David Mechanic

• PhD
• Managing Director at Rutgers, The State University of New Jersey

Cambridge Core - Sociology of Science and Medicine - A Handbook for the Study of Mental Health - edited by Teresa L. Scheid

A Handbook for the Study of Mental Health - edited by Teresa L. Scheid June 2017

Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for...

Rationing refers to the allocation of a scarce supply relative to need and demand. In market‐based economies, price typically establishes access to valued commodities except when ethical values, norms, and technical limitations make it impossible to allocate simply on the basis of price. Commonly recognized prototypes include allocation of scarce r...

Medical sociology builds on substantive areas of sociology. A dominant concern has been the distribution of health; illness and disability; services use; and class, race, ethnic, and age disparities. The field examines the organization and provision of service as shaped by culture, science and technology, and economic organization. The workforce, e...

Health care rationing is ubiquitous. It varies from formal approaches designed to allocate limited organs for transplantation to more common strategies and processes that constrain demand for care. Many countries seek to explicitly formulate priorities and translate these through benefit design and other explicit managerial decisions but much ratio...

The high prevalence of mental illness and substance abuse disorders and their significant impact on disability, mortality, and other chronic diseases have encouraged new initiatives in mental health policy including important provisions of the Affordable Care Act and changes in Medicaid. This article examines the development and status of the behav...

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral se...

Much written about aging focuses on the problems and challenges faced by elderly people. However, aging is a lifelong process in which physical, psychological, and social capacities and resources are acquired and modified. Understanding psychological function and mental health in later life requires a life-course perspective that takes account of b...

Health reform efforts in the United States have focused on resolving some of the fundamental irrationalities of the system whereby costs and services utilization are often not linked to improved patient outcomes. Sociologists have contributed to these efforts by documenting the extent of problems and by confronting central questions around issues o...

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy ex...

Context: Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. I...

Over the past twenty-five years, psychiatric services have shifted from hospital to community. Managed care reinforces this trend. Mental illness is better understood and less stigmatized, and services are more commonly used. But many in need do not receive care consistent with evidence-based standards, or at all. Challenges are greatest for people...

The emphasis on risk factor intervention at the individual level has predominated in efforts to reduce mortality and promote health. Interest in social and other nonmedical interventions, particularly socioeconomic status (SES) influences, has increased in recent years. This article focuses on the interaction of social structure and socioeconomic s...

Vulnerability, the susceptibility to harm, results from an interaction between the resources available to individuals and communities and the life challenges they face. Vulnerability results from developmental problems, personal incapacities, disadvantaged social status, inadequacy of interpersonal networks and supports, degraded neighborhoods and...

Recently, the focus of health policies and initiatives has been directed toward mental health. More precisely, depressive and anxiety disorders have received particular attention because of their disabling outcomes and prevalence among most populations. Despite this increased interest, numerous issues regarding patients' willingness to seek treatme...

To provide an overview of the importance of the data generated by the European Study of the Epidemiology of Mental Disorders (ESEMeD), which found that prevalence and burden of mood and anxiety disorders were high and that care of individuals with mental disorders was suboptimal. Thus, ESEMeD data, based on 21,425 noninstitutionalized adults from B...

Unemployment rates remain high among individuals with psychiatric disabilities despite growing evidence that supported employment programs (SEPs) can help such individuals to obtain and retain competitive employment. A complete understanding of factors that may facilitate or hinder the success of such supported employment efforts is urgently needed...

The United States spends greatly more per person on health care than any other country but the evidence shows that care is often poor and inappropriate. Despite expenditures of 1.7 trillion dollars in 2003, and growing substantially each year, services remain fragmented and poorly coordinated, and more than 46 million people are uninsured. Why can'...

Deinstitutionalization of persons with mental illnesses is now a fact of life. Many have criticized its consequences and insisted that the policy has been disastrous (Isaac and Armat 1990). Few, however, have demanded that we return to institutional solutions for care of persons with mental illnesses. Public mental hospitals in the United States ha...

Socioeconomic status fundamentally affects most health and disease outcomes, but black Americans are doubly disadvantaged by low status, discrimination, and residential segregation. Improving health and removing disparities are essential goals, but some efforts that improve the health of blacks in important ways also increase black-white disparity...

Health care delivery in the United States is an enormously complex enterprise, and its $1.6 trillion annual expenditures involve a host of competing interests. While arguably the nation offers among the most technologically advanced medical care in the world, the American system consistently under performs relative to its resources. Gaps in financi...

And that trust transfers from doctors to organisations T he season of goodwill provides the occasion to consider the importance of trust in facilitating social intercourse and a well functioning society.1 Trust provides the glue that makes cooperation possible without costly and intrusive regulation. Trust has declined in all social institutions...

Many believe that managed behavioral health care has been associated with reduced access to care. Data from a variety of sources suggest that access has increased, although patterns of care and locations of treatment have changed. Data from Healthcare for Communities, a nationally representative community survey, show that access to care has not de...

Americans love to hate Health Maintenance Organizations (HMOs). But popular opinion of managed care is based more on myth than performance. More important, Americans fail to realize the inevitable clash between what they want and what they are willing to pay for.

The managed care backlash is analyzed as a collective behavioral response led by attacks from threatened professional, provider, and special interest communities. Central to the backlash was the middle class's repudiation of explicit rationing at the point of service adopted by Health Maintenance Organizations (HMOs) and other managed care plans. A...

The number of inpatients in US public mental hospitals declined from 559,000 in 1955 to approximately 110,000 at present. Reductions resulted from release or transfer of long-term inpatients and from entrance barriers to new admissions. The timing and pace of deinstitutionalization substantially varied by state, but three quarters of the national r...

National health systems throughout the world face a number of pressures in common related to demography, epidemiology, developments in science and technology, medical demand, and rising public expectations. These pressures are producing convergence in the objectives and activities of these systems in several key areas, including cost-containment, h...

The author shares lessons he has learned over the past 45 years he has spent in the health care field, focusing on five areas: research; managed behavioral health care; health insurance and parity; service system availability and linkage; and dignified employment for persons with mental illness. He notes that a broad and sustained research effort i...

Most physicians continue to report overall career satisfaction, but increased public and patient expectations and administrative and regulatory controls contribute to perceptions of increased time pressures and erosion of autonomy. Increasingly, knowledgeable patients armed with information from the media, as well as guidelines developed by health...

Mental disorders are highly prevalent, but prevalence is different from need for treatment. Some mental disorders are a major source of distress, disability, and social burden, and many people who could benefit from treatment do not receive it. Need is typically self-defined or defined by clinicians who are motivated to bring treatment to those who...

This article has no abstract; the first 100 words appear below. Mental health and substance abuse services, commonly referred to as behavioral health services, have been more aggressively managed than most other medical and surgical services.¹ Managed behavioral health organizations came to public programs from the private sector, where they substa...

Despite renewed interest in population health concerns, elevation of this field in policy considerations faces many challenges. At present there is much concern about disparities and meeting improved population health objectives, but interest waxes and wanes with scientific developments and especially with dominant political alignments and ideologi...

The Social Security Disability benefit programs (SSDI and SSI) constitute an essential safety net for individuals unable to work because of disability. Eligibility for SSDI is based on work history and is viewed as an entitlement for individuals who meet disability criteria. SSI eligibility, however, depends on means testing and, although it is adm...

This paper explores various factors that account for the power of secretaries, hospital attendants, prison inmates, and other lower participants within organizations. Power is seen as resulting from access to and control over persons, information, and instrumentalities. Among the variables discussed affecting power are normative definitions, percep...

Although nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for schizophrenia, knowledge is limited about how to improve medication adherence. This systematic literature review examined psychosocial interventions for improving medication adherence, focusing on promising initiatives, reasonable stan...

Objective:: To investigate patients' perceptions of entitlement to time in general practice consultations for depression. Design:: Qualitative study based on interviews with patients with mild to moderate depression. Setting:: Eight general practices in the West Midlands and the regional membership of the Depression Alliance. Participants:: 32 gene...

Data from various national surveys find that approximately half the population with mental disorders is gainfully employed across the entire range of occupations; such persons have an employment rate of about two-thirds that of the general population. More than a third of persons with serious mental illness also work, and many hold high-status posi...

Serious efforts to address quality require coordinated, multi-faceted, multi-level strategies that address the organisational environments and cultures that affect how care is provided. Most efforts over the past 50 years to improve the care provided by physicians and other clinicians have been individually rather than system based. Such individual...

Many persons with serious psychiatric conditions who could benefit from available treatments do not receive care, and the barriers are generally understood to be limited knowledge, inadequacies in insurance coverage, and stigma. Sophisticated approaches are needed to realistically eliminate these and other barriers. Public policy should focus on cr...

Most aspects of mental illness and psychological well-being are influenced by social factors (such as gender, social class, race and ethnicity, and household patterns) and social institutions (such as disability and social security systems, labor markets, and health care organizations). The capacity to cope effectively with growing numbers of perso...

Eliminating disparities in health is a primary goal of the federal government and many states. Our overarching objective should be to improve population health for all groups to the maximum extent. Ironically, enhancing population health and even the health of the disadvantaged can conflict with efforts to reduce disparities. This paper presents da...

Technology refers to inputs (machines, bureaucratic procedures, management strategies) organized to achieve specified outcomes. Such inputs and how they are used arise from socio-cultural conditions and in turn influence social behavior and values. Advances in medical technology are due to the high value populations place on health, emerging develo...

A majority of adults with common mental disorders do not seek professional help. To better understand why not, we examined the correlates of various stages of help-seeking, including perceived need for professional help, seeking such help, and from which professionals participants sought help. The sample for this study comprised 1792 participants i...

Medical sociology builds on substantive areas of sociology. A dominant concern has been the distribution of health; illness and disability; services use; and class, race, ethnic, and age disparities. The field examines the organization and provision of service as shaped by culture, science and technology, and economic organization. The workforce, e...

In examining the importance of data systems, conceptual models, and serendipity in understanding health services, the case is made for a vigorous and responsive data infrastructure and more emphasis on conceptual development. Particularly important is the development of data systems that can keep pace with changes in health care organization and pa...

The focus on managed care and the managed care backlash divert attention from more important national health issues, such as insurance coverage and quality of care. The ongoing public debate often does not accurately convey the key issues or the relevant evidence. Important perceptions of reduced encounter time with physicians, limitations on physi...

Many believe that managed care creates pressure on physicians to increase productivity, see more patients, and spend less time with each patient. We used nationally representative data from the National Ambulatory Medical Care Survey (NAMCS) of the National Center for Health Statistics and the American Medical Association's Socioeconomic Monitoring...

This paper examines conceptions of trust among three groups of respondents diagnosed with either breast cancer, Lyme disease or mental illness. Interviews were carried out using an open-ended interview guide to explore how patients made assessments of trust in their doctors and health care plans. The guide followed a conceptual approach that asked...

Physicians complain about the growth of managed care structures and strategies and their effects on treatment autonomy and medical professionalism. Organizational changes and a competitive marketplace make the traditional view less relevant today. New concepts of professionalism are needed that recognize constraints and include patient advocacy wit...

To examine the sociodemographic, need, risk, and insurance characteristics of persons with severe mental illness and the importance of these characteristics for predicting specialty mental health utilization among this group. The Healthcare for Communities survey, a national study that tracks alcohol, drug, and mental health services utilization. D...

The study examined patterns of care for persons with mental illness in nursing homes in the United States from 1985 to 1995. During that period resident populations in public mental hospitals declined, and legislation aimed at diverting psychiatric patients from nursing homes was enacted. Estimates of the number of current residents with a mental i...

The study sought to identify predictors of noncompliance with medication in a cohort of patients with schizophrenia after discharge from acute hospitalization. Adult psychiatric inpatients with schizophrenia or schizoaffective disorder for whom oral antipsychotics were prescribed (N=213) were evaluated at hospital discharge and three months later t...

This study determines patient characteristics that predict early hospital readmission in schizophrenia and evaluates the extent to which inpatient staff accurately predict these readmissions. Adult inpatients with schizophrenia or schizoaffective disorder (N = 262) were evaluated at hospital discharge and 3 months later to assess hospital readmissi...

Managed care holds the promise of facilitating parity between general medical care and alcohol, drug, and mental health care by reducing expenditures, even while expanding benefits. Limitations in our knowledge of variations in needs and treatment standards for substance use and psychiatric illnesses make such disorders an easy target for managemen...

Managed care organizations (MCOs) are facing intense criticism at national, state, and local levels and battling initiatives that would impose stricter regulation. Medical directors of HMOs were surveyed regarding their organizations’ strategies of communication, the programs they have instituted to build trust, and their commitment to sponsoring f...

The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge. Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. S...

Policymakers in many countries seek to contain health care costs over the long range by promoting health and more effective health behavior. Such efforts can be directed at entire populations, at members of a health plan, at defined risk groups or single individuals at risk. Many health risks are associated with socio-economic status and social ine...

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between M...

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse,...

Using data from the National Hospital Discharge Survey and the Inventory of Mental Health Organizations, this article examines national trends in psychiatric inpatient care from 1988 to 1994 in general hospitals and mental hospitals. We find that discharges with a primary diagnosis of mental illness in general hospitals increased from 1.4 to 1.9 mi...

Trust, the expectation that institutions and professionals will act in one's interests, contributes to the effectiveness of medical care. With the rapid privatization of medical care and the growth of managed care, trust may be diminished. Five important aspects of trust are examined: technical and interpersonal competence, physician agency, physic...

This study focused on inpatients with schizophrenia or schizoaffective disorder who were scheduled to begin outpatient care with clinicians who had not previously treated them. The authors evaluated the effects of communication between the patients and their outpatient clinicians before discharge on patients' referral compliance, psychiatric sympto...

Without Abstract

The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodation for persons with psychiatric disabilities. Most persons with a history of mental disorder work productively and do not require accommodation. Many persons with serious mental illness need accommodation but are conscientious and productive workers. Diffi...

Our responsibility is not solely to be critics but to help make managed care more effective and responsive.

A thoughtful regulatory framework is needed to guide the evolution of the behavioral health care industry and to encourage high performance standards.

Effective communication between doctor and patient is a critical component of high-quality care. The physician's credibility has a significant effect on treatment outcomes. Because changes in medicine and larger cultural trends challenge the ability of clinicians to engage their patients' trust, new kinds of partnerships must be created. To do this...

The relationship between longitudinal variations of self-awareness and depressed mood in 479 adolescents was examined across four waves of data collection over a seven-year period. Self-awareness was significantly associated with depressed mood, and this association was strongest during midadoles-cence. Regression analyses of changes of depressed m...

As managed care achieves greater penetration in the marketplace, increasing attention is being devoted to models of integration and coordination of behavioral health with general medical care. In considering strategies and models, attention must be given to the heterogeneity of patient populations and the fact that successful approaches with some p...

An effective definition of psychopathology would be helpful in distinguishing between normal and abnormal behavior and would provide guidance for important public policy decisions. Overinclusive definitions, such as the capacity/disability formulation, do not provide meaningful direction for defining need or assessing eligibility for insurance or o...