Mental illness etiology beliefs among African American men with serious mental illness and their social support networks

Semi-structured qualitative interviews were conducted with 26 African American men with serious mental illness who were consumers of community mental health services and 26 members of their social support networks. All participants were asked what they believed had caused the consumers’ mental illness. Consumer participants most commonly identified chronic life stressors as a causal factor, while social supports most often identified intrinsic factors such as genetics or biology as causes of mental illness. Some support participants believed that unintentional drug use had precipitated the onset of mental illness or had no causal theories. The fact that some support participants could not identify a causal explanation may indicate failure on the part of mental health care systems to engage with consumers’ social support networks and provide education about mental illness and its causes. The implications of etiology beliefs on mental health service utilization are discussed.     

Therapist Effects on Disparities Experienced by Minorities Receiving Services for Mental Illness

OBJECTIVES: The authors examine if some of the reason clients from racial and ethnic minority groups experience outcome disparities is explained by their therapists. METHOD: Data from 98 clients (19% minority) and 14 therapists at two community mental health agencies where clients from racial and ethnic minority groups were experiencing outcome disparities were analyzed using hierarchical linear modeling with treatment outcomes at Level 1, client factors at Level 2, and therapists at Level 3. RESULTS: There were substantial therapist effects that moderated the relationship between clients' race and treatment outcomes (outcome disparities). Therapists accounted for 28.7% of the variability in outcome disparities. CONCLUSIONS: Therapists are linked to outcome disparities and appear to play a substantial role in why disparities occur.     

The firm and managerial misdirection of worker effort

This article models how a level of management between workers and the owner of a firm can affect the owner's decision either to internally integrate a function to make inputs or to contract out to buy inputs from an independent supplier. In the model, a self-serving manager can direct her workers to perform activities that serve her interests rather than those of the firm. This reduces the effectiveness of worker performance incentives intended to promote efforts that benefit the owner. Incentives may have to be increased to a level such that the owner prefers to buy inputs rather than make them internally.     

Market stability: backward-bending supply in a laboratory experimental market. 1999 Presidential address Western Economic Association

This article investigates the stability properties of markets with backward-bending supply curves. Parameters are chosen so that the two classic models of price dynamics, the Walrasian model and the Marshallian model, give opposite predictions. The results are (1) market instability can be observed, and (2) in the backward-bending case stability is captured by the Walrasian model and the Marshallian model of dynamics is rejected. Previous experiments have demonstrated that the Marshallian model works in the forward-falling case. Thus, which theory of dynamics is appropriate for a market depends on the underlying reasons for demand and supply shapes.     

The end of the Cuban contradiction in U.S. refugee policy

This article describes and analyzes the Clinton Administration's decision to end the almost automatic acceptance of Cubans as political refugees to the US. The decision came after the Balsero Crisis in July 1994 after many people stormed embassies and diplomatic residences in Havana, Cuba, demanding asylum and complaining about impoverished living conditions. Riots erupted. The May 2, 1995, policy ended the indefinite detention of over 28,000 Cubans in safe haven camps, repealed the Cuban Adjustment Act of 1966, restricted travel to Cuba, halted monetary remittances to Cuba, equalized the number of annual visas from Cuba, and legalized the return of Cubans adrift at sea. The goals were to solve the immediate migration crisis created by Cubans detained at Guantanamo Bay, to implement controls of future waves of Cuban asylum seekers, and to oppose Castro with economic and political initiatives. The economic embargo during the 1960s, 1970s, and 1980s devastated the Cuban economy and led to its alliance with the USSR. Each of the four waves of migration was distinctive in composition and reasons for migrating. By the mid-1990s, Cuba was no longer a threat, Soviet interests in Cuba had declined, and the policy was hoped to bring about the collapse of Castro and promotion of democracy. The 1994 resolution ended the contradictory and preferential treatment of Cubans. It also ended the selectivity of the US in admitting those from countries the US was directly opposed to. The permanence of the embargo due to legislation in 1996 is a push factor for mass migrations.     

Balance of care—a user's view of a new approach to joint strategic planning

Planning for care of the Elderly has to face the problems of an increasing elderly population; a wide range of alternative ways of caring for them (at widely differing costs); the fact that services are provided by several different organisations all facing difficult financial constraints; a range of professional opinion about the desirability or otherwise of alternative patterns of care and use of resources; a lack of data on how care is at present distributed; the lack of a structure for organising such data as are available; and the lack of an appropriate computer-based model for manipulating the large number of data elements necessary to describe and help to evaluate alternative plans for the future. The Balance of Care approach to the Joint Strategic Planning of Health and Social Services provision for the Elderly, is being used in pilot applications in two Areas in the UK. Its contribution to the solution of the problems outlined above is described by authors from the two Areas. The approach and the underlying model can be extended to strategic planning for other client groups requiring non-acute care.