There are so many inequalities in American life today, and they are so intertwined with one another that it makes it difficult to discuss one without discussing the other or others that may be involved within one subject area. This paper is going to try and focus on socioeconomic inequalities in the arena of mental health. This very deep subject matter would require a lot more information than this paper to convey the importance of recognizing inequality in this area.
This paper is going to try to stick to a very brief overview of our mental health care system in America, and also show a view of mental health issues and how some of them are related to status both social and economic. There are tens of thousands of people in this country suffering from a mental illness or disorder. Current data estimates that about 8. 2 million, or about 5 percent of the adult population suffer from mental and emotional problems that “seriously interfered with the ability to work or attend school or to manage day-to-day activities” (Willis, 1998).The younger population is also being diagnosed at an alarming rate with mental disorders such as depression and conduct disorders. Americans with psychological disorders such as anxiety or mood disorders are increasing at an alarming rate. “Nationwide surveys suggest that between 16 and 22 million adults in the United States, one of every eight, now receive therapy for psychological problems in the course of a year (Kessler et al.
, 1994). This increase in diagnosis can be traced back to around 1950.Since the 1950’s most health insurance companies changed or expanded their coverage to include mental health services (Comer, 19! 92). This is just a glimpse of how inequality can be seen in the system of health care.
Let’s take a look at how a person in America gets diagnosed with a disorder, then we can then go into specific disorders to discuss how socioeconomic as well as status can relate to some of them. Most likely, the first one to notice that a person may have a mental disorder is usually a friend or family member of that person. It is usually brought to the attention of the person that there may be a problem.Then if the person is lucky enough to have insurance through work or somewhere else, that person may seek treatment for said mental problems.
The type of insurance and the amount of money available will severely affect this person in their treatment. This is an important inequality issue because it is up to the insurance company to make decisions for patients. Insurance companies or health care management (HMO) companies have the right to determine such key issues as which therapists their clients may see, they have the right to decide how much to spend on a session, a!nd the companies can control the number of sessions for which the client can be reimbursed for. (Manderstreid & Sonnenschein, 1992). This is really an unfair system since there are so many different types of disorders and so many different types of treatment. A trained professional could is really the only person who could possibly predict the type of therapy needed for an individual, yet the insurance company feels that they are capable of doing it for the patient.
A persons’ economic standing can play a role in the type of treatment given and the duration paid for by the insurance company.It seems pretty unfair that a person with extra money would have more choices when dealing with the insurance companies. The person who has the extra money could elect to pay for the treatment him or herself. Another option that a person with money has is they could purchase the “better” insurance. “Better” insurance would more likely put them in touch with better therapists and pay for lengthy expensive treatments. This is a very unfair practice; it is the poor who need the most care.The evidence confirms that this happens frequently, especially among the poor and minority groups. “Dropping out of therapy is more common among clients who have less money, and members of minority groups have, on average, lower income” (Whaley, 1998).
This is somewhat troubling because the poor are two and one-half times as likely as the nonpoor to have a “ser! ious mental illness” (Manderscheid 1992). A community in which most of the members are at or below the poverty level will most likely have to deal with more stress than an average upper-middle class neighborhood.Poverty stricken neighborhood deal with higher rates of violence, more crime, higher divorce rates, and there are more minorities in poor neighborhoods. Put these two socioeconomic problems into perspective and there is a huge problem with the way insurance companies and HMO’s operate. A persons’ social status is also an important issue to recognize. A persons’ perceived social status alone could play a major role in diagnosis.
If a woman is suffering from a disorder such as schitzotypal personality disorder, she is likely to be judged as a drug addict or a bum.The treatment needed would be overlooked and perhaps the person would be given medicine and sent home or maybe no treatment at all. Further investigation of a person with this type of disorder by a psychiatrist trained in the field would most likely diagnose the correct disorder and note that people with that disorder tend to act as if they are on drugs, and the personal hygiene of a person that is schizotypal is below what is considered standard for normal middle class American. The insurance industry views people as a number, so it is up to the care provider to keep a balance between real life and numbers on a page.It is easy to assume that the person doing the original assessment at a hospi! tal is not properly trained in all forms of medicine and usually it is up to that person to suggest a treatment. This makes it very easy for people suffering from mental disorders to fall through the system. There are studies that have been done that show a link between socioeconomic status and mental disorders.
The disorders range from mood disorders such as major depressive disorder and bipolar disorder to anxiety disorders, which include anorexia and bulimia nervosa to schizophrenia.In children the most popular diagnosis is attention deficit hyperactivity disorder (ADHD) it is also been tied to socioeconomic status. Mood disorders such as depression are linked to socioeconomic status yet it seems that the upper class or at least above poverty level suffer more than those below the poverty line. This is shown by several different statistics on depression. Although clinicians do not agree on why this exists.
Studies on generalized anxiety disorder show quite a different picture. The rate at which people are diagnosed significantly increases as income goes down.“In the United States the rate is twice as high among people with incomes under $10,000 a year as among those with higher incomes (Blazer, 1991). Sociocultural theorists believe that one of the most powerful forms of societal stress comes from poverty and all the things that go along with living in a poverty stricken community. Women are also diagnosed more often in these two categories of mood disorders.
Common belief seems to be that women have more stress to deal with and perhaps they deal with it in a different manner.Anxiety disorders such as above mentioned generalized anxiety disorder seem to be more common among the poor, but a different type of anxiety disorder anorexia nervosa and obsessive compulsive disorder seems to be more popular among females in an income bracket that is above the poverty level. Some theorists believe that this disorder stems from a need to be perfect and never achieving it. Anorexics are constantly striving for the perfect body yet they always feel empty inside. Is this due to status? Perhaps status in the upper class to look a certain way could link the two.To the best of my knowledge there are studies being done right now that are trying to show this link. Schizophrenia is a psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of strange perceptions, disturbed thought processes, unusual emotions, and motor abnormalities according to Ronald Comer.
Research on schizophrenia shows a link between socioeconomic status and diagnosis of the disease. According to certain surveys, poor people in the United States are much more likely than wealthy people to experience schizophrenia.(Adapted from Keith, 1991).
Sociocultural theorists as well as psychologists agree that income alone is not the only factor leading to these diagnoses. Genetics does play a role, but another important point is that stress too is linked to schizophrenia. As said before the poor especially women suffer more stress than men. Children on the other hand are more and more likely to be diagnosed with disruptive behavior disorders.
Oppositional defiant disorder and conduct disorder is more common in boys and in lower income brackets.These are disorders that are defined by having poor emotional control, noncompliant, and argumentative behavior. It seems that possibly a social status issue is brought up here because Attention Deficit Hyperactivity disorder is still more common in males yet this diagnosis has reaches across socioeconomic lines. Those children diagnosed with ADHD are slightly higher in above poverty level income brackets of parents. ADHD has a lot of the same symptoms as oppositional defiant disorder although oppositional defiant disorder is a little more severe than ADHD.The diagnosis could change depending on the child’s’ behavior, a child is just a product of his or her environment. It could be possible that the poor child is no more severe than the wealthier ADHD child it cou! ld just be that a child from a poverty stricken neighborhood has a different way of expressing himself and therefore may seem more severe than ADHD.
There is a lot to cover when discussing these mental health diagnoses and our how our health care system takes care of them. In theory according to Karl Marx I believe that in a society that he describes would never let people fall through the net of health care.I also believe that a lot of the socioeconomic problems associated with mental health would just disappear because of the importance of the ideal that everybody is an equal in a Marxist society. It seems, even though it is not theory that the idea of social Darwinism is playing a game with our health care system in the United States. “The most potent rationale for class privilege in American history is social Darwinism, and archetype for class privilege in America. ” (Lowen, 1992). It seems in this country that the rich or upper-class tend to think in a social darwinistic type of way.
The attitude towards the poor seems to be one of let the fittest survive and the rest well you deserve your problems. I think th! ough that the health care system would somewhat fit into a functionalist point of view. There are going to be people who are going to get sick and then there will be doctors to provide help. The functionalists would see the high price charged by doctors as something they deserved because of all that a doctor has sacrificed to become one.
That just leads us straight to the mention of the HMO. The HMO and the way it runs itself fits right in with the capitalist ideal.”Yeah”, say the HMOs, “we can sell this business of health care! ” What if they can’t afford it? “Well”, says the HMO “they can get what they can pay for! ” I am not too sure if this point has been clear throughout the paper, I was just trying to point out a simple flaw with our system that seems to get more and more complex as you try to explain what is going on. The issue of money and mental health is important to me as it should be to everyone.
I do not yet suffer from a mental disorder. I also fall below the poverty line when counting my income.To top it all off I am a woman. Wow, my situation seems pretty dismal in the light of the research it seems as though I am doomed to be depressed or crazy and how on earth can I better myself if I cannot receive the proper treatment when I do feel I am about to go crazy, which does happen from time to time…now for example…I am struggling to keep this paper simple, yet I choose a topic that could fill volumes…I suppose I will survive though.
I think that this issue of socioeconomic status and mental health needs to be researched more, and especially in the area of our children.This system of HMO and insurance companies is not fair to many. It seems like a problem when you see educated people unable to afford insurance, children most of all need the help. The children cannot support themselves, therefore they are the largest uninsured age group in this country. This is a huge problem because current psychology strongly suggests that there is a far better outcome from treatment if it begins early in the disorder.
This class has been great for opening up the discussion of inequality in the classroom, or discussion classroom.This is good because maybe some person will hear something that they feel passionate about and get the ball rolling toward a change. To discuss inequality with others that you would not necessarily talk to is an interesting experience. For me it is fun to listen to how sheltered people seem to think things are and the vast differences of how they really are. Inequality in our health system is only discussed in certain groups. I have spent time working for a state funded social service agency, and what I realized working there is that there really is a machine working the poor.There are charts that are standard they are by far not the norm.
The system needs some change if there is going to be any progress. People are individuals, they should be treated as such especially in eye of the insurance company. Our country is still young and it is even better than ! other countries, but we should take a look at some other countries and see how there health system works. The Netherlands, Sweden, and Canada all have universal health care, and even though the same mental disorders are seen across countries and systems it seems to not be as much as a problem for society as a whole.It seems that in America negative energy feeds off of itself. An example is a person goes to be seen for anxiety they do not get treatment instead they get drugs and then sent home. They do not feel better neither are their feelings about the establishment. They then relay this to friends and so then a whole community might have negative feelings about getting help so they won’t.
Another scenario is similar except the person gets drugs and they make the person feel better, but then they run out. Oh says the doctor you don’t have insurance that will cover more medication.So then said person goes to the streets to self medicate. This money and health care p! roblem is very controversial. Something must be done before we have a society of psychopaths that could not get help because of money and so go without treatment until it gets worse and now they need to be locked up…at taxpayers expense of course. ———————————————————————— **Bibliography** Blazer, D.
G. , Hughes, D. , George, L. K. , Swartz, M.
, & Boyer, R. (1991). Generalized anxiety Disorder. Psychiatric disorders in America: The epidemiologic catchment area study.New York: Maxwell Macmillan International.
Comer, R. J. (1994). Abnormal Psychology, 4th edition Keith, S. J.
, Regier, D. A. , & Rae, D. S.
(1991). Schizophrenic disorders. In L.
N. Robins & D. S. Reiger (Eds. ), Psychiatric disorders in America: The Epidemiological Catchment Area Study.
New York: Free Press. Kessler, R. C. McGonagle, K. A. , Zhao, S.
, Nelson, C. B. , Hughes, M.. , Dshleman, S. , Wittchen, H. u. , & Kendler, K.
S. (1994). Lifetime and 12-month prevalence of DSM-III-R Psychiatric disorders among persons aged 15-54 in the United States: Results from the National Comorbidity Survey. Arch.Gen.
Psychiat. , 51(1), 8-19. Lowen, J. (1992). Lies My Teacher Told Me. Manderscheid, R.
W. , Henderson, M. J. , Witkin, M. J. , & Atay, J. E.
(1999). Contemporary Mental Health systems and managed care, In A. V. Horwitx& T. L. Scheid (Eds. ), A Handbook for the study of mental health.
Cambridge, England: Cambridge University Press. Whaley, A. L.
(1998). Racism in the prvision of mental health services: A social-cognitive Analysis. American Journal of Orthopsychaiatry. Willis, Angela Gonzalez et al. (1998). “Mental Illness and Disability in the U. S.
Adult Household Population. Mental Health, United states.