Community -based care for the severe mentally ill in Sweden and the United States.
Item
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Title
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Community -based care for the severe mentally ill in Sweden and the United States.
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Identifier
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AAI3284489
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identifier
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3284489
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Creator
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Rosenheck, Stephen.
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Contributor
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Adviser: Mimi Abramovitz
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Date
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2007
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Language
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English
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Publisher
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City University of New York.
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Subject
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Social Work | Health Sciences, Mental Health
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Abstract
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This dissertation compares the development of community-based care for the severe mentally ill in Sweden and the United States in the years between 1960 and 1995. The dissertation approaches this cross-national comparison from the perspective of Esping-Andersen's The Three Worlds of Welfare Capitalism (1990).;Only one prior study, Goodwin's Comparative Mental Health Policy (1997), has sought to apply Esping-Andersen's welfare state typology to the mental health sector. Goodwin argued that during deinsitutionalization there was a widespread cross-national pattern of neglect in the development of community-based care for the severe mentally ill, but that the nature and extent of the neglect varied from country to country in correspondence with Esping-Andersen's three welfare state types.;This dissertation shows that the element in Goodwin's argument concerned with variation according to welfare state type was incorrect. It finds that in Sweden and the United States there existed a parallel sequence of neglect and corrective legislation that deviates from Esping-Andersen's typology in two major ways. There was far more neglect in Sweden than the typology would predict, and far more corrective legislation in the United States, as well.;To explain these deviations the dissertation introduces a conceptual distinction between sector-transcendent and sector-specific causes of welfare state development. It argues that the deviations it describes were caused by the sector-specific historical legacy in mental health of the custodial asylum.;All advanced industrial democracies, regardless of welfare state type, shared this historical legacy in common. In all these nations asylums were operated by government, rather than the free market; and by government at a relatively high level of jurisdiction, a fact which defined the severe mentally ill as not a local government concern.;During deinstitutionalization, this legacy left unwillingness and unreadiness to assume responsibility for the severe mentally ill by local government, even in Sweden. At the same time, it gave state government a strong incentive to enact legislation to correct local government neglect, even in the United States.;The dissertation concludes that efforts to apply Esping-Andersen's typology to an individual sector of welfare state activity must recognize that sector-specific causal factors play an important role.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
