A Comparative Study of Neurotics Seen in a Community Mental Health Center and in Private Practice BESS UDELL, BA. Research Associate ROBIJN K. HORNSTRA, Director of Research Greater Kansas City Mental Kansas City, Missouri Differences that emerge plying for psychiatric with those applying confounded by marked
obvious
social
class
in the study reported here, which was supported in part by funds from the National Institute of Mental Health, we attempted to examine the differences between patients treated in the public and private sectors when diagnosis is held constant. In the late 1960s a survey was undertaken to ascertam the extent and utilization of all formal psychiatric
M,D, Health
Foundation
in comparisons of persons apcare at a mental health center to the private sector are diagnostic differences beyond
differences.
To
circumvent
that
problem and to ascertain what differences, if any, persist after diagnosis is held constant, the authors exammed 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
rotic applicants in the private sector are rals, are members of intact nuclearfamilies, have previous inpatient experience.
more medical and
neureferdo not
UThe considerable differences emerging from a comparison of the private psychiatric sector with a public agency such as a community mental health center reflect in large part the considerable differences between their respective clientele. First, there are disparities in social class; that is, the center draws its clientele from the lower socioeconomic levels, while private-sector clientele come from the upper levels.1 But even after allowing for those expected class distinctions, the comparison is even more confounded by diagnostic disparities. Unlike the private sector, a mental health center, by virtue of its easy accessibility and wide array of services, draws the most clinically diverse clientele. They range from large groups of the least socially disordered, such as neurotics, to largegroups of the most socially disordered, such as schizophrenics and alcoholics. Mrs. Udell’s address at the Greater Kansas City Mental dation is 600 East 22nd Street, Kansas City, Missouri 1 R. K. Hornstra and B. Udell, ‘ Uses of Psychiatric Insurance February
Coverage, 1973, pp.
Hospital 90-93.
&
Community
Health Foun64108. Services and
Psychiatry,
Vol.
24,
services-public
and
private,
inpatient
and
outpatient
-in a seven-county area surrounding Kansas City; the area’s population was 917,500. Extensive data were collected for two basic epidemiological populations: 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 count consisting of all persons in treatment on a single selected day. Those in the prevalence population were not necessarily seen on that day but were on a psychiatric roster or in a psychiatric caseload. The data presented here pertain to neurotics, the only major diagnostic
group
health We
center studied
treated
in similar
proportions
by
a mental
and by private practitioners. two groups in the one-year applicant population: neurotic adults who applied for treatment at the Western Missouri Mental Health Center (N =892), and those who turned to the private sector (N 1203). (Eighty-six per cent of the psychiatrists in private practice in the area cooperated in the study.) We first collected data pertaining to applicants’ ma=
jor
characteristics, contact
on first
complaints
Using problems,
with
including the chief complaints made the center. An ordering of all their
yielded
simple
ground coders
50
different
rules yielded
categories
for
categorizing
an
intercoder
of problems.
the
stated
reliability
coefficient beyond .90. Each applicant was allowed up to six presenting problems; the median number was three. Ranking by frequency showed that the 1 1 topranked problems covered between 75 and 80 per cent of all applicants, whether grouped together or placed in sub-groups by living arrangement, source of referral, or other characteristics. Therefore, analyses were eon fined to the top 1 1 problems. Among center patients, the problems included depression,
nervousness,
to self, sleep problems, lems in getting along
VOLUME
27 NUMBER
marital
difficulties,
physical complaints, with others. Center
4 APRIL
1976
dangerousness
and patients
probalso
269
The frequency of marital problems in both groups suggests that a happy or unhappy marriage has less to do with family stability than with the cultural value placed on such stability.
taken at face value without an attempt to classify or make inferences about them. In thus bypassing clinical phenomena, they furnish not only interesting and empirically grounded data about the reasons people give for seeking psychiatric care, but they also offer what in our view is a useful link between the observed and the inferred. Four things are notable about these problems.
because meaningful comparisons were not possible; less than 6 per cent of all blacks seeking psychiatric care turned to the private sector. Analyses pertain to the one-year applicant populations; comments about oneday prevalence patterns are made only where such patterns are relevant or at variance with those found among applicants. The variables are as follows: Sex. Center and private caseloads contained a proportionately greater number of women than men (P
obvious
social
class
in the study reported here, which was supported in part by funds from the National Institute of Mental Health, we attempted to examine the differences between patients treated in the public and private sectors when diagnosis is held constant. In the late 1960s a survey was undertaken to ascertam the extent and utilization of all formal psychiatric
M,D, Health
Foundation
in comparisons of persons apcare at a mental health center to the private sector are diagnostic differences beyond
differences.
To
circumvent
that
problem and to ascertain what differences, if any, persist after diagnosis is held constant, the authors exammed 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
rotic applicants in the private sector are rals, are members of intact nuclearfamilies, have previous inpatient experience.
more medical and
neureferdo not
UThe considerable differences emerging from a comparison of the private psychiatric sector with a public agency such as a community mental health center reflect in large part the considerable differences between their respective clientele. First, there are disparities in social class; that is, the center draws its clientele from the lower socioeconomic levels, while private-sector clientele come from the upper levels.1 But even after allowing for those expected class distinctions, the comparison is even more confounded by diagnostic disparities. Unlike the private sector, a mental health center, by virtue of its easy accessibility and wide array of services, draws the most clinically diverse clientele. They range from large groups of the least socially disordered, such as neurotics, to largegroups of the most socially disordered, such as schizophrenics and alcoholics. Mrs. Udell’s address at the Greater Kansas City Mental dation is 600 East 22nd Street, Kansas City, Missouri 1 R. K. Hornstra and B. Udell, ‘ Uses of Psychiatric Insurance February
Coverage, 1973, pp.
Hospital 90-93.
&
Community
Health Foun64108. Services and
Psychiatry,
Vol.
24,
services-public
and
private,
inpatient
and
outpatient
-in a seven-county area surrounding Kansas City; the area’s population was 917,500. Extensive data were collected for two basic epidemiological populations: 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 count consisting of all persons in treatment on a single selected day. Those in the prevalence population were not necessarily seen on that day but were on a psychiatric roster or in a psychiatric caseload. The data presented here pertain to neurotics, the only major diagnostic
group
health We
center studied
treated
in similar
proportions
by
a mental
and by private practitioners. two groups in the one-year applicant population: neurotic adults who applied for treatment at the Western Missouri Mental Health Center (N =892), and those who turned to the private sector (N 1203). (Eighty-six per cent of the psychiatrists in private practice in the area cooperated in the study.) We first collected data pertaining to applicants’ ma=
jor
characteristics, contact
on first
complaints
Using problems,
with
including the chief complaints made the center. An ordering of all their
yielded
simple
ground coders
50
different
rules yielded
categories
for
categorizing
an
intercoder
of problems.
the
stated
reliability
coefficient beyond .90. Each applicant was allowed up to six presenting problems; the median number was three. Ranking by frequency showed that the 1 1 topranked problems covered between 75 and 80 per cent of all applicants, whether grouped together or placed in sub-groups by living arrangement, source of referral, or other characteristics. Therefore, analyses were eon fined to the top 1 1 problems. Among center patients, the problems included depression,
nervousness,
to self, sleep problems, lems in getting along
VOLUME
27 NUMBER
marital
difficulties,
physical complaints, with others. Center
4 APRIL
1976
dangerousness
and patients
probalso
269
The frequency of marital problems in both groups suggests that a happy or unhappy marriage has less to do with family stability than with the cultural value placed on such stability.
taken at face value without an attempt to classify or make inferences about them. In thus bypassing clinical phenomena, they furnish not only interesting and empirically grounded data about the reasons people give for seeking psychiatric care, but they also offer what in our view is a useful link between the observed and the inferred. Four things are notable about these problems.
because meaningful comparisons were not possible; less than 6 per cent of all blacks seeking psychiatric care turned to the private sector. Analyses pertain to the one-year applicant populations; comments about oneday prevalence patterns are made only where such patterns are relevant or at variance with those found among applicants. The variables are as follows: Sex. Center and private caseloads contained a proportionately greater number of women than men (P
