Competing Realities

This volume takes a fresh look at the problems of designing effective and humane service care delivery systems for the seriously mentally ill. The author addresses a number of major themes, including the differing definitions of mental illness and the differing treatment technologies that have logically developed from them, the varying theories regarding the structure and design of the service delivery system, and the policy dilemmas that lead to inconsistent and inequitable treatment. Demonstrating that there are wide areas of agreement among the disputing professionals. Chandler offers guidelines for finding these zones of agreement and achieving a consensus for realistically improving the system of care. The focus throughout is on the development of practical problem-solving strategies for professionals, advocates, patients, and their families. A particularly valuable feature is the inclusion of an in- depth case study that demonstrates the application of effective conflict resolution techniques in the mental health setting.

Following an introductory overview of the persistent problems of people with mental illnesses, Chandler analyzes the recurring themes and issues that have surrounded the mental health field since its earliest conception. She goes on to examine such issues as the failure of the deinstitutionalization policies for the seriously and persistently mentally ill and the changing roles and responsibilities of state and local governments, families, mental health providers, and welfare agencies. The remaining chapters explore the nature of advocacy in the mental health field. Chandler describes the framework and belief structures of prominent advocacy organizations, discusses the advocacy wars among the organizations and agencies whose goal it is to help the mentally ill, and delineates a negotiation strategy for meeting the needs of the mentally ill. Topics such as the rise of the National Alliance for the Mentally Ill, the growth of patient rights groups, and strategies for altering the definitions of mental illness receive extended treatment. In the final chapter, Chandler outlines the knowledge necessary to understand the complex issues surrounding the mentally ill and the skills necessary to work successfully in this field.

SUSAN MEYERS CHANDLER is an Associate Professor at the School of Social Work at the University of Hawaii. In 1988, she was awarded the title of Mental Health Social Worker of the Year by the National Association of Social Workers' State Chapter.