02765nam a2200241   4500000000100000008004100001260003700042653001700079653002000096653002100116653002700137653002400164653001600188100001200204700001600216700001300232245009800245856017500343300001200518520195700530022001402487020002202501       2016                            d  bEmerald Group Publishing Limited10aself-concept10aQuality of Life10aPerceived stigma10amental health services10ainternalized stigma10afunctioning1 aPerry B1 aMarcussen K1 aRitter C00aRevisiting the relationships among community mental health services, stigma, and well-being.   uhttp://www.emeraldinsight.com/series/amsohttp://www.emeraldinsight.com/doi/book/10.1108/S1057-6290201617http://www.emeraldinsight.com/doi/10.1108/S1057-629020160000017007  a177-2063 a<p><strong>Purpose </strong>This chapter examines the effects of mental health services and stigma on changes in self-concept and well-being for individuals with SPMI.</p>

<div><strong>Methodology/approach </strong>Data for this chapter come from structured interviews and service data for 140 individuals with severe and persistent mental illnesses. We use structural equation modeling to examine the relationship between perceived and internalized stigma, as well as the relationships among stigma, self-concept (self-esteem and mastery), and well-being (quality of life and functioning).</div>

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<div><strong>Findings </strong>We find that case management is negatively related to quality of life and psychiatric services are positively related to functioning. Crisis services and assessment are associated with mastery in opposite directions. Internalized stigma is positively associated with self-esteem and mastery, and negatively associated with functioning. We do not find a relationship between services and stigma.</div>

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<div><strong>Research limitations/implications </strong>A limitation to this chapter is the sample size, which prohibits us from examining a full range of services and outcomes. Nonetheless, our findings provide information about how services and stigma impact well-being, and may be used as a starting point for considering strategies for improving services and reducing stigma. Future work should consider pairing outcomes with services to determine their effectiveness.</div>

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<div><strong>Originality/value </strong>This chapter builds on previous research that examines the relative effects of services and stigma among individuals in community health care by extending measures of both services and stigma, and by examining the relationship between them, in order to better determine their implications for self-concept and well-being.</div>
  a1057-6290  a978-1-78560-403-4