Competing Realities: The Contested Terrain of Mental Health Advocacy

Competing Realities: The Contested Terrain of Mental Health Advocacy

Competing Realities: The Contested Terrain of Mental Health Advocacy

Competing Realities: The Contested Terrain of Mental Health Advocacy


This volume takes a fresh look at the problems of designing effective and humane service care delivery systems for the seriously mentally ill. The author addresses a number of major themes, including the differing definitions of mental illness and the differing treatment technologies that have logically developed from them, the varying theories regarding the structure and design of the service delivery system, and the policy dilemmas that lead to inconsistent and inequitable treatment. Demonstrating that there are wide areas of agreement among the disputing professionals, Chandler offers guidelines for finding these zones of agreement and achieving a consensus for realistically improving the system of care.


The problems of people who are seriously and persistently mentally ill are vast and complex. While there is general awareness about the scope and severity of this issue, its extent is still unknown. Documenting exactly how many people suffer from mental illnesses is difficult for several reasons. First, there is still a stigma attached to having a mental illness, which results in a reluctance to admit or report it; thus there is a significant underreporting of the true prevalence. Second, the complex array of existing treatment systems--from the public, state hospitals to the exclusive, private clinics with fee for service practitioners-makes finding, monitoring, and following up on mentally ill people difficult. Third, the variety of diseases labeled mental illness and the varying prognoses among individuals diagnosed with the same illness make estimating its frequency and prevalence difficult.


The published estimates of the number of people suffering from a mental disorder at any given point in time is about 10 percent of the total population (Brown, The Transfer of Care, 1985). Using a frequency count in the community, the Midtown Manhattan Study found that 23 percent of the adult population in New York City were affected by a serious psychiatric impairment at any point in time (Srole et al., 1962).

More recent studies estimate that 15 percent of the population is affected by a mental disorder in a one-year period (Current Population Reports,Bureau of Census, 1987). As newer techniques of case identification are developed, the numbers increase. Public health epidemiologists now estimate annual prevalence rates of more than 20 percent of the population per year will suffer some form of mental illness. That is, approximately 48 million American adults suffer from a mental-emotional disorder at some time during their lives (Torrey . . .

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