Michael Dear

Attitudes toward the mentally ill and reactions to mental health facilities

Abstract Community mental health facilities are generally regarded as engendering public opposition due to their negative external effects. However, the factors affecting public reaction to these facilities have not been clearly specified. In this paper it is argued that public reaction is a function of the physical and social characteristics of the host neighbourhood, the characteristics of the facility itself and public attitudes toward the mentally ill. Empirical attention is subsequently focussed on the relationships between attitudes toward the mentally ill and reactions to potential and existing facility locations. The data used were collected in a questionnaire survey recently conducted in Toronto, Ontario. Attitudes are measured in terms of four scales: authoritarianism, benevolence, social restrictiveness and community mental health ideology. Results show strong relationships supporting the primary importance of attitudes toward the mentally ill as a basis for explaining and predicting public reaction to community mental health facilities. Attitudes toward facilities are shown to be more favourable than commonly supposed, leading to the conclusion that opposition is limited to a vocal minority whose views are not representative of their community as a whole.

Planning for Mental Health Care: A Reconsideration of Public Facility Location Theory

This paper suggests that a critical reassessment of the theory of public facility location is long overdue. A comprehensive theory should contain three standard analytical components: location as access; location as externality; and definition of the policy context for public facility planning. Recent empirical research on mental health facility location is used to illustrate the significance of these analytical themes.

Impact of mental health facilities on property values.

Community opposition to the establishment of a smallscale mental health facility is often intense. One frequently voiced fear is that the establishment of a facility will cause property values in its vicinity to decline. This paper examines empirical evidence of the impact on property values in the neighborhood of 12 mental health centers in Philadelphia. It is concluded that such facilities have an indeterminate effect on property values in their vicinity, contrary to popular opinion.

Economic cycles and mental health care policy: An examination of the macro-context for social service planning☆

Abstract This paper examines the political economy of social service planning. Specifically, it is concerned to demonstrate the links between the general state of the economy and mental health care policy. An examination of the social history of the asylum clarifies the importance of two trends in developing policy attitudes: changing political and professional judgments regarding the appropriate form of confinement for the insane; and variations in care associated with fiscal pressures and chemotherapeutic advances. These trends are explored in detail for the case of the Province of Ontario. The secular (long term) trend in Ontario for the period 1875–1977 is dominated by an increase in levels of admissions, discharges and numbers of patients on the hospital books. These century-long trends are reversed only after 1960, in a climate of increasing costs, mistrust of mental hospitals and advances in drug treatment of mental patients. As a consequence of policy changes, the levels of admissions and discharges increase rapidly, while the resident hospital population diminishes. There is a simultaneous increase in the levels of psychiatric activity in the new treatment centers—the psychiatric units of general hospitals and community-based mental health units. The crucial 1960–1977 period is subject to a more precise time series analysis. Monthly data for five indicators of policy practice at one psychiatric hospital (Hamilton) is related to two indicators of economic activity. Using an iterative least squares regression technique, clear relationships are demonstrated between the rates of unemployment and inflation and the levels of admission, discharge, patients on books, vacancy rate and number of available beds in the hospital.

A model for predicting utilization of psychiatric facilities

This paper develops a parsimonious model for predicting utilization of a regional system of psychiatric facilities based on census data. The model combines conceptual simplicity with readily-available data sources. In practical terms, the model removes the need to undertake comprehensive and expensive utilization surveys. In theoretical terms, the model indicates that the fundamental relationship between utilization rates and key social indicators is stable through time. Although further testing is necessary, it would seem that these key indicators can provide reasonable estimates of psychiatric morbidity for up to ten years in the future.

Thirteen Axioms of a Geography of the Public Sector

Decisions made in the public sector affect almost all aspects of our lives. The welfare of future generations depends upon those decisions now being made. It is odd, therefore, that the spatial outcomes of public sector decisions do not form a more prominent focus in contemporary geographic theory. The purpose of this essay is to correct this imbalance, by outlining a framework for the study of a geography of the public sector. Four themes are pursued: preliminaries; pattern; process; and theory and methodology. Together, they define the thirteen principal axioms of a public sector geography.

Assigning service-dependent elderly to appropriate treatment settings.

Abstract The assignment of service-dependent elderly people to appropriate treatment settings has three phases: assessment of client need; identification of appropriate treatment setting; and placement of the client in that setting. Optimal placement depends upon successfully matching the external and internal treatment setting needs of the client. In analysis of an extended sequence of assignment by the Assessment and Placement Service (APS) of Hamilton-Wentworth (in the Province of Ontario), a highly consistent pre-placement assessment procedure ensured the allocation of a client to an appropriate treatment setting. Staff of the ‘host’ treatment setting overwhelmingly endorsed the placement. There was evidence of minor misjudgements in certain assessment categories, but overall consistency levels were high. A significant minority (14%) of clients were dissatisifed with their placements. General characteristics which influenced client attitude included dislike of being institutionalized, isolation from friends and community, and absence of a rewarding social environment within the treatment setting. The physical setting of, and services offered at, the treatment settings were favourably regarded. The study sample included 33 clients, who were more functionally competent than the general APS population.