We are pleased to offer the third edition of A Handbook for the Study of Mental Health. While the second edition is only seven years old, recent changes to psychiatric classification systems (DSM-5), mental health services, and policy called for a new edition. Eric Wright took over as co-editor given his expertise in mental health systems and policy, and we undertook a substantial revision of the contents of the volume. Several new chapters in Part I address DSM-5 and psychiatric nosology, and raise important questions for future researchers. Part III includes a new chapter on community mental health organizations, another on adolescent suicide and public health interventions, as well as a new chapter on mental health policy. The Epilogue is also a new addition; it is addressed to researchers and provides guidelines for integrating disparate areas of scholarship in the sociology of mental health and illness. These new additions make the Handbook an essential resource for scholars, and we thank our new authors for their contributions and insights. Returning authors worked hard to substantially revise their chapters, and we thank them for their tireless commitment to the Handbook. We also completely rewrote the introductions to each part to provide a framework for the ensuing chapters. As with the previous two editions, proceeds from this volume benefit the American Sociological Association Section on Mental Health.

When Allan Horwitz and Teresa Scheid prepared the first edition of this volume in 1998, there was much apprehension over the future of mental health care reform. This apprehension increased with the second edition, and is somewhat abated with the passage of the Affordable Care Act, which provides the opportunity to improve mental health service offerings. A series of tragic mass shootings – especially those at Sandy Hook Elementary School in Newton, Connecticut, and at the Emanuel African Methodist Episcopal Church in Charleston, South Carolina – has also provided impetus for policy makers to examine mental health services. At the same time, there is also renewed interest in exerting greater social control over people with mental health problems (i.e., loosening criteria for involuntary commitment, imposing additional limitations on the ability to possess guns). In Part III, we address the system of mental health care services and those policies that shape care delivery systems.

Mental health care must be understood in terms of its wider social context: the care and treatment provided to individuals with mental health problems reflects wider social values and priorities. Hence, the mental health system (i.e., the network of organizations, services, and health care professionals) will change as society changes. Specifically, widely held values and beliefs about mental health and attitudes toward the mentally ill as well as professional treatment preferences will shape the political climate, economic priorities, and the type of services available. It is for this reason that it is so difficult to achieve consensus on what type of system of care will work, and why it is so difficult to implement change (Mechanic, 2006).

As David Rochefort (1999) has argued, mental health policy has been plagued by recurrent tensions and ambiguities. Mental health care in the public sector is shaped by federal, state, and local policies and varies widely from community to community. While there have been several federal reports on the state of mental health care in the US (e.g., the 1999 Surgeon General's Report on Mental Health, the 2003 Presidential Commission on Mental Health), there has been no clear-cut federal policy such as that which emerged in 1963 with the Community Mental Health Reform Act. As noted by Wolff (2002), in the US mental health policy is framed at the state level, and there is tremendous state variation.

Mental health and mental disorder represent two different areas of theory, research, and policy implications, reflecting our common tendency to dichotomize healthy and sick, normal and abnormal, sane and insane. David Mechanic (2006) argues that the term “mental health” has no clear or consistent meaning, and in terms of the sociological literature, this is generally true. Mental health is not merely the absence of disease or disorder; it involves self-esteem, mastery, and the ability to maintain meaningful relationships with others. While most of us fall short of optimal well-being (or happiness), those who experience mental health problems or psychological distress have been the focus of most sociological research.

However, definitions of mental health problems, illnesses, or disorders are also not so straightforward. Following Horwitz (2002b), “mental diseases” reflect underlying internal dysfunctions that have universal features (i.e. schizophrenia and to a lesser degree bipolar disorder). A valid “mental disorder” reflects some internal psychological system that is unable to function as it should, and this dysfunction is socially inappropriate. For most disorders, symptoms are not specific indicators of discrete, underlying diseases (such as schizophrenia), instead many conditions arise from stressful social conditions (such as depression, anxiety, eating disorders). Cultural processes shape the symptoms associated with mental disorders, and it is important to distinguish mental disorders from normal reactions to social stressors. Horwitz (2002b) uses the terminology of “mental illness” to refer to those conditions which a particular group has defined as a mental illness (and often point to behaviors that are deemed deviant, for example homosexuality in previous psychiatric classifications). For simplicity, we will use the term mental health problem or disorder in this introduction – but students should keep in mind the implications of using the term mental illness. In Chapter 1, Horwitz argues that sociological approaches regard mental health and mental health problems as aspects of social circumstances. He provides a very thorough overview of how various social conditions affect levels of mental health and mental health problems, and in turn how social contexts shape the definition as well as the response to mental health problems. Chapter 1 develops a framework for a sociological understanding of mental disorder and mental health problems and also directs the reader to other chapters in the volume that illustrate Horwitz's arguments.

Social context defines not only the sources of stress, but also the social relationships within which stress is developed and mitigated. In addition to describing sources of stress and social support, the considerations of social context in Part II situate stress that accompanies social status (e.g., social class, gender, race, age) as well as role occupancy (e.g., spouse, worker). We begin with a review of the historical development of what is now referred to as the stress process model, originating with work of Leonard Pearlin. Aneshensel and Avison (2015) have provided an excellent overview of Pearlin's body of work, and Deborah Carr (2014) offers a very concise and readable overview of sociological research on stress in her book Worried Sick: How Stress Hurts Us and How to Bounce Back.

The sociological study of stress and social support has been dominant in mental health research since the 1960s. Thirty years of research has demonstrated a consistently positive relationship between life stress and psychological distress. In the 1970s, researchers modified the life stress model to take into account the important role that social support and other resources play in assisting individuals to cope with the stressful events in their lives. Intervening models, or coping theories, focus on how coping resources are mobilized after the stressful event, whereas distress-deterring models argue that coping resources (such as a supportive family) may actually reduce the likelihood of external stress occurring, or else can help alter the meaning of stress.

Because stress does not affect everyone the same way, researchers must also take into account vulnerability to stress. Vulnerability was originally conceived as a purely psychological concept; sociologists view it as a group concept as well. For example, membership in some social categories (minority status or gender) provides an individual with differential access to resources, as well as a different socialization experience which may structure one's reaction to both stress and illness, and consequently result in very different mental health experiences. Link and Phelan (1995) identify access to resources as a fundamental cause of disease because such access influences your exposure to various risk factors (for example, stress) and your ability to either avoid or cope with psychological distress.