.

A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems

Context: The relationship between mental illness and violence has a significant effect on mental health policy, clinical practice, and public opinion about the dangerousness of people with psychiatric disorders. Objective: To use a longitudinal data set representative of the US population to clarify whether or how severe mental illnesses such as schizophrenia, bipolar disorder, and major depression lead to violent behavior. Design:Data on mental disorder and violence were collected as part of the National Epidemiologic Survey on AlcoholandRelatedConditions(NESARC),a2-wavefaceto-face survey conducted by the National Institute on Alcohol Abuse and Alcoholism. Participants: A total of34653 subjects completed NESARC waves 1 (2001-2003) and 2 (2004-2005) interviews. Wave 1 data on severe mental illness and risk factors were analyzed to predict wave 2 data on violent behavior.

/pdf/the-intricate-link-between-violence-and-mental-disorder-ny1vems62x.pdf

The intricate link between violence and mental disorder: Results from the national epidemiologic survey on alcohol and related conditions

Substantial strides have been made in the field of violence risk assessment. Numerous robust risk factors have been identified and incorporated into structured violence risk assessment instruments. The concepts of violence prevention, management, and treatment have been infused into contemporary thinking on risk assessment. This conceptual development underscores the necessity of identifying, measuring, and monitoring changeable (dynamic) risk factors--the most promising targets for risk reduction efforts. However, empirical investigation of dynamic risk is virtually absent from the literature. In this article, the authors (a) differentiate risk status (interindividual risk level based largely on static risk factors) from risk state (intraindividual risk level determined largely by current status on dynamic risk factors), (b) analyze the relevance of contemporary risk assessment measures for capturing dynamic risk, and (c) distill potentially important dynamic risk factors from the literature in order to facilitate future research. Suggestions for theory development and research design are provided.

VIOLENCE RISK ASSESSMENT: Getting Specific About Being Dynamic

Outpatient commitment, although often viewed as merely an extension of inpatient commitment, is only one of a growing array of legal tools used to mandate treatment adherence. The authors describe various forms of mandated community treatment. People with severe and chronic mental disorders often depend on goods and services provided by the social welfare system. Benefits disbursed by representative payees and the provision of subsidized housing have both been used as leverage to ensure treatment adherence. Many discharged patients are arrested for criminal offenses. Favorable disposition of their cases by a mental health court may be tied to participation in treatment. Under outpatient commitment statutes, judges can order committed patients to comply with prescribed treatment. Patients may attempt to maximize their control over treatment in the event of later deterioration by executing an advance directive. The ideological posturing that currently characterizes the field must be replaced by an evidence-based approach.

https://ps.psychiatryonline.org/doi/pdfplus/10.1176/appi.ps.52.9.1198

Mandated community treatment: Beyond outpatient commitment

Persons who handle money for patients with mental disabilities often use access to funds as leverage to promote adherence to treatment. Drawing on data from a five-site study involving interviews of 1011 patients at community mental health centers, this paper explores who provides money assistance, the predictors of leverage use, and its impact on patients. A substantial minority of patients reported having experienced leverage. Substance abuse and frequent hospitalization were the strongest clinical predictors, suggesting that functional impairment is a key determinant. Patients experiencing money leverage were also likely to experience other forms of leverage, and although they were more likely to feel coerced, they were also more likely to believe that money leverage was effective. Family members seemed to provoke fewer negative feelings as money managers. The frequency with which money leverage is used suggests attention is needed to both the fairness of leverage and the means of minimizing negative effects.

Use of leverage over patients' money to promote adherence to psychiatric treatment.

The Commissioner of Social Security has the authority to make benefit payments to an individual or organization other than the beneficiary when doing so would serve the beneficiary’s interest. When the U.S. Social Security Administration (SSA) determines a beneficiary is incapable of managing or directing the management of his or her benefits, a representative payee is assigned. The decision to appoint a representative payee entails weighing the beneficiary’s personal autonomy and preferences against interventions meant to protect his or her best interests. The consequential nature of this decision implies the need to make such decisions with great care and the best evidence available.

Paul S. Appelbaum

Papers

Mandated community treatment: Beyond outpatient commitment

Use of leverage over patients' money to promote adherence to psychiatric treatment.

Informing Social Security's Process for Financial Capability Determination