Indiana Consortium For Mental Health Services Research Indiana University

Abstract

Reprint # 48: The Social Dynamics of Responding to Mental Health Problems
Past, Present, and Future Challenges to Understanding Individuals' Use of Services

BERNICEA.PESCOSOLIDO, CAROLA. BOYER, KERI M. LUBELL

INTRODUCTION

Since social scientists first directed their attention to understanding how individuals recognize and respond to mental illness, they have struggled to capture both the underlying process or dynamic that drives the search for care and the social, cultural, medical, and organizational characteristics that shape the fate of persons dealing with mental health problems. At the present time, the dominant approaches to studying what many people call "help seeking" or "decision making," and others more generally call "illness behavior" or "service use" focus on well-developed but essentially correlation models of the factors associated with use, compliance and outcomes. The Health Belief Model (Strecher, Champion & Rosenstock, 1977), the Theory of Reasoned Action and its close counterpart, the Theory of Planned Behavior (Maddux & DuCharme, 1977), and the Behavior Health Service Utilization (Aday & Awe, 1997; Andersen, 1995) share an a outlining a comprehensive set of factors that shape the use of both preventive and curative services. Although these models do not ignore the underlying process of service, assumptions focus primarily on the factors that facilitate or discourage entry into treatment (for a review, see Gochman, 1997; Pescosolido, 1991; 1992; Pescosolid 1999). Rarely are the dynamics of coping with health problems a part of the study of illness behavior. With the dynamics assumed, empirical studies in this collect information on the extent and volume of use, and on a wide range of factors to influence the behavior of those entering care and treatment.

Our approach here is less traditional as we trace the theoretical and empirical work describing the process of coping with mental illness and the patterns of using systems of care. As the health care system is fundamentally transformed, understanding how individuals respond to mental illness, what pathways they travel, and what factors shape their trajectories requires a step backward to reevaluate what is known about service use and where further research is needed. We begin by describing two classic studies that initially invoked an "illness career" approach and by highlighting their fundamental lessons. Later, we explore the recognition of mental illness, different modes of entry into the formal system of care, the availability and use of diverse systems of care, and the patterns and pathways to care. We conclude by focusing on the Network-Episode Model that combines the strengths of previous process and contingency models of utilization. New empirical findings are drawn from past studies as well as ongoing studies of persons wit mental illness, from samples in the general population that report mental health p and from others who offer their opinions on the nature and cause of mental health problems.