Drawing the Line: The Cultural Cartography of Utilization Recommendations for Mental Health Problems

Department of Sociology, Boston University, 96 Cummington Street, Boston, Massachusetts 02115, USA.
Journal of Health and Social Behavior (Impact Factor: 2.72). 07/2009; 50(2):228-44. DOI: 10.1177/002214650905000208
Source: PubMed


In the 1990s, sociologists began to rethink the failure of utilization models to explain whether and why individuals accessed formal treatment systems. This effort focused on reconceptualizing the underlying assumptions and processes that shaped utilization patterns. While we have built a better understanding of how social networks structure pathways to care and how disadvantaged sociocultural groups face substantial barriers to treatment, we have less understanding of the larger cultural context in which individuals recognize and respond to symptoms. Drawing from recent innovations in the sociology of culture, we develop the concept of "cultural mapping" to describe if and how individuals discriminate among different available sources of formal treatment. Using data from the 1996 Mental Health Module of the General Social Survey, we compare Americans' willingness to recommend providers in the general medical and specialty mental health sectors. The results indicate that, despite unrealistically high levels of endorsement, individuals do discriminate between providers based on their evaluation of the problem, underlying causes, and likely consequences. While perceived severity leads individuals to suggest any type of formal care, problems attributed to biological causes are directed to general or specialty medical providers (doctors, psychiatrists, and hospitals); those matching symptoms for schizophrenia or seen as eliciting violence are allocated to the specialty mental health sector (psychiatry, mental hospital); and those seen as being caused by stress are sent to nonmedical mental health providers (i.e., counselors). These findings help to explain inconsistencies in previous utilization studies, and they suggest the critical importance of maintaining a dialogue between medical sociology and the sociology of culture.

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    • "Also, significant inequities have been found among the Latino communities (López et al., 2012a), especially among Puerto Ricans who have one of the lower rates of treatment seeking (Alegría et al., 2001; Keyes et al., 2012). Literature has shown that it is critical to understand how socio-cultural factors such as stigmatization shape opinions, beliefs, and attitudes about mental illnesses (Link, 2013; Olafsdottir & Pescosolido, 2009). However, the impact of the stigmatization among specific serious mental illnesses, such as BPD, has not yet been addressed by the scientific literature. "
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    ABSTRACT: The experiences of stigmatization among people living with specific Serious Mental Illnesses (SMI), such as Borderline Personality Disorder (BPD) has not been addressed by the scientific literature. In this study we wanted to explore how people living with BPD experience stigmatization. We examine the experiences of 8 people (7 women and 1 man) living and receiving treatment for BPD in Puerto Rico. We used an exploratory qualitative design with semi-structured interviews. To interpret our data, we conducted a thematic analysis. We discuss three categories that focus on one identified theme: the interpersonal dimension of the stigmatization process. These categories are (a) society’s views of people living with BPD, (b) family relationships, and (c) partner relationships. Our findings show that people with BPD experience a high attributed personal responsibility, discrimination, social exclusion, and lack of social support. In addition, our findings suggest that the stigmatization of BPD might be more complex than other mental illnesses as it shares characteristics of both SMI and less severe forms of mental illness. We also discuss the importance for practitioners to address stigmatization in therapy and the importance for research to address other aspects of the stigmatization process such as its structural dimension. Keywords: Stigmatization, Borderline Personality Disorder, Puerto Rico, Thematic Analysis
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    • "As the findings demonstrate, a consideration of social and cultural factors that are present in African American women's lives is critical for the study of preventative care utilisation behaviour. Though sociologists have long recognised that health behaviour is influenced by these factors, this research extends the existing literature by testing a more comprehensive model of culturally specific factors on an understudied type of health service utilisation, preventative care (Kleinman 1980, Olafsdottir and Pescosolido 2009). In addition, by focusing on an underserved and under-researched population, this work also provides some basis for understanding how the effect of such influences can vary depending on the type of health services examined. "
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    ABSTRACT: Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low-income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help-seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.
    Sociology of Health & Illness 04/2014; 36(7). DOI:10.1111/1467-9566.12141 · 1.88 Impact Factor
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    • "The endorsement of both views was only weakly positively correlated. This is consistent with previous research on the broadening of public conceptualisations of mental illness over time (Phelan et al., 2000) and could reflect two cultural meanings of 'mental illness', one being more medical and the other representing a broader and partly more pejorative view (Olafsdottir and Pescosolido, 2009). "
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    ABSTRACT: 'Mental illness' is a common label. However, the general public may or may not consider various conditions, ranging from major psychiatric disorders to stress, as mental illnesses. It is unclear how such public views affect attitudes towards people with mental illness and reactions to one's own potential mental illness, e.g. in terms of help-seeking or disclosure. In representative English population surveys the classification of six conditions (schizophrenia, bipolar disorder, depression, drug addiction, stress, grief) as a mental illness was assessed as well as attitudes towards, and contact with, people with mental illness, intentions to disclose a mental illness and to seek treatment. A factor analysis of how strongly respondents perceived the six conditions as a mental illness yielded two factors: (i) major psychiatric disorders and (ii) stress- and behaviour-related conditions including drug addiction. In regression analyses, higher scores on the first, but not the second, factor predicted less perceived responsibility of people with mental illness for their actions, and more support for a neurobiological illness model and help-seeking. Classifying stress-related/behaviour-related conditions as mental illnesses, as well as not referring to major psychiatric disorders as mental illnesses, was associated with more negative attitudes and increased social distance, but also with stronger intentions to disclose a mental illness to an employer. Negative attitudes and social distance were also related to ethnic minority status and lower social grade. Referring to major psychiatric disorders as mental illnesses may reflect higher mental health literacy, better attitudes towards people with mental illness and help-seeking. A broader concept of mental illness could, although increasing negative attitudes, facilitate disclosure in the workplace. Public views on what is a mental illness may have context-dependent effects and should be taken into account in anti-stigma campaigns.
    Australian and New Zealand Journal of Psychiatry 02/2012; 46(7):641-50. DOI:10.1177/0004867412438873 · 3.41 Impact Factor
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