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Social class and the pre-hospitalization and post-hospitalization experience of the mentally ill Cox, Michael C. 1967

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S o c i a l C l a s s and the P r e - H o s p i t a l i z a t i o n  and P o s t -  H o s p i t a l i z a t i o n E x p e r i e n c e s o f the M e n t a l l y 111. by M i c h a e l C. Cox W i l l i a m A. Hodgson J u d i t h L. Langdon Nancy M. Leishman David G. Malchow S h e r r i e L . Poplack  T h e s i s Submitted  i n P a r t i a l F u l f i l l m e n t o f the Requirements  f o r the Degree o f MASTER OF SOCIAL WORK i n the School o f S o c i a l Work  I Accepted as conforming  t o the standard r e q u i r e d  Degree o f Master  o f S o c i a l Work  The U n i v e r s i t y o f B r i t i s h December,1967.  Columbia  f o r the  1  In  presenting  for  an  that  advanced  the  I  thesis  for  Department  shall  further  agree  the  make  freely  representatives.  h.i;s  of  this  thesis  may  for  permission.  of  . Columbia  be  of  British  available  permission  or  by  f u l f i l m e n t of  University  it  that  The U n i v e r s i t y o f B r i t i s h V a n c o u v e r 8, Canada Date  partial  purposes  my w r i t t e n  Department  at  in  scholarly  publication  without  thesis  degree  Library  Study.  or  this  for  granted  It  is  financial  for  the  Columbia,  I  reference  and  extensive  by  the  requirements  copying  Head  understood  gain  shall  of  this  my  that  not  of  agree  be  copying  allowed  ABSTRACT  T h i s r e s e a r c h p r o j e c t was undertaken t o determine i f there are s o c i a l c l a s s d i f f e r e n c e s and  post-hospitalization  as m e n t a l l y i l l .  i n the p r e - h o s p i t a l i z a t i o n  experiences o f i n d i v i d u a l s  S o c i a l c l a s s was d e f i n e d  through the  a p p l i c a t i o n o f e d u c a t i o n a l l e v e l and o c c u p a t i o n a l The data o b t a i n e d from the R i v e r v i e w H o s p i t a l a two year p e r i o d  defined  status. covered  from A p r i l 1, 1965 through March 31, 1967.  Three main hypotheses were formulated t o d e a l w i t h the following  topics:  (1) The r e l a t i o n s h i p between s o c i a l c l a s s and employment. (2) The r e l a t i o n s h i p between s o c i a l c l a s s and d u r a t i o n of i l l n e s s p r i o r t o admission t o h o s p i t a l . (3) The r e l a t i o n s h i p between s o c i a l c l a s s and c o n t a c t w i t h f a m i l y or r e l a t i v e s . S i g n i f i c a n t trends were found t o e x i s t .  Representative  o f these were: (1) R e l a t i n g s o c i a l c l a s s and employment b e f o r e admission to h o s p i t a l and f o l l o w i n g d i s c h a r g e from h o s p i t a l , more h i g h e r c l a s s s u b j e c t s than lower c l a s s s u b j e c t s were employed b e f o r e admission t o and f o l l o w i n g d i s c h a r g e from h o s p i t a l . (2) R e l a t i n g s o c i a l c l a s s and the p e r i o d o f mental i l l n e s s p r i o r t o h o s p i t a l i z a t i o n , the r e s u l t s show more h i g h e r c l a s s s u b j e c t s than lower c l a s s h o s p i t a l i z e d w i t h i n a one year p e r i o d f o r p s y c h o t i c mental i l l n e s s . The f i n d i n g s o f t h i s r e s e a r c h p r o j e c t  support the s t a t e d  hypotheses, c o n f i r m the r e s u l t s shown by other s t u d i e s , opened new areas f o r f u r t h e r r e s e a r c h , and i n d i c a t e d application of findings  f o r s o c i a l work  possible  practice.  TABLE OF CONTENTS  Introduction Statement o f Hypotheses Study Design P l a n o f Data A n a l y s i s Results Discussion Summary o f F i n d i n g s Conclusion Appendix A Appendix B Bibliography  LIST OF TABLES  Page No.  Table  1.  Comparison o f e d u c a t i o n a l l e v e l s o f the t o t a l Riverview H o s p i t a l population with t h a t o f the B r i t i s h Columbia urban population  5  Table  2.  Employment b e f o r e h o s p i t a l i z a t i o n by s o c i a l class  9  Table  3.  Employment on d i s c h a r g e from h o s p i t a l by social class  10  Table  4.  Employment on d i s c h a r g e from h o s p i t a l by social class  10  Table  5.  D u r a t i o n o f i l l n e s s p r e - h o s p i t a l i z a t i o n by social class  11  Table  6.  D u r a t i o n o f i l l n e s s , p r e - h o s p i t a l i z a t i o n by s o c i a l class - psychosis  12  Table  7.  - D u r a t i o n o f i l l n e s s , p r e - h o s p i t a l i z a t i o n by s o c i a l c l a s s - sociopathology  12  Table  8.  D u r a t i o n o f i l l n e s s , p r e - h o s p i t a l i z a t i o n by s o c i a l class - neurosis  13  Table  9.  L i v i n g arrangements a t d i s c h a r g e by s o c i a l class  13  Table  2 A. Employment b e f o r e h o s p i t a l i z a t i o n by o c c u p a t i o n  i  Table  3 A. Employment on d i s c h a r g e from h o s p i t a l by occupation  i  Table  4 A. Employment on d i s c h a r g e from h o s p i t a l by occupation  i i  Table  5 A. D u r a t i o n o f i l l n e s s p r e - h o s p i t a l i z a t i o n by occupation  i i  Table  6 A. D u r a t i o n o f i l l n e s s , p r e - h o s p i t a l i z a t i o n by occupation - psychosis  i i i  Table  7 A. D u r a t i o n o f i l l n e s s , p r e - h o s p i t a l i z a t i o n by occupation - sociopathology  i i i  Table  8 A. D u r a t i o n o f i l l n e s s , p r e - h o s p i t a l i z a t i o n by occupation - neurosis ,  iv  LIST OF TABLES  (continued)  Page No. Table  9 A. L i v i n g arrangements a t d i s c h a r g e by occupation  Table  9 B. P r e - h o s p i t a l i z a t i o n l i v i n g arrangements i n c l u d i n g only higher c l a s s  Table 10.  Readmissions t o h o s p i t a l  iv v vi  ACKNOWLEDGEMENTS  The w r i t e r s would l i k e t o take t h i s o p p o r t u n i t y t o thank all  those who a s s i s t e d us i n the completion o f t h i s  research p r o j e c t .  We would p a r t i c u l a r l y  l i k e t o thank  Mrs. P a t r i c i a Tanabe, our t h e s i s a d v i s o r , f o r h e r guidance and s u p p o r t .  To those employees a t the  R i v e r v i e w H o s p i t a l who p a r t i c i p a t e d i n c o l l e c t i n g f o r t h i s study, we extend our h e a r t f e l t  thanks.  data  - 1 S o c i a l C l a s s and the P r e - h o s p i t a l i z a t i o n and P o s t h o s p i t a l i z a t i o n Experiences  o f the M e n t a l l y 111.  Introduction The r a t i o n a l e f o r t h i s study i s t w o f o l d .  If a  r e l a t i o n s h i p can be shown t o e x i s t between s o c i a l c l a s s and the  ( p r e - h o s p i t a l i z a t i o n and p o s t - h o s p i t a l i z a t i o n )  experiences o f the m e n t a l l y i l l ,  these f i n d i n g s c o u l d be  a p p l i e d e i t h e r toward the adoption o f p r e v e n t i v e measures or toward the d i f f e r e n t i a l treatment piatients.  o f the h o s p i t a l i z e d  In a d d i t i o n t o the p r a c t i c a l a p p l i c a t i o n f o r  p r e v e n t i o n and treatment,  t h i s study may r a i s e  f o r f u r t h e r Canadian r e s e a r c h .  questions  To date most r e s e a r c h  r e l a t i n g s o c i a l c l a s s and mental i l l n e s s has been done by s o c i a l s c i e n t i s t s i n the U n i t e d S t a t e s . I t i s o n l y through  the d i l i g e n t a p p l i c a t i o n o f  r e s e a r c h methods, the i n t e l l i g e n t c o l l e c t i o n , and  compilation  i n t e r p r e t a t i o n o f data t h a t r e l i a b l e i n f o r m a t i o n can  be o b t a i n e d  f o r p r a c t i c a l use by workers i n the f i e l d o f  s o c i a l work. In t h i s study,  those assumed as m e n t a l l y i l l  are those  who were h o s p i t a l i z e d a t R i v e r v i e w Mental H o s p i t a l .  This  study w i l l be a n a l y z i n g the data concerning those p a t i e n t s who were d i s c h a r g e d d u r i n g the two year p e r i o d from A p r i l 1, 1965 through March 31, 1967. A p a t i e n t ' s s o c i a l c l a s s w i l l be e v a l u a t e d i n the manner o f H o l l i n g s h e a d and R e d l i c h ' s assessment o f c l a s s s t a t u s u s i n g the v a r i a b l e s o f e d u c a t i o n and o c c u p a t i o n . (3)  - 2 I t i s assumed t h a t s o c i a l s t r a t i f i c a t i o n e x i s t s i n Canada and  can be  level.  i n d i c a t e d by  u s i n g o c c u p a t i o n a l s t a t u s and  Consequently, the o p e r a t i o n a l  combines o c c u p a t i o n a l s t a t u s and two  groups o f c o n t r a s t i n g  composed o f p a t i e n t s who o c c u p a t i o n s and  had  d e f i n i t i o n of s o c i a l c l a s s  education l e v e l .  s o c i a l class status; had  professional  To  distinguish  a higher  class  or managerial  completed grade twelve or more  u n i v e r s i t y d e g r e e s ) ^ and  educational  (including  a lower c l a s s composed of those i n  s e m i - s k i l l e d or u n s k i l l e d o c c u p a t i o n s whose completed e d u c a t i o n was  grade e i g h t or l e s s were used. Recent s t u d i e s have shown a c o r r e l a t i o n between s o c i a l c l a s s  and be  mental i l l n e s s .  However, s o c i a l c l a s s does not appear  a d i r e c t cause o f mental i l l n e s s .  purpose o f t h i s r e s e a r c h p r o j e c t  It i s  the  t o e s t a b l i s h whether there i s  a r e l a t i o n s h i p between a p a t i e n t ' s p r e - h o s p i t a l i z a t i o n and  (8 - p.248)  to  s o c i a l c l a s s and  post-hospitalization  some o f h i s  experiences.  Statement o f Hypotheses One  concern which p a t i e n t s have upon d i s c h a r g e from a  mental h o s p i t a l i s the community.  themselves i n  the  I f there i s some r e l a t i o n s h i p between the s o c i a l  c l a s s o f the p a t i e n t s one  task of r e - e s t a b l i s h i n g  studied  i n d i c a t i o n would be  concern l e a d s to the  and  a d a p t a b i l i t y i n the  that of securing  statement o f the  employment.  community, This  f i r s t main h y p o t h e s i s .  Hypothesis I - The h i g h e r the s o c i a l c l a s s of the p a t i e n t , the g r e a t e r the p r o b a b i l i t y he would be employed p r e - h o s p i t a l i z a t i o n and p o s t hospitalization .  - 3 T h i s h y p o t h e s i s was c a t e g o r i z e d  i n t o three  sub-hypotheses.  I A - The h i g h e r the s o c i a l c l a s s o f the p a t i e n t the more l i k e l y he would be employed f u l l time b e f o r e admission t o h o s p i t a l . I B -  The h i g h e r the s o c i a l c l a s s o f the p a t i e n t the more l i k e l y he would be employed f o l l o w i n g d i s c h a r g e from h o s p i t a l .  I C - The h i g h e r the s o c i a l c l a s s o f the p a t i e n t the more l i k e l y he would r e t u r n t o the same j o b upon d i s c h a r g e . These sub-hypotheses considered  f o r study were based on  the  f o l l o w i n g assumptions.  There i s a g r e a t e r  understanding  and  acceptance o f mental i l l n e s s by the h i g h e r c l a s s e s and i t  i s the h i g h e r c l a s s p a t i e n t who i s more l i k e l y t o be employed by someone o f the h i g h e r s o c i a l c l a s s . h i g h e r e d u c a t i o n have g r e a t e r there  In Canada, those w i t h  employment o p p o r t u n i t i e s .  Also,  i s l e s s p o s s i b i l i t y o f replacement o f p e r s o n n e l i n the  p r o f e s s i o n a l and managerial p o s i t i o n s than i n the u n s k i l l e d or semi-skilled positions. A second concern i s the d u r a t i o n pre-hospitalization.  o f the mental  illness  There may be a r e l a t i o n s h i p between the  s o c i a l c l a s s o f the p a t i e n t and the l e n g t h o f d e l a y  before  hospitalization. Hypothesis I I - The lower the s o c i a l c l a s s o f the p a t i e n t , the longer the d u r a t i o n o f h i s mental i l l n e s s prior to hospitalization. Higher s o c i a l c l a s s e s a r e presumably more knowledgeable o f the antecedent p a t h o l o g i c a l symptoms o f mental i l l n e s s . Witmer and Conover  (II) found t h a t there was l e s s r e c o g n i t i o n  o f p a t h o l o g i c a l symptoms than o f the subsequent symptoms.  behavioral  Assuming i t i s the lower c l a s s r a t h e r than the higher  class that f a i l  t o r e c o g n i z e p a t h o l o g i c a l symptoms, t h e i r  f i n d i n g may have been i n f l u e n c e d by i n c l u d i n g more lower than h i g h e r c l a s s s u b j e c t s i n t h e i r study.  class  Therefore, the  h i g h e r s o c i a l c l a s s would d e t e c t mental i l l n e s s e a r l i e r and, consequently,  make an e a r l i e r r e f e r r a l .  The lower  social  class  would be more d i s p o s e d t o base t h e i r r e c o g n i t i o n o f mental i l l n e s s on b e h a v i o r a l symptoms.  The lower s o c i a l c l a s s may  have a g r e a t e r t o l e r a n c e o f d e v i a n c e . not be aware o f the treatment  Furthermore, they may  f a c i l i t i e s f o r the m e n t a l l y  A f i n a l h y p o t h e s i s concerns  ill.  the s o c i a l environment t o  which a p a t i e n t r e t u r n s upon d i s c h a r g e from h o s p i t a l .  Possibly  the h i g h e r the s o c i a l c l a s s , the more c o n t a c t there would be w i t h f a m i l y and r e l a t i v e s . Hypothesis  I I I - The h i g h e r the s o c i a l c l a s s o f the p a t i e n t , the g r e a t e r the p r o b a b i l i t y he would be d i s c h a r g e d t o the home o f f a m i l y or relatives.  Moore and Benedek ( 6 ) found t h a t upper and middle p a t i e n t s were d i s c h a r g e d more o f t e n t o t h e i r f a m i l i e s .  class A  s t a b l e f a m i l y s i t u a t i o n may be l e s s a v a i l a b l e t o the lower  class  p a t i e n t upon d i s c h a r g e . Study  Design "In the p a s t , s o c i a l work r e s e a r c h has g i v e n p r i o r i t y t o  d i a g n o s t i c - d e s c r i p t i v e s t u d i e s e s s e n t i a l f o r agency a d m i n i s t r a t i v e purposes,  f o r assessment o f need and f o r communicating and  understanding  p r o f e s s i o n a l helping processes."  To a s s e s s the r e l a t i o n s h i p ,  ( 5 - p.58)  (or i t s absence) between s o c i a l  - 5 c l a s s and the p r e - h o s p i t a l i z a t i o n and p o s t - h o s p i t a l i z a t i o n experiences  o f the m e n t a l l y i l l ,  a descriptive-diagnostic  study was undertaken. The data used i n t h i s study i n c l u d e d a l l those p a t i e n t s who were d i s c h a r g e d from Riverview Mental H o s p i t a l d u r i n g the two year p e r i o d from A p r i l 1, 1965 through March 31, 1967. During  t h i s time 8,708 p a t i e n t s were d i s c h a r g e d ,  who were d i s c h a r g e d more than once.  i n c l u d i n g some  For the purpose o f the  p r e s e n t r e s e a r c h , t h i s was the most r e c e n t p e r i o d f o r which data were a v a i l a b l e .  As such,  the data a r e c o n s i d e r e d  r e p r e s e n t a t i v e o f the u s u a l p a t i e n t p o p u l a t i o n . The e d u c a t i o n a l l e v e l o f the study p o p u l a t i o n was compared w i t h t h a t o f the t o t a l B r i t i s h Columbia p o p u l a t i o n  1  t o assess  the v a l i d i t y o f the sample p o p u l a t i o n . TABLE 1 - COMPARISON OF EDUCATIONAL LEVELS OF THE TOTAL RIVERVIEW HOSPITAL POPULATION WITH THAT OF THE BRITISH COLUMBIA URBAN POPULATION. Hospital Population  Grade 0 through grade 8  N = 8708  B r i t i s h Columbia Urban P o p u l a t i o n N - 768, 811  38.53 p e r c e n t  30.98 p e r c e n t  Grade 9 through grade 11 33.66  34.34  Grade 12 and 13, some u n i v e r s i t y e d u c a t i o n or u n i v e r s i t y degree.  34.68  Not Known  1  23.51 4.30 100.00 p e r c e n t  0.00 100.00 p e r c e n t  The e d u c a t i o n a l l e v e l was taken from the Dominion Bureau o f S t a t i s t i c s , 1961 Census o f Canada.  - 6 A l t h o u g h the d i r e c t i o n o f the d i f f e r e n c e between these two p o p u l a t i o n s i s toward  lower e d u c a t i o n among the h o s p i t a l  p o p u l a t i o n , the h o s p i t a l p o p u l a t i o n does n o t d i f f e r markedly from the B r i t i s h Columbia  urban p o p u l a t i o n .  The data c o l l e c t i o n was undertaken  r o u t i n e l y by R i v e r -  view H o s p i t a l p e r s o n n e l f o r h o s p i t a l r e c o r d s , and f o r p r o v i n c i a l and  f e d e r a l s t a t i s t i c s on mental  illness.  The data were recorded on the R i v e r v i e w H o s p i t a l and Discharge S t a t i s t i c a l Sheets  (See Appendix A ) .  Admission  Items  down t o and i n c l u d i n g column t h i r t y were completed by the a d m i t t i n g nurse upon a d m i s s i o n . f i f t y were completed  Columns t h i r t y - o n e  through  by the a t t e n d i n g p h y s i c i a n w i t h i n t e n  days o f the p a t i e n t ' s a d m i s s i o n .  The d i s c h a r g e h i s t o r y ,  r e c o r d e d b y the a t t e n d i n g p h y s i c i a n , was compiled on every p a t i e n t upon d i s c h a r g e from h o s p i t a l .  Although w r i t t e n  i n s t r u c t i o n s f o r completing these forms a r e now a v a i l a b l e , a t the time o f data c o l l e c t i o n o n l y v e r b a l i n s t r u c t i o n s were given the r e c o r d e r s . S i n c e the data c o l l e c t i o n was not done by the r e s e a r c h team and was designed f o r other purposes,  s e v e r a l l i m i t a t i o n s were  inherent.  F o r those p a t i e n t s who were n o t the head o f t h e i r  household,  there was no l i s t i n g o f t h e head o f the household's  occupation.  S e v e r a l o f the r e c o r d e d o c c u p a t i o n s were combined  i n t o c a t e g o r i e s without s u f f i c i e n t regard f o r the continuum o f social class.  F i n a l l y , c a t e g o r i e s o f l i v i n g arrangements p r e -  h o s p i t a l i z a t i o n and p o s t - h o s p i t a l i z a t i o n d i d n o t completely correspond.  A g r e a t e r number o f c a t e g o r i e s o f l i v i n g arrangements  - 7 appeared on the s t a t i s t i c a l sheets a t d i s c h a r g e than a t intake. P l a n Of Data A n a l y s i s Throughout the study the independent v a r i a b l e o f s o c i a l c l a s s was  used.  W i t h i n the p r o f e s s i o n a l and managerial w i t h grade twelve  composed o f those  occupations who  those  e d u c a t i o n a l l e v e l or higher were s e l e c t e d  t o compose the h i g h e r s o c i a l c l a s s . was  occupations  had  The lower s o c i a l  class  i n the s e r a i - s k i l l e d or u n s k i l l e d  grade e i g h t e d u c a t i o n or l e s s .  Limiting  the e d u c a t i o n a l l e v e l s i n the o c c u p a t i o n a l groupings  as  indicated, insured a d i s t i n c t s o c i a l c l a s s d i f f e r e n t i a t i o n i n the sample p o p u l a t i o n . As t h e r e was  no r e c o r d o f the o c c u p a t i o n o f the head o f  the household o f some women p a t i e n t s , and o f housewife was  the  i n s u f f i c i e n t as a determinant  classification of s o c i a l  male p a t i e n t s o n l y were used i n the sample p o p u l a t i o n .  class, Those  between the ages o f twenty-one and s i x t y - f i v e o n l y were considered. age.  T h i s excluded  Only f i r s t admissions  students or those over  employment  were used t o i n s u r e t h a t t h e r e  would not be a d u p l i c a t i o n o f data by i n c l u d i n g the r e t u r n i n g patients. age and  Thus the c o n s t a n t c o n t r o l s i n t h i s study are  sex,  admission.  Hypothesis and employment.  I concerns the r e l a t i o n s h i p between s o c i a l The  sample p o p u l a t i o n was  class  male, f i r s t - a d m i s s i o n  - 8 p a t i e n t s between the ages o f twenty-one and s i x t y - f i v e . h y p o t h e s i s was d i v i d e d i n t o three Hypothesis I A - The h i g h e r  The  sub-hypotheses. the s o c i a l c l a s s , the more  l i k e l y the p a t i e n t would have been employed f u l l time p r i o r t o h i s admission t o h o s p i t a l .  The p a t i e n t ' s employment s t a t u s  p r i o r t o h o s p i t a l i z a t i o n ( f u l l time employed, v e r s u s r e g u l a r p a r t time, seasonal, compared  f o r higher  u n s e t t l e d , unemployed or r e t i r e d ) was and lower s o c i a l c l a s s e s .  Hypothesis I B -  The h i g h e r  the s o c i a l c l a s s , the more  l i k e l y the p a t i e n t would be employed f o l l o w i n g d i s c h a r g e hospital.  from  I n the sample population p a t i e n t s who d i e d i n h o s p i t a l  were e x c l u d e d .  The p a t i e n t ' s employment s t a t u s on  discharge  from h o s p i t a l (to o l d j o b , t o new j o b , or unemployed-employable) was compared  for higher  and lower s o c i a l c l a s s e s .  Hypothesis I C - The higher  the s o c i a l c l a s s , the more  l i k e l y the p a t i e n t would r e t u r n t o the same j o b on from h o s p i t a l .  I n the sample p o p u l a t i o n  discharge  those who d i e d i n  h o s p i t a l and those who were unemployed p r i o r t o h o s p i t a l i z a t i o n . The sample p o p u l a t i o n  was male, f i r s t - a d m i s s i o n p a t i e n t s  between the ages o f twenty-one and s i x t y - f i v e .  This  population  was d i v i d e d i n t o three d i a g n o s t i c c a t e g o r i e s :  (1) p s y c h o t i c  a f f e c t i v e psychosis,  (2) s o c i o p a t h i c -  schizophrenic  psychosis,  -  a n t i s o c i a l and immaturity r e a c t i o n s , p e r s o n a l i t y p a t t e r n disturbances,  and p e r s o n a l i t y t r a i t d i s t u r b a n c e s ,  - phobic and a n x i e t y r e a c t i o n s , d e p r e s s i v e compulsive r e a c t i o n s , h y s t e r i c a l r e a c t i o n s .  and  reactions, Duration  (3) n e u r o t i c obsessiveof  - 9 i l l n e s s p r i o r t o admission  ( l e s s than or g r e a t e r  than one year)  was compared f o r h i g h e r  and lower s o c i a l c l a s s e s w i t h i n each  o f the three d i a g n o s t i c  categories.  Hypothesis I I I  concerns the r e l a t i o n s h i p between  c l a s s and c o n t a c t w i t h f a m i l y and r e l a t i v e s .  social  The h i g h e r the  s o c i a l c l a s s , the more l i k e l y the p a t i e n t would be d i s c h a r g e d t o the home o f h i s f a m i l y o r r e l a t i v e s .  The sample  population  was male, f i r s t - a d m i s s i o n p a t i e n t s , between the ages o f twentyone and s i x t y - f i v e .  L i v i n g arrangements on d i s c h a r g e  (separate  l i v i n g , i n s t i t u t i o n a l l i v i n g , or l i v i n g w i t h f a m i l y or r e l a t i v e s ) were compared f o r h i g h e r  and lower s o c i a l c l a s s e s .  Results. Hypothesis I A TABLE 2 - EMPLOYMENT BEFORE HOSPITALIZATION F u l l employment p r i o r t o admission  BY SOCIAL  Not f u l l y employed p r i o r t o admission  CLASS. TOTAL  Higher Class  46 (58.97%)  Lower Class  32 (41.03%)  78  130 (19.14%) 544 (80.86%) 674 The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The c a t e g o r y "not f u l l y employed p r i o r t o admission" i n c l u d e s r e g u l a r p a r t time employment, seasonal employment, u n s e t t l e d , unemployed, and r e t i r e d . F i f t y - n i n e percent  nineteen  percent  o f the p a t i e n t s i n the h i g h e r  c l a s s and  o f the p a t i e n t s i n the lower c l a s s were employed  - 10 on a f u l l time b a s i s p r i o r t o admission. Hypothesis  I B  TABLE 3 - EMPLOYMENT ON DISCHARGE FROM HOSPITAL BY SOCIAL CLASS. :  Employed on discharge  Unemployed on discharge  TOTAL  Higher Class  50 (67.57% )  Lower Class  241 (41.80%)  24 (32.43%)  74  271 (58.20%)  512  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty one and s i x t y f i v e . Those who d i e d i n h o s p i t a l were excluded. S i x t y - s e v e n p e r c e n t o f the p a t i e n t s i n the h i g h e r and  class  f o r t y - t w o p e r c e n t o f the-patients- i n the lower c l a s s were  employed upon d i s c h a r g e from h o s p i t a l . Hypothesis  I C  TABLE 4 - EMPLOYMENT ON DISCHARGE FROM HOSPITAL BY SOCIAL CLASS Returned t o old job  Went t o new j o b  Unemployed a f t e r discharge  TOTAL  Class  37 (75.60%)  3 (6.00%)  9 (18.40%)  49  Lower Class  86 (54.00%)  17 (10.70%)  56 (35.30%)  159  Higher  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . Those who d i e d i n h o s p i t a l and those whoe" were unemployed p r i o r t o h o s p i t a l i z a t i o n were excluded. S e v e n t y - s i x p e r c e n t o f the p a t i e n t s i n the h i g h e r c l a s s and  - 11 f i f t y - f o u r p e r c e n t o f the p a t i e n t s i n the lower c l a s s r e t u r n e d to t h e i r o l d j o b upon d i s c h a r g e from h o s p i t a l . S i x percent o f the p a t i e n t s i n the h i g h e r c l a s s and eleven p e r c e n t o f the p a t i e n t s i n the lower c l a s s went to a new j o b upon d i s c h a r g e from h o s p i t a l . E i g h t e e n p e r c e n t o f the p a t i e n t s i n the h i g h e r c l a s s and t h i r t y - f i v e p e r c e n t o f the p a t i e n t s from the lower c l a s s were unemployed upon d i s c h a r g e .  The i n d i c a t i o n s are the h i g h e r the  c l a s s the more l i k e l y the p a t i e n t w i l l be employed upon d i s c h a r g e . The t r e n d i s s i m i l a r t o t h a t i n h y p o t h e s i s I B. Hypothesis I I TABLE 5 - DURATION OF ILLNESS PRE-HOSPITALIZATION BY SOCIAL  Higher Class Lower Class  Duration l e s s than one year  D u r a t i o n more than one year  TOTAL  46  (59.75%)  31  (40.25%)  77  287  (47.21%)  321  (52.89%)  608  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . S i x t y p e r c e n t o f the p a t i e n t s i n the h i g h e r c l a s s and f o r t y seven p e r c e n t o f the p a t i e n t s i n the lower c l a s s were w i t h i n a years d u r a t i o n o f i l l n e s s .  admitted  CLASS.  - 12 TABLE 6 - DURATION OF ILLNESS, PRE-HOSPITALIZATION BY SOCIAL CIASS-PSYCHOSIS . ; Duration l e s s than one year Higher Class Lower Class  11  (91.65%)  167  (50.31%)  D u r a t i o n more than one year  TOTAL  1 (8.35%) 165  (49.69%)  12 332  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The sample p o p u l a t i o n i n c l u d e d the a f f e c t i v e p s y c h o s i s and s c h i z o p h r e n i c p s y c h o s i s . Ninty-two p e r c e n t  o f the p s y c h o t i c p a t i e n t s i n the h i g h e r  c l a s s and f i f t y p e r c e n t o f the p a t i e n t s i n the lower c l a s s were h o s p i t a l i z e d w i t h i n a years d u r a t i o n o f i l l n e s s . TABLE 7 - DURATION OF ILLNESS, PRE-rHOSPITALIZATION CIASS-SOCIOPATHOLOGY. Duration l e s s than one year Higher Class Lower Class  D u r a t i o n more than one year  BY  SOCIAL  TOTAL  7  (29.16%)  17  (70.84%)  24  78  (40.21%)  116  (59.79%)  194  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The sample p o p u l a t i o n i n c l u d e d a n t i - s o c i a l and immaturity r e a c t i o n s , p e r s o n a l i t y p a t t e r n d i s t u r b a n c e s , and p e r s o n a l i t y t r a i t d i s t u r b a n c e s . The i l l n e s s o f seventy-one p e r c e n t o f the s o c i o p a t h i c p a t i e n t s in  the h i g h e r c l a s s and s i x t y p e r c e n t o f the p a t i e n t s i n the lower  c l a s s continued  f o r more than one year p r i o r t o h o s p i t a l i z a t i o n .  - 13 TABLE 8-DURATION OP ILLNESS, PRE-HOSPITALIZATION BY SOCIAL CLASS-NEUROSIS . TOTAL  D u r a t i o n more than one year  Duration l e s s than one year Higher Class  17  (73.91%)  6  (26.09%)  23  Lower Class  76  (53.15%)  67  (46.85%)  143  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The sample p o p u l a t i o n i n c l u d e d phobic and a n x i e t y r e a c t i o n s , d e p r e s s i v e r e a c t i o n s , obsessive-compulsive reactions," h y s t e r i c a l r e a c t i o n s . Seventy-four p e r c e n t o f the n e u r o t i c p a t i e n t s i n the h i g h e r c l a s s and f i f t y - t h r e e p e r c e n t o f the p a t i e n t s i n the lower c l a s s were h o s p i t a l i z e d w i t h i n a years d u r a t i o n o f i l l n e s s . Hypothesis I I I TABLE 9-LIVING ARRANGEMENTS AT DISCHARGE BY SOCIAL To f a m i l y  Higher Class Lower Class  54, (65.36%) 372  (50.41%)  To separate living arrangement 1  (1.20%)  27  (3.66%)  CLASS.  To institution  28 (33.44%) 339  (45.94%)  TOTAL  83 738  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . Family includes with parents, with s i b l i n g s , with spouse, w i t h a d u l t c h i l d r e n , w i t h other r e l a t i v e s . I n s t i t u t i o n i n c l u d e s p r i v a t e h o s p i t a l or n u r s i n g home, b o a r d i n g or f o s t e r home, p e n a l i n s t i t u t i o n , mental h e a l t h i n - p a t i e n t , out o f p r o v i n c e h o s p i t a l .  - 14 S i x t y - f i v e p e r c e n t o f the p a t i e n t s i n the h i g h e r c l a s s and f i f t y p e r c e n t o f the p a t i e n t s i n the lower  c l a s s were d i s c h a r g e d  t o the home o f f a m i l y or r e l a t i v e s . One p e r c e n t o f the p a t i e n t s i n the h i g h e r c l a s s and three p e r c e n t o f the p a t i e n t s i n the lower c l a s s were d i s c h a r g e d t o separate l i v i n g  accommodations.  T h i r t y - f o u r p e r c e n t o f the p a t i e n t s i n the h i g h e r and  f o r t y - s i x p e r c e n t o f the p a t i e n t s - i n the lower  proceeded t o another  class  class  i n s t i t u t i o n upon d i s c h a r g e .  D j , s c u g s A o n  The  t r e n d s t h a t emerged from the analyzed data  a number o f t h i n g s .  That more people  suggest  i n the h i g h e r c l a s s appear  to be employed both p r i o r t o and a f t e r d i s c h a r g e from h o s p i t a l may mean t h a t t h e r e a r e more j o b s a v a i l a b l e f o r those h i g h e r e d u c a t i o n , an i n d i c a t i o n o f h i g h e r The  with  class.  t r e n d o f more h i g h e r c l a s s people r e t u r n i n g t o t h e i r  o l d j o b a f t e r d i s c h a r g e might be r e l a t e d t o h i g h e r " c l a s s people having more s k i l l s and hence, b e i n g l e s s d i s p e n s a b l e i n t h e i r jobs, regardless o f t h e i r past  illness.  In both s o c i a l c l a s s e s few people o b t a i n e d new j o b s on d i s c h a r g e from h o s p i t a l .  T h i s might be r e l a t e d t o t h e i r  having  to d i v u l g e t h e i r h i s t o r y o f mental i l l n e s s t o the p r o s p e c t i v e employer, which may a f f e c t t h e i r chances o f o b t a i n i n g new employment. The data s t u d i e d r e g a r d i n g h y p o t h e s i s I suggest  subjects  - 15 from the h i g h e r c l a s s tend t o be employed b e f o r e and a l s o a f t e r d i s c h a r g e from h o s p i t a l .  admission  The h i g h e r c l a s s  s u b j e c t s a l s o r e t u r n e d t o t h e i r o l d j o b s more than the lower class.  The f a c t t h a t few people o b t a i n e d new jobs on d i s c h a r g e  from h o s p i t a l , r e g a r d l e s s o f c l a s s , supports the p o s s i b i l i t y t h a t those i n the h i g h e r c l a s s have more c o n n e c t i o n s w i t h p a s t a s s o c i a t i o n s , and u t i l i z e these r e s o u r c e s i n the community when d i s c h a r g e d from Regarding  hospital.  h y p o t h e s i s I I , without t a k i n g i n t o account the  d i a g n o s i s , i t was found t h a t h i g h e r c l a s s p a t i e n t s were more l i k e l y than lower c l a s s p a t i e n t s t o be h o s p i t a l i z e d w i t h i n a year o f the onset o f t h e i r mental i l l n e s s .  To account  for this  s l i g h t t r e n d towards e a r l i e r h o s p i t a l i z a t i o n among the h i g h e r c l a s s one might assume t h a t t h e r e i s l e s s r e c o g n i t i o n o f mental i l l n e s s or g r e a t e r t o l e r a n c e o f deviance, amont} the lower  class.  For the l a t t e r , r e f e r r a l i s l a t e r , a f t e r the i l l n e s s has p r o g r e s s e d f o r some time.  Taking o n l y those f o r t y p e r c e n t i n  the h i g h e r c l a s s whose i l l n e s s had continued f o r more than one year b e f o r e h o s p i t a l i z a t i o n i t i s p o s s i b l e t h a t some were r e c e i v i n g treatment  from other r e s o u r c e s , such as p r i v a t e  p s y c h i a t r y o r mental h e a l t h c l i n i c s ,  the use o f which may be  l e s s f o r lower c l a s s p a t i e n t s , e s p e c i a l l y s i n c e knowledge and acceptance  o f mental i l l n e s s i s l e s s among the lower c l a s s .  might account  f o r the d i f f e r e n c e i n d u r a t i o n o f i l l n e s s p r e -  hospitalization . By c o n s i d e r i n g the t o t a l number o f p a t i e n t s f a l l i n g  into  This  - 16 each d i a g n o s t i c category,  there appears t o be a h i g h e r i n c i d e n c e  o f p s y c h o s i s than n e u r o t i c or s o c i o p a t h i c p e r s o n a l i t y d i s o r d e r among the lower c l a s s than among the h i g h e r .  This finding  i s c o n s i s t e n t w i t h those o f H o l l i n g s h e a d and R e d l i c h . (3) Among the h i g h e r c l a s s , h o s p i t a l i z a t i o n f o r p s y c h o s i s takes p l a c e much e a r l i e r than among the lower c l a s s .  The h i g h e r  c l a s s e s may f e e l t h a t Rlverview i s a more a p p r o p r i a t e s e t t i n g f o r the treatment  o f p s y c h o s i s and, t h e r e f o r e , they do not  d e l a y admission by r e f e r r i n g the p a t i e n t t o p r i v a t e p s y c h i a t r i s t s or mental h e a l t h c l i n i c s . From the f i n d i n g s , p a t i e n t s , - p a r t i c u l a r l y i n the h i g h e r c l a s s , s u f f e r i n g from s o c i o p a t h i c p e r s o n a l i t y d i s o r d e r s are u n l i k e l y t o be admitted d u r a t i o n o f the i l l n e s s .  t o the h o s p i t a l u n t i l a f t e r a year's The symptoms o f s o c i o p a t h o l o g y may be  hard t o d e t e c t and s o c i o p a t h s are u n l i k e l y t o r e f e r f o r treatment.  Perhaps lower c l a s s s o c i o p a t h s are c o n f i n e d  more o f t e n i n c o r r e c t i o n a l i n s t i t u t i o n s and r e f e r r e d there f o r p s y c h i a t r i c treatment. earlier,  themselves  from  S i n c e p s y c h o t i c s are r e f e r r e d  there may be an i n d i c a t i o n t h a t those d i s p l a y i n g  s o c i o p a t h i c symptomatology are t o l e r a t e d more r e a d i l y i n the community. In c o n t r a s t t o the long d u r a t i o n o f i l l n e s s b e f o r e i  h o s p i t a l i z a t i o n f o r s o c i o p a t h s , n e u r o t i c s ( e s p e c i a l l y the higher c l a s s ) a r e more l i k e l y t o be h o s p i t a l i z e d w i t h i n a year's d u r a t i o n . Presumably there i s b e t t e r understanding  o f the symptoms o f  n e u r o s i s and Riverview i s seen as an a p p r o p r i a t e source o f  - 17 treatment. illness,  Perhaps more than In any other type o f mental  i t i s the n e u r o t i c p a t i e n t who seeks treatment  a f t e r becoming  shortly  ill.  I f p u b l i c e d u c a t i o n about mental h e a l t h more f r e q u e n t l y reaches the h i g h e r - c l a s s ,  they are p r o b a b l y more c o n s c i o u s  o f R i v e r v i e w as a r e s o u r c e f o r treatment and so make a r e f e r r a l d i r e c t l y through  t h e i r p h y s i c i a n or p s y c h i a t r i s t .  a c e r t a i n i n i t i a t i v e on t h e i r p a r t .  This implies  The lower c l a s s may be  l e s s knowledgeable about the r e s o u r c e , and thus r e q u i r e an i n t e r m e d i a r y agency t o make r e f e r r a l . Proceeding t o h y p o t h e s i s I I I , i t was found  that higher  c l a s s p a t i e n t s more f r e q u e n t l y than lower c l a s s p a t i e n t s were d i s c h a r g e d t o t h e i r f a m i l y .  T h i s confirms the f i n d i n g s  o f Moore and Benedek. (6) W i t h i n both c l a s s e s , b u t p a r t i c u l a r l y the h i g h e r c l a s s , s l i g h t l y more e x - p a t i e n t s were l i v i n g witht h e i r f a m i l i e s r a t h e r than on t h e i r own or i n i n s t i t u t i o n s .  If  the lower c l a s s i n g e n e r a l r e f l e c t s a h i g h e r i n c i d e n c e o f institutionalization^  then the p r e s e n t r e s u l t s concerning the  m e n t a l l y - i l l corresponds w i t h t h i s d i s t r i b u t i o n . seem the h o s p i t a l attempts  I t would  t o discharge i t s p a t i e n t s to families  where p o s s i b l e , and h i g h e r c l a s s p a t i e n t s are more l i k e l y t o have a more s t a b l e f a m i l y group. Very  few p a t i e n t s a r e discharged t o separate  living  arrangements, which may suggest t h a t the h o s p i t a l d i s c o u r a g e s independent  l i v i n g f o r ex-mental p a t i e n t s , and r e f e r s the  p a t i e n t t o some group w i t h i n the community.  This further  confirmed the r e s u l t s o f Table 8 (b) i n Appendix B, showing l i v i n g arrangements o f the upper c l a s s p a t i e n t s p r e - h o s p i t a l i z a t i o n  - 18 Many more i n d i v i d u a l s entered h o s p i t a l from separate arrangements than were r e l e a s e d t o a s i m i l a r l i v i n g  living situation.  Perhaps many o f those without f a m i l i e s were r e f e r r e d  on  d i s c h a r g e t o i n s t i t u t i o n a l l i v i n g , e s p e c i a l l y "group l i v i n g " . In Appendix B, Tables 1  (a) through 8  (a) demonstrate  the p e r c e n t o f s u b j e c t s f a l l i n g i n t o each c a t e g o r y when c l a s s d i s t i n c t i o n s are made on o c c u p a t i o n alone and the t o t a l range of educational l e v e l i s included. r e l a t i v e l y unchanged  S i n c e the r e s u l t s remain  (apart from the f a c t t h a t the d i f f e r e n c e s  between h i g h e r and lower c l a s s e s become s l i g h t l y s m a l l e r ) i t can be assumed t h a t i n Canada o c c u p a t i o n and e d u c a t i o n a l l e v e l s correspond,  so t h a t one or the other may  social class.  be an index o f  John P o r t e r s t a t e s i n "The V e r t i c a l  Mosaic:"  "As suggested e a r l i e r e d u c a t i o n a l and o c c u p a t i o n a l l e v e l s are h i g h l y c o r r e l a t e d ; t h a t i s , people who have l i t t l e e d u c a t i o n are not l i k e l y t o have h i g h c l a s s p o s i t i o n s as measured by o c c u p a t i o n . " (9 - p.155) The data i n Table 10  (See Appendix B) i n d i c a t e t h a t  r e g a r d l e s s of s o c i a l c l a s s ,  fewer n e u r o t i c s are re-admitted  t o _ h o s p i t a l than p s y c h o t i c s or s o c i o p a t h s .  Interpretation  o f t h i s f a c t might be t h a t n e u r o t i c symptoms are more a c c e p t a b l e i n the community. Summary o f F i n d i n g s . From- t h e p r e c e d i n g d i s c u s s i o n , s e v e r a l major f i n d i n g s were e v i d e n t concerning s o c i a l c l a s s and mental i l l n e s s w i t h i n  - 19 the h o s p i t a l p o p u l a t i o n sampled.  Only those d i f f e r e n c e s o f t  f i f t e e n p e r c e n t o r more between the h i g h e r and lower c l a s s e s a r e noted  social  here.  B r i e f l y s t a t e d , these f i n d i n g s are as f o l l o w s : 1 - The h i g h e r c l a s s s u b j e c t s were more l i k e l y t o be employed p r i o r t o h o s p i t a l i z a t i o n and f o l l o w i n g d i s c h a r g e the lower  than  c l a s s s u b j e c t s . ( T h i r t y - n i n e percent more h i g h e r  than lower  class).  2 - The-higher  c l a s s s u b j e c t s were more l i k e l y t o be  employed f o l l o w i n g d i s c h a r g e from h o s p i t a l than the lower subjects.  class  (Twenty-six  class  p e r c e n t more h i g h e r c l a s s than lower  class).  3 - The h i g h e r c l a s s s u b j e c t s were more l i k e l y t o r e t u r n t o t h e i r o l d j o b s f o l l o w i n g d i s c h a r g e from the h o s p i t a l than the lower c l a s s s u b j e c t s . (Twenty-one p e r c e n t more h i g h e r than lower  class  class).  4 - The h i g h e r c l a s s s u b j e c t s were l e s s l i k e l y t o be unemployed f o l l o w i n g d i s c h a r g e from the h o s p i t a l than the lower c l a s s s u b j e c t s . (Seventeen  p e r c e n t more o f the lower  unemployed f o l l o w i n g d i s c h a r g e than the h i g h e r  c l a s s were  class).  5 - The h i g h e r c l a s s s u b j e c t s were more l i k e l y t o be admitted class.  t o h o s p i t a l w i t h i n a one year p e r i o d than the lower  (Twenty-three p e r c e n t more o f the h i g h e r c l a s s were  admitted  t o h o s p i t a l within a years duration o f t h e i r  illness).  6 - The h i g h e r c l a s s s u b j e c t s were more l i k e l y t o be h o s p i t a l i z e d w i t h i n a one year p e r i o d f o r p s y c h o t i c i l l n e s s  - 20 than the lower  c l a s s s u b j e c t s . (Forty-two p e r c e n t more o f the  h i g h e r c l a s s were h o s p i t a l i z e d f o r p s y c h o t i c i l l n e s s b e f o r e t h e i r mental i l l n e s s had progressed beyond one year than the lower  class) . 7 - The h i g h e r c l a s s s u b j e c t s were more l i k e l y t o be  h o s p i t a l i z e d w i t h i n a one year p e r i o d f o r n e u r o t i c i l l n e s s the lower c l a s s subjects.(Twenty-one  than  p e r c e n t more o f the higher  c l a s s were h o s p i t a l i z e d f o r n e u r o t i c i l l n e s s b e f o r e  their  mental i l l n e s s had p r o g r e s s e d beyond one year than the lower class) . 8 - The h i g h e r c l a s s s u b j e c t s were more l i k e l y t o be d i s c h a r g e d t o the home o f f a m i l y o r r e l a t i v e than the lower class.  ( F i f t e e n p e r c e n t more o f the h i g h e r c l a s s were d i s c h a r g e d  to the home o f f a m i l y or r e l a t i v e than the lower c l a s s . ) qoncluslQn,s These f i n d i n g s c o n f i r m the o r i g i n a l e x p e c t a t i o n s o f t h i s research p r o j e c t .  I t i s found t h a t there i s a h i g h e r  f o r the h i g h e r c l a s s t o beenployed f o l l o w i n g d i s c h a r g e from h o s p i t a l .  b e f o r e admission  probability  t o and  The assumption i s t h a t the  h i g h e r c l a s s have more access t o employment because o f t h e i r e d u c a t i o n a l background, and more understanding o f mental i l l n e s s . and acceptance  Whether indeed,  and acceptance  there i s more  understanding  o f mental i l l n e s s i n the h i g h e r s o c i a l c l a s s e s  than i n the lower  s o c i a l c l a s s e s c o u l d w e l l be a t o p i c f o r  f u r t h e r study and r e s e a r c h . More o f the h i g h e r c l a s s s u b j e c t s were h o s p i t a l i z e d w i t h i n  - 21 a one  year p e r i o d  there  i s more t o l e r a n c e  c l a s s e s , and  -  f o r p s y c h o t i c mental i l l n e s s .  o f p s y c h o t i c b e h a v i o r among the  a topic for further  This finding also  research.  Since d i f f e r e n c e s i n the h i g h e r c l a s s and regarding  lower  l e s s l i k e l i h o o d t h a t they w i l l be h o s p i t a l i z e d  upon f i r s t demonstrating t h i s b e h a v i o r . c o u l d be  Presumably  awareness and  lower c l a s s  a c c e p t a b i l i t y o f mental i l l n e s s were  suggested, these should be h o s p i t a l i z e d p a t i e n t s and  considered outpatients.  i n the treatment o f Various  articles  suggest a d i f f e r e n c e i n v a l u e o r i e n t a t i o n between s o c i a l The  classes.  s o c i a l worker i n v o l v e d i n treatment w i t h p a t i e n t s i n  mental h o s p i t a l s should be aware o f these d i f f e r e n c e s i n v a l u e s and  the consequent d i f f e r e n c e s i n t o l e r a n c e  of deviant-behavior.  These d i f f e r e n c e s have i m p l i c a t i o n f o r the assessment, and  treatment o f h i g h e r and  h o s p i t a l , and  lower c l a s s p a t i e n t s i n a mental  f o r those treated, on an o u t p a t i e n t  A means o f l e s s e n i n g  basis.  the number o f admittances to mental  h o s p i t a l s i s through a program o f community e d u c a t i o n mental i l l n e s s .  diagnosis  regarding  A concerted e f f o r t i n t h i s d i r e c t i o n could  r e s u l t i n treatment b e i n g given  i n the community b e f o r e  the  i l l n e s s reaches the p o i n t where i n s t i t u t i o n a l care i s necessitated. Through r e s e a r c h can be r e a l i z e d and research.  The  techniques the s o l u t i o n s t o these problems  applied i n practice.  The  first  second step i s a p p l i c a t i o n o f the  step,is  research  f i n d i n g s i n a c t u a l p r a c t i c e , w i t h i n d i v i d u a l s , groups communities.  and  - 22 -  T h i s r e s e a r c h p r o j e c t has confirmed e x i s t i n g r e s e a r c h f i n d i n g s , uncovered  some new problems,  and suggested the  r e l e v a n c e and a p p l i c a b i l i t y o f these f i n d i n g s i n s o c i a l work practice.  Appendix THIS  IS  A T O  C E R T I F Y  H O S P I T A L ' - 6  H O S P ,  ON  T H E  T H A T D A T E  T H E  U N D E R M E N T I O N E D  SHOWN  WAS  A D M I T T E D  To  NO.  T O  THIS  B E L O W : •iOC . 1 N 3 U H . N O .  1ST AD M . CiVCN  S A MC. 3  lW C  ~)  i  MO. 14-18  D  11-13  A.  i  7  A I L I T A f i V NO .  DAT W .C . S .  AD0KCS3  NO. D»ITfS-| C O L U U l l A  1 8-20 AGK  DATE  or  BIRTH  | 2 l  MARITAL  ST. [oQnn  CAN.  Y« . TO  22-23 Y R . T O C A N .  0 .C .  i N C IA N  2  4-2B R £ L f C ION 2 ©  27 O C C U P . E T .  OCCUPATION  28  SCHOOL  2 0  METHOD  NO.  AODSK 00  M E N T A L  H E.3PONS I B I L T Y  AOM.  NO.  D E P A R T M E N T A N D  O.V.A. ON  H E A L T H  SERVICES  OF  H E A L T H  HOSPITAL  INSUHANCS;  RIVERV1EW H O S P I T A L  F.A.  E S S O N O A L S . FAMILY  PHONI  P H Y 8 IC I A N  RtFIRNINC  PHYSICIAN  NEXT  PHONE  NO.  PHONE  NO.  BRANCH SERVICES  S.C .  OF KIN  1 1 1 PRIVATE  COL. 30 SOURCE OF ADMISSION  1 PSYCH.  1 4  PHYSICIAN  UNIT - G E N E R A L  j 7 1 MENTAL HOSPITAL  C O L . 31 WAS P R E V I O U S LY UNDER C A R E OR A D M I T TED TO:  CD | 4  [ AFTER  CARE  1 8  j OTHER  (SPECIFY)  '  1 MENTAL  N O . OF  1 6 | PRIVATE  CLINIC  I  OF  I P S Y C H . UN IT GEN. HOSP.  12  ] 1 —2  I 5  |5-6  ! 1 1 NOT S T A T E D  12  1 SEXUAL  FACTOR:  | 4  | PREGNANCY  1 5  j PHYSICAL  ILLNESS  1 7  | PARENT  j 6  1 OTHER:  (SPECIFY)  1 0  | NOT K N O W N  CDs  WEEKS  O ; NOT  34 OF  3  RESIDENCE:  TIMES  jWITH  E  | 1 I UNDER  -  4 MONTHS  PROBLEM  APPLICABLE  WITH  j 3-4  EPISODES PSYCH.  WEEKS  7MOS.-1  1 7  CHILDREN  | GROUP  YR.  I OVER  I  YR.  CD EORM PSLCOHYOMOELN TP,R OUBNLEEMMP L O Y M E N T  MARITAL  CD CD LE OA TS HE  CD W ITH  PARENT  OR  ILLNESS  S I B L I NGS  [ 5 1 WITH OTHER  CHILDREN  LIVING  j 3 I OR  OF  REALITIVE  PRIVATE  LIVING INFANT  UNIT  m  OR  ! •» | W I T H A D U L T  ,„,,,-  jOTHER  [~3  MONTHS  HO. OF MENTAL HEALTH  ——  1 6  NO. OF T IMES-  WEEKS  [ 1 1 WITH  SPOUSE  SEPARATE OR  1 WK.  HOSPITAL  1  3  EPISODES .  "  MENTAL  _  NO.  PRIVATE PSYCH.  1  1MENTAL HEALTH CENTRE  1 3  1 S  HOSPITAL  PRECIPITATING  NATURE  I 5  rj-]  NONE  INSTITUTION  l  33  COL.  INPATIENT  I PENAL  PUBLIC  COL. 32 DURATION OF ILLNESS BEFORE ADMISSION:  COL.  -  HOSP.  I 2  RELATIV  HOSP.  NURSING  r^n '  HOME  BOARDING  OR  ' FOSTER HOME  OBSERVED MENTAL STATUS [ T ~ | N O R M A L AND  CD  FLATTENED  CD  C O L . 35  IjM  AFFECT  14  COL.  ANXIOUS  . DEPRESSED L§J  WITHOUT  OF  THOUGHT  1 EUPHORIC WITH  MOTOR ACTIVITY  I 2  BIZARREJ  I SEN'SORIUM  i3  | SLOW  I 4  ) INADEQUATE  OF  COL.  39  SEHAVIOUR  l~2~l  '  jSEXUAL 1  ABERRATION  (OBSERVED) L A C K OF  INITIATIVE  CONDITIONS  48-49 : EPILEPSY  Li_J  M E N T A L  40  [TJ  N O R M A L  [7] D I S O R I E N T A T E D  R E T A R D A T I O N  OR  MORE  ANTI-SOCIAL  CD r^T  |3J  0 07 -  ADM1SS.I0H S T M I S T I C A L  SHEET  PHOBIAS  HELLUCINATIONS  ORIENTATION  4 2 - 4 5  'I  | OBSESSIONS ,  SOMATIO COMPLAINTS . ETC n r ~ | D E L U S ION A N D  COL.  DIAGNOSTIC IMPRESSION  COL.  I 4  MIXED  CD  \ ~  COL.  l~3~] H AELO LC UC U IN PR PA I ETDE D W I T H  ONE  BIZARRE  OTHER SIGNIFICANT  1 D E L U S IONAL  T H H7 T C OOL .U G 3  3 fit 4  AGGRESSIVE  ABNORMALITY  CONTENT CLOUDED  [ 1 j C O M P U L S IVE  | O V E R A C T IVE  I'D  | D I S C O N N E C T E D OR SPEEDED  r—>  1 6 | C O M B I N A T ION  1 1 [ NORMAL  38  I 4 CD  I S  OR  12  SLOWED  SUICIDAL  TENDENCIES  COL.  NO  36  STREAM  | INAPPROPR IATE  I S  CD  I 1 ! NORMAL  APPROPRIATE  COL.  41  MEMORY  i 1 I INTACT  G O  IMPAIRED  IN  S P H E R E S  STATISTICAL SHEET  (DISCHARGE)  fSVERVIE'V/ HOSP!TAL, _  HOSP. NO.  SUHNAMC  E5,SOH0ALE  iiNS*Tif. NO.  i  CONFIRMED DIAGNOSIS COL.  42-45  OTHER SIGNIFICANT CONDITIONS  LD  COU_5.0_.  f i l  EPILEPSY  MENTAL  RETARDATION  DO  BOTH  CD  N O  LD  Y E S  [ £ j  N E I T H E R  TREATMENT DRUGS  COL. 51  COL.  COL.  5 2  PHENOTHIA,  LD  OTHER  LD  NO T R A N Q U I L I Z E R S  LD LD LD  MONO-AMINO-OXIDASE  «ES  COL.  TRANQUILIZERS  OTHER NO  INHIBITORS  [Tl  YES  55  | 1 | NO OTHER SPECIFIC THERAPY  THERAPIES  DRUGS  COL.  ANTICONVULSANTS DRUGS FOR P H Y S I C A L OTHER  56  DISORDERS  (SPECIFY)  1 HOME  |2 |  SOMNOLENT INSULIN  |3 I  LOBOTOMY  i4 |  COMBINATION OF ( ] ) AND ( 2 )  & TRANS LEVEL  PHENOTHI AZINE  OF  i z d  TRANQUILIZERS  IMPROVEMENT  LD  NOT APPLICABLE  LD  SYMPTOMS P R E S E N T - U N C O N T R O L L E D  LD  SYMPTOMS P R E S E N T - C O N T R O L L E D  59  MONO-AMINO-OXIDASE INHIBITORS  60  OTHER ANTIDEPRESSANTS  LD  S Y M P T O M F R E E - NO INSIGHT  61  OTHER  LD  SYMPTOM F R E E - P A R T I A L INSIGHT  WEDICAL  18 I  REFERRAL 63  LIVING ARRANGE-' MENTS 65-M  NOT  COL.  LD  APPLICABLE  LD  I t | NONE i2 |  SOCIAL  LD  FAMILY  frO j  PRIVATE  1031  NOT  JOI j [C5]  LD  AGENCY  r=-| |8 |  DOCTOR  OF  SEPARATION 67  ,  .  jt I  CAUSE OF DEATH | [ C O L . 75 - 7 3  AFTER CLINIC MENTAL CENTRE  H O M E WITH  H O M E WITH  L  EMPLOYMENT  | 0 I  STATUS  CARE HEALTH  COL,  NOT  13  64  j  G E N E R A L HOSP -IN-PATIENT  2  j  1  I 3 I  WITH O T H E R  APPLICABLE  ON M E D I C A L  ADVICE  62  APPLICABLE  TO OLD T O N EW  ,  PARENTS  fgSj  JOB  ,  [2[  CHILDREN AGAINST  .MEDICAL ADVICE  RELATIVES  OROUP .  CHILDREN)  LIVING  PRIVATE HOSPITAL  STUDENV  JOB  LD  NURSING HOME  |03|  B O A R D I N G OR F O S T E R  DEATH  UNEMPLOYABLE  {•jQj PENAL INSTITUTION MENTAL HEALTH IN-PATIENT jl2| OUT-OF-PROVINCE HOSPITAL  OR  [S3]  |3 |  HOUSEWIFE  . , UNEMPLOYED £ | EMPLOYABLE  RETIRED  L I V I N G OR  (WITH I N F A N T  |Q?1  SPOUSE  .  . SEPARATE  OR M O R E  pTl  PSYCHIATRIST  L I V I N G WITH A D U L T NATURE  OTHER HOSPITAL -IN-PATIENT  H O M E WITH S I B L I N G S  JCOJ  COL.  COL.  OTHER NO O T H E R  OTHER  COL.  NO  ANTI-DEPRESSANTS  MEDICATION  COL.  rn  THERAPY  ANTI-DEPRESSANTS  DISCHARGE C O L . 57  54  GROUP  LD LD LD LD  5 3  E. C . T .  LD  DATE OF DISCHARGE OR D E A T H C O L . &&-7@  Rlfi  NOT KNOWN  HOME DURATION |OF STAY I  COL-  71 - 74 AUTOPSY  MKO  ~3C  (541)  - i Appendix B The f o l l o w i n g t a b l e s correspond w i t h t a b l e s 2 through 9 but i n c l u d e a l l l e v e l s o f e d u c a t i o n . Hypothesis I TABLE 2 A - EMPLOYMENT BEFORE HOSPITALIZATION F u l l employment p r i o r t o admission P r o f e s s i o n a l and managerial S k i l l e d and unskilled  BY OCCUPATION  Not f u l l y employed p r i o r t o admission  TOTAL  84  (60.86%)  54  (39.14%)  138  266  (21.00%)  990  (79.00%)  1256  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The category"not f u l l y employed p r i o r t o admission" i n c l u d e s r e g u l a r p a r t - t i m e employment, seasonal employment, u n s e t t l e d , unemployed, and r e t i r e d . TABLE 3 A - EMPLOYMENT ON DISCHARGE FROM HOSPITAL BY OCCUPATION Employed on discharge P r o f e s s i o n a l and managerial S k i l l e d and unskilled  Unemployed on discharge  TOTAL  93  (70.99%)  38  (29.01%)  131  448  (44.93%)  549  (55.07%)  997  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . Those who d i e d i n h o s p i t a l and those who were unemployed p r i o r t o h o s p i t a l i z a t i o n were excluded.  Appendix B  (continued)  TABLE 4 A - EMPLOYMENT ON DISCHARGE PROM HOSPITAL BY OCCUPATION ; Returned to old job Professional managerial  and  S k i l l e d and unskilled  63  (71.59%)  168  (51.86%)  Went t o new j o b  Unemployed a f t e r discharge  9 (10.33%) 45  (13.89%)  TOTAL  16  (18.08%)  88  111  (34.25%)  324  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . Those who d i e d i n h o s p i t a l and those who were unemployed p r i o r t o h o s p i t a l i z a t i o n were excluded. Hypothesis I I TABLE 5 A - DURATION OP ILLNESS PRE-HOSPITALIZATION BY OCCUPATION Duration less than one year Professional and managerial S k i l l e d and unskilled  D u r a t i o n more than one year  TOTAL  70  (52%)  64  (48%)  134  535  (47%)  599  (53%)  1134  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e .  -iii Appendix B (continued) TABLE 6 A - DURATION OF ILLNESS, PRE-HOSPITALIZATION BY OCCUPATION PSYCHOSIS. Duration l e s s than one year  D u r a t i o n more than one year  TOTAL  P r o f e s s i o n a l and managerial S k i l l e d and unskilled  18 (78%)  5 (22%)  23  314 (49%)  326 (51%)  640  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The sample p o p u l a t i o n i n c l u d e d the a f f e c t i v e p s y c h o s i s and s c h i z o p h r e n i c p s y c h o s i s . TABLE 7 A - DURATION OF ILLNESS, PRE-HOSPITALIZATION BY OCCUPATION SOCIOPATHOLOGY. Duration l e s s than one year P r o f e s s i o n a l and managerial S k i l l e d and unskilled  11  D u r a t i o n more than one year  TOTAL  (23%)  37 (77%)  48  175 (41%)  253 (59%)  428  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The sample p o p u l a t i o n i n c l u d e d a n t i - s o c i a l and immaturity r e a c t i o n s , p e r s o n a l i t y p a t t e r n d i s t u r b a n c e s , and p e r s o n a l i t y t r a i t d i s t u r b a n c e s .  - iv Appendix B  (continued)  TABLE 8 A - DURATION OF ILLNESS, PRE-HOSPITALIZATION BY OCCUPATION NEUROSIS . Duration less than one year  D u r a t i o n more than one year  TOTAL  P r o f e s s i o n a l and managerial S k i l l e d and Unskilled  25  (74%)  168  (54%)  9 (26%) 145  34  (46%)  313  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . The sample p o p u l a t i o n i n c l u d e d phobic and a n x i e t y reactions, depressive reactions, obsessivecompulsive r e a c t i o n s , h y s t e r i c a l r e a c t i o n s .  TABLE 9 A - LIVING ARRANGEMENTS AT DISCHARGE BY OCCUPATION To f a m i l y  To separate living arrangement  To institution  TOTAL  P r o f e s s i o n a l and managerial S k i l l e d and Unskilled  94 (63.90%) 704  (51%)  1 (00.70%) 50  (4%)  53 619  (35.40%) (45%)  147 1373  The sample p o p u l a t i o n was male, f i r s t admissions, between the ages o f twenty-one and s i x t y - f i v e . Family i n c l u d e s w i t h p a r e n t s , w i t h s i b l i n g s , w i t h spouse, w i t h a d u l t c h i l d r e n , w i t h o t h e r relatives. Institution includes private h o s p i t a l or n u r s i n g home, b o a r d i n g or f o s t e r home, p e n a l i n s t i t u t i o n , mental h e a l t h i n p a t i e n t , out o f p r o v i n c e h o s p i t a l .  -  Appendix B  V -  (continued)  TABLE 9 B - PRE-HOSPITALIZATION LIVING ARRANGEMENTS INCLUDING ONLY HIGHER CLASS.  Higher Class  To f a m i l y  To separate living arrangement  To institution  TOTAL  49 (63%)  22 (28%)  7 (9%)  78  I n c l u d e s o n l y those e d u c a t i o n a l l e v e l s which d i s t i n g u i s h h i g h e r and lower c l a s s .  - viAppendix B  (continued)  TABLE 10 - READMISSIONS Psychosis  TO HOSPITAL. Sociopath  Neurosis  TOTAL  Higher Class  40 (45%)  30 (34%)  19 (21%)  89  Lower Class  460 (63%)  173 (23%)  99 (14%)  732  The sample p o p u l a t i o n was male, ages twenty-one through s i x t y - f i v e , who had been readmitted t o hospital.  BIBLIOGRAPHY 1.  Clausen, John A. and Marian R. Yarrow. "Paths t o the Mental H o s p i t a l . " The J o u r n a l o f S o c i a l I s s u e s . V o l . I I , November, 1955.  2.  Freeman, Howard E . and O.G. Simmons. "Mental P a t i e n t s i n the Community: F a m i l y S e t t i n g s and Performance L e v e l s . " American S o c i o l o g i c a l Review. V o l . 23, 1958.  3.  H o l l i n g s h e a d , August and F r e d e r i c k C. R e d l i c h . S o c i a l C l a s s and Mental I l l n e s s . John W i l e y and Sons, New York, 1958.  4.  H o l l i n g s h e a d , August B. and J.K. Myers. " S o c i a l C l a s s and Mental I l l n e s s : A Follow-up Study." Mental H e a l t h R e p o r t s . P u b l i c H e a l t h S e r v i c e P u b l i c a t i o n No. 1568. U.S. Government and P r i n t i n g O f f i c e , Washington, D.C.  5.  Kahn, A . J . "The Design o f Research." In S o c i a l Work Research, Polansky, W.A. (Ed). U n i v e r s i t y o f Chicago, 1960. pp. 48-73.  6.  Landy, David and Robert S. A l b e r t . "Waiting f o r H o s p i t a l i z a t i o n : A Study o f Persons P l a c e d on a H o s p i t a l W a i t i n g L i s t and T h e i r F a m i l i e s . " A r c h i v e s o f G e n e r a l P s y c h i a t r y . V o l . 1, 1959.  7.  Moore, Robert A., Benedek, E.P. and John G. W a l l a c e . " S o c i a l C l a s s , S c h i z o p h r e n i a and the P s y c h i a t r i s t . " American J o u r n a l o f P s y c h i a t r y , V o l . 120, August, 1963.  8.  Myers, J.K., Bean, Lee L., and Max P. Pepper. S o c i a l C l a s s and Mental I l l n e s s . John W i l e y and Sons, New York, 1958.  9.  Myers, J.K., and D.H. R o b e r t s . F a m i l y and C l a s s Dynamics i n Mental I l l n e s s . John W i l e y and Sons, New York, 1959.  10. P o r t e r , John. The V e r t i c a l M o s a i c . The U n i v e r s i t y o f Toronto P r e s s , 1965. 11. S c h e f f , Thomas J . (Ed) Mental I l l n e s s and S o c i a l P r o c e s s e s . Harper and Row, New York, 1967. 12. Weiss, P., Macaulay, J . and A. P i n c u s . "Geographic F a c t o r s and the Release o f P a t i e n t s from S t a t e Mental H o s p i t a l s . " American J o u r n a l o f P s y c h i a t r y , Vol.123, 1966. 13. Witraer, C.A. and C.G. Conover. "A Study o f C r i t i c a l I n c i d e n t s i n the H o s p i t a l i z a t i o n o f the M e n t a l l y 111." S o c i a l Work. V o l , 4, No. 1, 1959. 14. Census o f Canada, 1961. " P o p u l a t i o n - S c h o o l i n g by Age Dominion Bureau o f S t a t i s t i c s .  Groups."  

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