Pescosolido B A, Gardner C B, Lubell K M
Department of Sociology, Indiana University, Bloomington 47405, USA.
Soc Sci Med. 1998 Jan;46(2):275-86. doi: 10.1016/s0277-9536(97)00160-3.
Previous work examining how individuals enter mental health treatment comes either from the health services utilization tradition, which implicitly assumes that clients make decisions to seek care, or from the socio-legal perspective, which examines how clients are forced into care. This paper draws from the Network-Episode Model to systematically consider the different social processes through which people come to enter psychiatric treatment by exploring the "stories" told by individuals making their first major contact with the mental health system. We combine the use of qualitative and quantitative methods to examine data from the Indianapolis Network Mental Health Study, a longitudinal study of individuals in treatment at the largest public and voluntary facilities in the city. We analyze detailed self-reports of how they came to use mental health services, classifying these stories as "choice," "coercion," or "muddling through". Using multinomial logit analyses, we examine how factors such as gender, race and diagnosis shape the types of stories that individuals tell. The preliminary results indicate that fewer than half of the stories (45.9%) match the notion of choice underlying the dominant utilization theories. Almost a quarter of respondents (22.9%) report coercion and nearly one-third (31.2%) tell stories that lack a clear agent. Diagnosis and social networks tap differences in how individuals experience entry into care. Individuals diagnosed with bipolar disorder or who have larger, closer social networks are more likely to tell stories of coercion. We discuss the theoretical, methodological, and clinical implications of findings drawn from this examination of clients' stories.
以往关于个体如何进入心理健康治疗的研究，要么源于卫生服务利用传统，该传统隐含地假定患者会做出寻求治疗的决定；要么源于社会法律视角，该视角审视的是患者如何被强制接受治疗。本文借鉴网络事件模型，通过探究首次与心理健康系统产生重大接触的个体所讲述的“故事”，系统地考量人们进入精神科治疗的不同社会过程。我们结合使用定性和定量方法，对印第安纳波利斯网络心理健康研究的数据进行分析，该研究是对该市最大的公立和志愿机构中接受治疗的个体进行的纵向研究。我们分析了他们如何开始使用心理健康服务的详细自我报告，将这些故事归类为“选择”“强制”或“蒙混过关”。通过多项逻辑回归分析，我们考察了性别、种族和诊断等因素如何塑造个体所讲述的故事类型。初步结果表明，不到一半的故事（45.9%）符合主导利用理论所隐含的选择概念。近四分之一的受访者（22.9%）报告受到了强制，近三分之一（31.2%）讲述的故事中没有明确的行为主体。诊断和社会网络揭示了个体在接受治疗过程中的不同体验。被诊断患有双相情感障碍的个体或拥有更大、更亲密社会网络的个体，更有可能讲述受到强制的故事。我们讨论了从对患者故事的此次考察中得出的研究结果在理论、方法和临床方面的意义。
