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Annals of the Association of American Geographers Volume 67, 1977 - Issue 4
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Original Articles

PSYCHIATRIC PATIENTS AND THE INNER CITYFootnote∗

MICHAEL DEAR Assistant Professor of Geography, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
Pages 588-594 | Published online: 15 Mar 2010

  • ∗This research was supported by Grant No. PR 539C of the Ontario Ministry of Health. I would like to thank Dr. Marcel Lemieux, Medical Director of Hamilton Psychiatric Hospital, for his cooperation and helpful discussions on this topic, and Mr. Paul Tice, who acted as research assistant on this project.
  • 1Much evidence on recent trends in inner cities is contained in John S. Adams, ed., Urban Policymaking and Metropolitan Dynamics: A Comparative Geographical Analysis (Cambridge, Mass.: Ballinger, 1976).
  • 2See C. J. Smith, “Being Mentally Ill—In the Asylum or Ghetto,”Antipode, Vol. 7 (1975), pp. 53 59; and J. Wolpert, M. Dear, and R. Crawford, “Satellite Mental Health Facilities,”Annals, Association of American Geographers, Vol. 65 (1975), pp. 24 35.
  • 3R. Reich, “Care of the Chronically Mentally Ill—A National Disgrace,”American Journal of Psychiatry, Vol. 130 (1973), pp. 911 12.
  • 4This argument is pursued in Wolpert, Dear, and Crawford, op. cit., footnote 2; and in M. Dear, “Spatial Externalities in Locational Conflict,”London Papers in Regional Science, Vol. 7 (1976), pp. 152 67.
  • 5A. M. Freedman, “Historical and Political Roots of the Community Mental Health Centers Act,”American Journal of Orthopsychiatry, Vol. 37 (1967), pp. 487 94; and D. H. Mechanic, Mental Health and Social Policy (Englewood Cliffs, N.J.: Prentice-Hall, 1969).
  • 6Similar trends have been reported in the United States and in Great Britain; see, respectively, E. Wolpert and J. Wolpert, “From Asylum to Ghetto,”Antipode, Vol. 6 (1974), pp. 63 76, and Kathleen Jones, Opening the Door: A Study of New Policies for the Mentally Handicapped (London: Routledge and Kegan Paul, 1975), especially chp. 1.
  • 7A good summary is provided in A. Beigel and A. I. Levinson, eds., The Community Mental Health Center: Strategies and Programs (New York: Basic Books, 1972); more current evidence is found in L. D. Ozarin, “Community Alternatives to Institutional Care,”American Journal of Psychiatry, Vol. 133 (1976), pp. 69 72.
  • 8See, for example, H. B. M. Murphy, “Foster Homes: The New Back Wards?”Canada's Mental Health, Vol. 71 (1971), supplement; and H. R. Lamb and V. Goertzel, “Discharged Mental Patients—Are They Really in the Community?”Archives of General Psychiatry, Vol. 24 (1971), pp. 29 34.
  • 9J. Fracchia, “Public Perception of Ex-Mental Patients,”American Journal of Public Health, Vol. 66 (1976), pp. 74 76; and Stewart Page, “The Elusive Character of Psychiatric Stigma,”Canada's Mental Health, Vol. 22 (1974), pp. 15 17.
  • 10See, for example, U. Aviram and S. P. Segal, “Exclusion of the Mentally Ill,”Archives of General Psychiatry, Vol. 29 (1973), pp. 126 31; L. L. Bachrach, “A Note on Some Recent Studies of Released Mental Hospital Patients in the Community,”American Journal of Psychiatry, Vol. 133 (1976), pp. 73 75; and Wolpert, Dear and Crawford, op. cit., footnote 2, especially pp. 27–31.
  • 11See, for example, Wilfred A. Cassell, “Comparing Costs of Hospital and Community Care,”Hospital and Community Psychiatry, Vol. 23 (1972), pp. 17 20; and D. M. Sheehan and J. Atkinson, “Comparative Costs of State Hospital and Community-based Inpatient Care in Texas,”Hospital and Community Psychiatry, Vol. 25 (1974), pp. 242 44.
  • 12Some of these ambiguities are discussed by J. B. Stubblebine and B. Decker, “Are Urban Mental Health Centers Worth It?”American Journal of Psychiatry, Vol. 127 (1971), pp. 908 12, and Vol. 128 (1971), pp. 480–83.
  • 13For aspects of this debate, see the British Medical Journal, No. 6002, 17 January 1976, pp. 111–12; Hospital and Community Psychiatry, Vol. 25 (1974), pp. 383–401; and H. R. Lamb and V. Goertzel, “The Demise of the State Hospital—A Premature Obituary,”Archives of General Psychiatry, Vol. 26 (1972), pp. 489 95.
  • 14R. Clement, E. Ruch, and B. Sindon, “A Study of the Placement of the Psychiatric Patient,”Canada's Mental Health, Vol. 24 (1976), pp. 17 19.
  • 15Lamb and Goertzel, op. cit., footnote 8.
  • 16M. Silverstein, Psychiatric Aftercare: Planning for a Community Mental Health Service (Philadelphia: University of Pennsylvania Press, 1968).
  • 17Smith, op. cit., footnote 2.
  • 18Representative survey experiences are to be found in F. A. Allodi and H. B. Kedward, “The Vanishing Chronic,”Canadian Journal of Public Health, Vol. 29 (1973), pp. 279 84; J. Goodman, C. A. Woodward, and D. L. Streiner, “Wanted: A Tracking System for the Psychiatric Patient,” paper presented at the National Conference on Evaluation in Alcohol, Drug Abuse and Mental Health Programs, Washington, D.C., 1974; and C. J. Smith, “Distance and the Location of Community Mental Health Facilities,”Economic Geography, Vol. 52 (1976), pp. 181 91.
  • 19Smith, op. cit., footnote 2; Wolpert, Dear, and Crawford, op. cit., footnote 2; and Dear, op. cit., footnote 4.
  • 20Goodman, Woodward, and Streiner, op. cit., footnote 18, especially pp. 3–4.
  • 21Quebec Division of the Canadian Mental Health Association, A Survey of the Situation of Persons One Year After Discharge from Psychiatric Hospitalization,”Canada's Mental Health, Vol. 23 (1975), pp. 14 15.
  • 22D. L. Streiner, J. Goodman, and C. A. Woodward, “Correlates of the Hospitalization Decision: A Replicative Study,”Canadian Journal of Public Health, Vol. 66 (1975), pp. 411 15.
  • 23W. M. Michaux, The First Year Out: Mental Patients after Hospitalization (Baltimore: Johns Hopkins University Press, 1969); and H. H. Strupp, R. E. Fox, and K. Lesser, Patients' Views of their Psychotherapy (Baltimore: Johns Hopkins University Press, 1969).
  • 24Lamb and Goertzel, op. cit., footnote 8; D. G. Langsley, M. Pavel, and K. Flomenhaft, “Avoiding Mental Hospital Admission: A Follow-up Study,”American Journal of Psychiatry, Vol. 127 (1971), pp. 127 30; and J. Myers and L. Bean, A Decade Later: A Follow-up of Social Class and Mental Illness (New York: John Wiley, 1968).
  • 25Further discussion of this hypothesis is to be found in M. Dear, “Locational Factors in the Demand for Mental Health Care,”Economic Geography, Vol. 53 (December 1977), pp. 223 40, and Smith, op. cit., footnote 18.
  • 26This is due, in part at least, to community resistance to psychiatric aftercare facilities in other neighborhoods.
  • 27Wolpert, Dear, and Crawford, op. cit., footnote 2; and Wolpert and Wolpert, op. cit., footnote 6.
  • 28Aspects of nonuser attitudes toward mental health facilities are considered in Dear, op. cit., footnote 4, and in M. Dear, R. Fincher, and L. Currie, “Measuring the External Effects of Public Programs,”Environment and Planning A, Vol. 9 (December 1977), pp. 137 47.

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