Managing Madness in the Community: The Challenge of Contemporary Mental Health Care

Managing Madness in the Community: The Challenge of Contemporary Mental Health Care

Managing Madness in the Community: The Challenge of Contemporary Mental Health Care

Managing Madness in the Community: The Challenge of Contemporary Mental Health Care


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--fifteen 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.


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 twenty hospitalizations. Had he been born a couple of decades earlier, Jabar could easily have spent those decades in a state hospital. Instead, coming of age and becoming ill in the era of deinstitutionalization, he fell into the all- toofamiliar pattern of contemporary community care for people diagnosed with severe mental illness: residential and psychiatric instability. Having attended Suburban’s day program while living at a nursing facility for a few years, Jabar made the move to Suburban’s group home a few years prior to our meeting.

Compared to the alternatives he had experienced in the mental health system, living at Suburban had many advantages. All the residential programs he had been involved in had met his basic needs— food, a roof over his head, basic medical and psychiatric care— but he was given a lot more autonomy at Suburban. Two areas in particular stood out for Jabar. First, he had much more control over his money at Suburban than at the nursing facility where he had previously lived. the nursing facility was for- profit, as most are, and kept all his income except for a $30 per month allowance, which remained the same regardless of whether he supplemented his Social Security income through work or not. At Suburban, however, it was different: “Here, everything over my rent, I keep. I work … I get to keep all my money,” he said. Jabar also liked having more control over when and how much he ate than he had in previous . . .

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