James R. Greenley

Organization, management, and client effects on staff burnout

Employee burnout is perceived to be a serious problem in human service organizations serving persons with severe mental illness. There has been considerable investigation of burnout and many of its possible causes, but little investigation of the role of client severity in relationship to burnout. Furthermore, theoretical models linking environmental context, organization structure, and management processes to burnout have seldom been proposed or examined. Building on our previous work, we employ a theoretical framework that conceptualizes environmental context, organization structure, management processes, client severity and staff characteristics as influencing work satisfaction and burnout. We examine this in a survey of 311 staff in 42 community mental health service organizations. Controlling for individual staff characteristics, results suggest that organization structure, culture, and management process are important to work environment and in turn to satisfaction and subsequently to burnout. Contrary to the literature, client severity was not associated with burnout nor to work dissatisfaction.

The prevalence of psychological distress and help-seeking in a college student population

SummaryThis paper examines the prevalence of treated and untreated psychological distress as measured by various indices within subgroups of a student population. Comparisons are made on these indices between a random sample of the college population of 1502 respondents and applicants from the same population seeking psychiatric and counseling assistance. As anticipated, we found high levels of reported distress in the random sample although it is difficult to assess the clinical significance of such reports. Forty-five per cent of students in the random sample scored six or higher on the Langner 22-item scale as compared with 75 % among psychiatric applicants and 66 % among counseling applicants. While half of the psychiatric sample, and a third of the counseling sample, reported that their problems often prevent activities, only a tenth of the random sample gave comparable responses. Forty-seven predictors of levels of reported distress were examined. Most socio-demographic factors have either modest or no effect on reported distress; women, younger students and unmarried students were more likely to report distress. Other variables found to be correlated with reported distress include: having a high proportion of friends with emotional problems, identifying with introspective others and a low sense of self-efficacy and control. The significance of these and other findings is evaluated in light of methodological issues and uncertainties in the measurement of distress in community populations.

Rural-Urban Differences in Psychiatric Status and Functioning Among Clients with Severe Mental Illness

Studies of clients with severe mental illness (SMI) typically focus on individuals in larger urban areas. Less is known about clients in rural and smaller urban areas. Here we compare the psychiatric status, home and community activities of daily living, and social and vocational functioning of 1600 adult clients with SMI from 18 small-city and rural Wisconsin counties. Rural clients are less likely to have a diagnosis of schizophrenia or organic brain syndrome; have higher levels of general pathology, including more belligerent, bizarre, nervous, and depressive behaviors; and engage in fewer vocational activities than urban clients.

Neglected organization and management issues in mental health systems development.

Fragmented and often uncoordinated public services for the more severely mentally ill are often characteristic of the current U.S. mental health system. The creation of local mental health authorities has been promoted as part of a solution, as has happened in Wisconsin at the county level and is championed in the ongoing Robert Wood Johnson Foundation funded innovative service sites for severely mentally ill adults. There are indications that these innovative mental health authorities will fall short of fulfilling their promise. Basic principles from the management and organizations literature are used to identify several organization and management issues that may have been neglected. These include resource management, attention to system goals, monitoring and feedback, and the promotion of desirable interorganizational cultures.

Validity of Case Manager Reports of Clients' Functioning in the Community: Independent Living, Income, Employment, Family Contact, and Problem Behaviors

Validity of case manager reports of client functioning in the community was assessed by examining the correspondence between case manager reports and client reports of several widely-used indicators of client well-being, including independent living, income, employment, family contact, and problem behaviors. Effects of how well case managers knew their clients and of using telephone interviews vs. self-administered questionnaires to gather case manager data were also investigated. Data were gathered from 6 case managers and 55 of their seriously mentally ill clients in a rural Wisconsin Community Support Program. Indicators of independent living and employment displayed reasonably good agreement and support the use of case manager reports in research. Indicators of income and problem behaviors produced lower levels of client-case manager agreement at least in part because client reports proved an inadequate criterion for these measures.

Alternative Views of the Psychiatrist's Role

Two views of the inpatient psychiatrists role are examined using data from a study of discharges from a mental hospital. One view of the psychiatrist sees him in the traditional professional role using his skills to advise and direct patients. Another view of the psychiatrist pictures him rationalizing and legitimizing in medical-psychiatric terms actions taken toward patients, such as discharges, which occur neither for professionally acknowledged medical nor psychiatric reasons. The desires regarding discharge timing held by the patient and a member of his family are found strongly and positively related to the actual timing of release. These desires account for almost all of the relationship between the psychiatrists medical-psychiatric evaluation of the patient and the timing of discharge, suggesting, along with other supporting data, that the psychiatrists professional judgments are at best indirect determinants of the discharge decision. Observations of psychiatrist-patient relationships over time also suggest that psychiatrists sometimes alter their evaluations of a patients psychiatric condition in response to pressures from the family and patient, allowing professional prescription of discharge or retention as the family or patient demands. Implications of these findings are briefly explored.

Sociodemographic characteristics of severely mentally ill clients in rural and urban counties.

Sociodemographic differences between rural and urban clients with severe mental illness (SMI) are explored using approaches which extend research in this area beyond limitations found in the few existing studies. Sixteen hundred adult clients from 18 Wisconsin counties are classified according to the degree of rurality of their counties of residence, using two definitions: a dichotomous metropolitan-non-metropolitan grouping and population density. There are significant differences between rural and urban clients for age, gender, and marital status, but not education or income. Young (18–35 years), unmarried males are more likely to live in more densely populated counties. Older (65 and older) women who are currently or previously married are more likely to live in less densely populated counties.

Organizational influences on access to health care

Abstract This paper argues that organization-environment relations in health and related fields have a significant impact on patterns of referral and rejection. Two separate areas of research, i.e. basic research on organization-environment relations and research on two aspects of access to health care (referrals and rejections) are reviewed and integrated. Within an exchange framework propositions are developed concerning organizational resources, autonomy, and domain consensus. Finally, it is suggested that organization-environment relations and organizational structures influence the production of treated rates of various personal problems, rates which are often used in research as well as in program and policy decisions.

Types of authority and two problems of psychiatric wards

This paper concerns the relationship between authority structures and two “problems” reported in the literature as common to “milieu” or “therapeutic community” wards. Psychiatric wards with rational-legal and charismatic authority structures are found more likely to experience mood and morale swings on the part of patients and staff and to spend excessive time and energy changing ward rules.

Trends in Urban American Psychiatry: Practice in Chicago in 1962 and 1973

SummaryA 1973 mailed survey of all psychiatrists practicing in Chicago utilized many questions identical to those used in a 1962 survey of this same population. By 1973, more psychiatrists were working in the public sector than in 1962, but by 1973, their interest in a social and community therapeutic orientation had decreased. The psychoanalytic orientation remained strong, though interest in analytic training had declined. In both private and organizational practice, the average Chicago psychiatrist was seeing more Blacks, poor people and Catholics, and fewer Jews, in 1973 than in 1962. Societal changes associated with these changes in psychiatric practice are discussed.