The picture painted by Sylvia Plath for her fictional character Esther, who had mental health problems, is one of a lifetime of increasingly inadequate and exclusionary care. It had a resonance for many of her contemporaries in the same position because of the danger of being comitted to a large state hospital when the family could no longer afford private care. The situation now is different — we pride ourselves on having moved away from institutional care. But is the experience of using mental health services any less bleak? Studies carried out in the 1980s on families’ perception of services consistently found dissatisfaction with what was on offer (Benson 1994; Biegal et al. 1995; Hatfield et al. 1996a; Kuipers 1993; Mueser et al. 1996). This contrasted sharply with the perceptions of professionals and policymakers, who saw the changes in systems of mental health care as an improvement on the earlier era (Hafner and An der Heiden 1989; Rogers and Pilgrim 1996; Watkins and Callicutt 1997). Feedback from studies carried out during the 1990s has been mixed. Families surveyed by NAMI in the USA in 1993 were positive in their overall responses (Hatfield et al. 1996a). Nevertheless, they had not used the full range of services in the proportions suggested by official and professional reports:
Of all services used, medication was reported by the largest proportion, followed by individual therapy, hospitalization, and case management. Only about a third of the consumers had used crisis care, day care, residential services, and rehabilitation. Use of group therapy was reported by nearly half, and family therapy by about a fourth. (Hatfield et al. 1996a: 826)
Mental Health Mental Disorder Mental Health Service Mental Health Care Mental Health Professional
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