Most mental health care today takes place not in hospital settings, but rather in a range of community-based organizations. This chapter lays out the scope of community mental health care and outlines the major approaches and findings in social scientific and organizational research done on specialist mental health care settings. While the average (non-office-based) specialty community mental health organization is private and nonprofit, public funds make up a large portion of the support for community care. While psychiatrists continue to play a prominent role in community mental health, there are a range of workers providing services in non-hospital settings. The chapter groups existing research on community mental health care organizations by the theoretical lens the studies use in their analysis. The approaches differ in levels of analysis as well as in which “slice” of organizational life they focus on. Important insights into the operation of community mental health care come from research in each theoretical tradition. For discussion, readers might ask what a client presenting for mental health care in the community can expect to encounter. How is the clinical work of mental health care workers shaped by the type of organization where they provide care?

This chapter examines the assessment and measurement of mental disorders. Researchers must distinguish between clinical prevalence (people who are treated for mental disorder) and true prevalence (the actual rate of disorder in a community, including those not in treatment). The measurement of mental illness must be conceptually valid; that is, there must be criteria that successfully distinguish cases of disorder from cases of non-disorder. In the past, researchers relied upon general symptom checklists, which identify a threshold above which an individual is considered disordered, but without specifying a particular disorder. An alternative to checklists is provided by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) of mental disorders, which provides sets of diagnostic criteria for specific disorders. The assumption behind the DSM is that mental disorders result from internal psychological dysfunctions (i.e., failures of proper functioning of mental processes), a presumption that Wakefield and Schmitz accept but demonstrate is often violated by the DSM's own criteria for mental disorder. Their critique of the DSM's approach to measurement is illustrated with several DSM diagnoses. In addition to thoroughly discussing the conceptual basis of the DSM, Wakefield and Schmitz provide examples of the attempts to use DSM-derived criteria to measure prevalence of mental disorder in the community. These examples demonstrate the recurrent problems with creating conceptually valid measures for use in psychiatric epidemiology. It is unclear whether these problems can be overcome or circumvented with methodological innovations. The student should consider why it is so difficult to determine who is mentally disordered, and to distinguish mental disorder from intense normal distress. Is a conceptually valid resolution of these problems possible?

Keith and Brown present a conceptual model for understanding the way in which the interrelationships among race, gender, and socioeconomic status (SES) influence mental well-being for African American women. Mental well-being is affected by social, cultural, and psychological factors as well as by physical health and health behavior; in turn these factors are influenced by one's social status (i.e., race, gender, SES). African American women are subject to racism, sexism, and for some, heterosexism, which diminish their educational attainment, personal and household incomes, occupational status, wealth accumulation, and opportunities for socioeconomic advancement. Consequently, African American women have fewer resources than their white counterparts and are far more limited in their capacity to cope with crises and adversities. Stressors such as poverty and economic hardship also challenge the adaptive abilities of many African American women. They are less likely to be married and, if married, more likely to be employed and responsible for more household chores than white married women. Parenthood often is another source of stress as many African American women are single parents. The particular set of roles that African American women must fulfill may also expose them to more stressful life circumstances. Combining employment and parenthood roles increases the likelihood that they will experience role overload and role conflict, especially when coping resources are limited. A key argument made by Keith and Brown is that there is a strong connection between mental and physical health. African American women have poorer physical health with higher rates of diabetes, hypertension, HIV infection, and lupus, which lead to higher mortality rates than white women. Additionally, African American women are less likely to use health care, which may be due to a lack of access, among other factors. However, the extended social networks of African American women may provide important sources of social support. What other types of social support would help African American women cope with the many sources of stress in their lives and would immigrant and LGBT women need additional supportive resources?

How mental distress is understood and defined has significant social and political implications. For this reason, psychiatric nosology – the classification of mental disorders – has come to occupy a central role in debates over mental health policy, patient identity politics, and the professional authority of psychiatry. This chapter explores the sociological research on psychiatric nosology. The first section examines the history of classification of mental disorders in the United States, focusing on the professional dynamics that have shaped the Diagnostic and Statistical Manual of Mental Disorders (DSM). The second section describes three key areas of sociological research on psychiatric nosology – medicalization, diagnostic practice, and patient identity – that highlight the manner in which social and political factors influence the classification of mental disorders and the concomitant effects of psychiatric nosology. How does medicalization impact our understanding and classification of mental health disorders? How do social and political factors affect the categorization of mental disorders? Specifically, how has the production, use, and reception of the DSM shaped political (professional or otherwise) considerations?

Limonic and Lennon examine the mental health consequences of work and unemployment. The authors discuss the different theoretical models for understanding the relationship between work and psychological well-being. Changes in the nature of work, the stability of the labor market, and the involvement of women in the workforce have had important consequences for psychological well-being. Jobs that are demanding and precarious, and provide few opportunities for control, have negative consequences for mental health. Limonic and Lennon also consider the effect of unpaid work, specifically housework, on mental health and well-being. Like paid work, housework involves varying levels of control and stressful demands. Unemployment has a negative effect on well-being because it may reduce self-esteem and economic security, and thus produce anxiety and depression. Yet it is important to examine the economic context within which individuals experience unemployment. Several recent approaches, which integrate community-level conditions and individual characteristics, are described. The authors conclude by providing an overview of the current research on the effects of unemployment during the Great Recession. New research points to long-lasting consequences of job displacement for the individuals affected as well as their families and communities. What are some of the impacts of the Great Recession on labor market outcomes for young job seekers? How do these possible outcomes affect mental health trajectories?

This chapter investigates the amount of research interest in the relationship between mental health and terrorism. In addition, Johnson and colleagues have begun to identify the seminal research in the field as the frequency of publications increased allowing dominant and coherent trends of study to emerge. Both broad theoretical advances and focused conceptual refinements have been identified and discussed. The authors have also sought to identify the broader lacunae in the field and suggest future directions for research. Their results reveal that the dramatic increase in research focusing on the topics of terrorism and mental health reached their highpoints five to ten years after the September 11, 2001, attacks on the World Trade Center in New York and the Pentagon in Washington, DC, and the hijacked plane that crashed in Pennsylvania. The first highpoint occurred after five years with respect to health and terrorism specifically, while research on terrorism in general continued to rise in the social science literature for another five years before its first major descent was recorded in 2012. The reaction to those attacks themselves dominated much of the research. In addition to ongoing attention to mental health topics and risk behaviors occurring as a result of those attacks, a developing trend in positive outcomes such as post-traumatic growth (PTG) and especially resilience have been noted.

While the frequency of published research generally has started to wane in the second decade following the September 11 attacks, many of the questions raised by the research in the first decade remain unanswered. Will new tragedies in understudied parts of the world demand resurgence in research focusing on the association between mental health and terrorism, or will it take another crisis among Western nations (e.g., the current wave of refugees into Europe from non-European Union nations)? With waves of terrorism washing over large regions of the globe, what factors determine who and what topics are drawing the attention of mental health researchers? How would you define resilience in the face of terrorism and what examples of it can you provide? What work remains to be done on resilience to broaden its application to sociology?

Williams, Frech, and Carlson examine the evidence for an effect of marital status on mental health, with a particular focus on the factors that identify who benefits from marriage, who suffers from marital dissolution, and under what circumstances. They evaluate three possible explanations for observed associations of marital status with mental health: (1) the marital resource model; (2) the marital crisis model; and (3) selection bias. They conclude that the best recent evidence suggests that, on average, entering marriage improves mental health and exiting marriage undermines mental health, at least in the short run. However, their central argument is that these average associations obscure a great deal of heterogeneity in the experience of marriage and in its consequences for mental health. The authors consider a range of individual, demographic, and relationship characteristics that are likely to moderate the effect of marriage and marital dissolution on mental health. These include gender, marital quality, age / life course, race/ethnicity, values and beliefs, and prior mental health. Students should discuss what other factors are likely to influence whether marriage and divorce are beneficial, neutral, or harmful for mental health. How might the impact of marriage and divorce on mental health change with the times, particularly as alternative family forms become more prevalent?

In this chapter, Woo, Walton, and Takeuchi examine and summarize some cultural issues in the treatment of racial and ethnic minorities with mental health problems. They review some key data on the use of mental health services by ethnic minorities including consideration of access to services, use of services, and service outcomes. Many geographic areas have been dramatically altered by the rising racial, ethnic, and cultural diversity of the United States, creating different and sometimes novel approaches to the prevention and treatment of mental health problems. The authors examine a range of efforts to address these needs at provider, agency, and community levels. They ask you to consider the following questions in reading the chapter. As a society, how broadly are we willing to recognize and respond to growing culturally diverse mental health needs? What efforts can be made to resolve the mental health disparities among racial and ethnic minorities?

Although many disciplines study mental health, not every discipline thinks of mental health in the same way. This chapter considers how decisions regarding outcomes – that is, what scientists are trying to explain or, in quantitative studies, the dependent variable – affect conclusions regarding what we think causes mental illness. The chapter considers various axes along which outcomes are considered, focusing on three of the most prominent: categorical versus dimensional, symptoms versus syndromes, and functioning versus disorders. The chapter then reviews the consequences of decisions regarding these axes. Decisions regarding outcomes have important consequences, many of which are quite subtle. Yet decisions are often justified on an ad hoc basis and, indeed, there may be no objectively correct way to measure psychiatric disorders. To be sure, the natural sciences can reveal something about the true nature of mental illness, including research on genes that speaks to the boundaries between psychiatric disorders, but much of the emerging evidence in this regard fails to provide clear guidance. Long-standing controversies regarding outcomes are unlikely to be resolved anytime soon, but research will continue to study psychiatric disorders. In the end, what is the best way to conceptualize and measure mental health?

Sociological approaches regard mental health and illness as aspects of social circumstances. One type of sociological study examines the sorts of social conditions that influence levels of mental health and illness such as negative life events, ongoing stressful circumstances, demanding social roles, levels of social support, and the strength of cultural systems of meaning. Another type of study focuses on how social and cultural influences shape the definitions of and responses to mental health problems. These kinds of studies show how key recent trends including the medicalization of a growing number of conditions, the increased use of prescription drugs to deal with mental health problems, and a greater willingness to identify emotional suffering as mental illnesses that require professional help, are transforming how modern societies deal with psychological problems. The sociological study of mental health and illness is both distinct from and complementary to more individualistic psychological and biological approaches to these topics. What would be an example of the difference between how a sociologist and a psychiatrist might view someone's mental health problems? What are the advantages and disadvantages of each approach? Some people think that using prescription drugs for mental health problems is a helpful way of responding to suffering while others emphasize the dangers involved in growing rates of prescription drug use. Which view do you think is best supported?

For the last 150 years in the United States, people who had been committed to psychiatric hospitals and treated against their will have championed the cause for social justice and the right of all persons to exercise self-determination and choice over their bodies and minds. These persons have mobilized political support for change through what is now called the mental health consumers/survivors movement. This chapter briefly reviews the early roots of that movement and then focuses on changes in its development and both its accomplishments and challenges faced in the modern period from about 1970 to 2015. It discusses how, despite differences within the movement, recovery has become a rallying theme, promoted by peer experts as well as non-consumer supporters. Why, then, are its decades of accomplishments and recovery agenda currently at risk of being dismantled by impending federal legislation?