Three utilization styles at an urban mental health center.

The authors report a study of utilization of services based on data obtained on two patient groups at an urban mental health center: a one-year applicant population, consisting of an unduplicated count of all adults applying for psychiatric care during a one-year period; and a one-day prevalence population, consisting of all persons on a psychiatric roster on a single selected day. Juxtaposing diagnosis, applicant-to-prevalence ratios, and treatment or services used, they found three styles of utilization of services--the intensive user, as exemplified by the neurotic in psychotherapy, the casual user (the schizophrenic attending medication clinic), and the pseudo user (the alcoholic using detoxification services). The intensive user represents a minority utilization style, while the last two styles are predominat at the center. Taken together they characterize the typical patient as a therapeutically passive user of services.

A comparative study of neurotics seen in a community mental health center and in private practice.

Differences that emerge in comparisons of persons applying for psychiatric care at a mental health center with those applying to the private sector are comfounded by marked diagnostic differences beyond obvious social class differences. To circumvent that problem and to ascertain what differences, if any, persist after diagnosis is held constant, the authors examined demographic and psychosocial characteristics of neurotics in a one-year adult applicant population, the only major diagnostic group treated in large numbers and similar proportions by the center and the private sector. Findings showed that significantly more neurotic applicants in the private sector are medical referrals, are members of intact nuclear families, and do not have previous inpatient experience.

Good patients and bad. Therapeutic assets and liabilities.

This is an extension of an earlier article that identified three utilization styles at an urban mental health center where, apart from a minority of intensive users, casual users, and pseudousers predominate and, combined, characterize the therapeutically passive user. The present article compares center data to added data from the private sector, where the intensive user predominates. Center/private differences are examined, and correlates of differing utilization styles are identified, such as sex, diagnosis, marital/living arrangements, referral source, and social engagement factor. The later is associated with differences not attributable to diagnostic severity of social impairment. The growing division of labor, wherein the privates sector is engaged in intensive psychiatric treatment while the center increasingly operates an emergency/crisis/maintenance service, is shown to reflect a gross public/private maldistribution of therapeutic assets and liabilities.