Good patients and bad. Therapeutic assets and liabilities

This is an extension of an earlier article that identified three utilization styles at an urban mental health center where, apart from a minority of intensive users, casual users, and pseudousers predominate and, combined, characterize the therapeutically passive user. The present article compares center data to added data from the private sector, where the intensive user predominates. Center/private differences are examined, and correlates of differing utilization styles are identified, such as sex, diagnosis, marital/living arrangements, referral source, and social engagement factor. The later is associated with differences not attributable to diagnostic severity of social impairment. The growing division of labor, wherein the privates sector is engaged in intensive psychiatric treatment while the center increasingly operates an emergency/crisis/maintenance service, is shown to reflect a gross public/private maldistribution of therapeutic assets and liabilities.