Date of Award

Spring 1-1-2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Sociology

First Advisor

Stefanie Mollborn

Second Advisor

Jennifer Bair

Third Advisor

Sanyu Mojola

Fourth Advisor

Patrick Krueger

Fifth Advisor

Dayna Matthew

Abstract

In this dissertation, I take a multi-method qualitative approach to examine one city's ("Elkgate") adult mental health system. Using a combination of observation and in-depth and informal interviews of police officers, jail employees, private and public outpatient mental health clinicians and emergency room staff, and archival analysis of official forms and state and federal legislation, I consider this Elkgate's mental health system an amalgamation of correctional and medical organizations based on environmental necessity as opposed to organizational will. Beyond providing a detailed examination of one mental health system and identifying effective and strained inter-organizational interactions in place--an important contribution in the present political climate criticizing the "broken" mental health system nationwide--this research questions traditional beliefs surrounding health disparities and applies a multi-level analysis to examine and explain complaints and frustrations of professionals. For example, I analyze the benefits of Elkgate's public mental health services available to the poor and indigent over private services. Contextualizing the structure of care of these two service types within the role of a federal Act regarding patient information and privacy (Health Insurance Portability and Accountability Act), I also question how continuity of care may both positively and negatively affect patient care. This research also considers the consequences of poor inter-organizational integration across the system on consumer populations identified by professionals as disproportionately underserved. Combining organizational and intersectionality literatures, I propose that underserved populations in Elkgate's mental health system are the result of gaps between organizations that do not serve populations located at intersections of mental health who are both mentally ill and have other needs. I argue that this results in consumers who face greater disadvantage across multiple statuses. Finally, the timeliness of this research in terms of national and international interest in mental illness and systems of mental health, lends itself to significant policy implications presented in this dissertation for organizations involved in mental health, mental health systems and state and federal legislation.

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