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Managing Madness in the Community

The Challenge of Contemporary Mental Health Care

by Kerry Dobransky

Publication Year: 2014

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 Community dispels 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 like One Flew Over the Cuckoo’s Nest and Shutter 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 Community lays 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.

Published by: Rutgers University Press

Series: Critical Issues in Health and Medicine

Title Page, Copyright Page

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pp. i-vi


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pp. vii-viii


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pp. ix-x

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Preface and Acknowledgments

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pp. xi-xvi

The roots of this project can be traced to my time as a social worker. In the late 1990s and early 2000s, I worked in child welfare in a state that was participating in the Annie E. Casey Foundation’s Family to Family initiative. The initiative held as its goal to build a “family-centered, neighborhood-based” child...

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1. Introduction

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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...

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2. Logic and Constraint

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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...

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3. Diagnosis, Labeling, and Social Control

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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...

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4. Empowerment Practice, Practical Empowerment

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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...

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5. The Realities of Community Integration

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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...

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6. The Right Person for the Job

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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...

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7. Conclusion

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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...


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pp. 153-156


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pp. 157-166


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pp. 167-170

About the Author, Series Page

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pp. 171-174

E-ISBN-13: 9780813563107
E-ISBN-10: 0813563100
Print-ISBN-13: 9780813563091
Print-ISBN-10: 0813563097

Page Count: 190
Illustrations: 4 tables
Publication Year: 2014

Series Title: Critical Issues in Health and Medicine