A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.     

Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

“I'm a police officer not a social worker or mental health nurse”: Online discourses of exclusion and resistance regarding mental health‐related police work

Despite estimates suggesting that around 15% of UK police incidents involve people with a mental health concern, officers receive very little mental health training. The police have faced high‐profile criticisms over their handling of mental health‐related incidents, whereas the underfunding and fragmentation of UK mental health services has led to concerns that police officers are being forced to undertake a primary role in mental health care. At a time of austerity and widespread cuts to public services, it is important to explore how particular groups work to justify the parameters of their professional duties. This article therefore explores the discourses surrounding mental health problems on an online police discussion forum, highlighting two distinct ways in which mental health‐related work is represented as being incompatible with policing. First, mental health problems are delegitimised and conflated with “scrounging,” positioning individuals as undeserving of police time; second, mental health problems are reified and associated with violence and extreme behaviour, justifying the use of force by police officers and deflecting responsibility onto mental health services. Findings are consistent with previous research suggesting that mental health work is not perceived to be a valid part of the police role.     

Mental health and North American Indian/Native communities: Cultural transactions,education, and regulation

Critical issues in the delivery of mental health services to North American Indians/Natives residing in rural areas are discussed by describing Indian populations/communities; briefly summarizing available literature concerning the nature of mental health problems within Indian communities; examining Indian belief systems relevant to participation in mental health service delivery processes; exploring community expectations for structuring participatory interactions which may inhibit utilization of mental health services; and describing transactions between Indian consumers and non-Indian professionals which have become typical over time. The rural context was examined as it interacts with individual and community characteristics to affect Indian mental health. Relations between geography and culture, important in understanding the mental health problems of Indian people, are discussed in regard to expanding community healing resources through empowerment, and viewing "education as transformation" as a key concept in enhancing community healing processes.     

Hmong Mental Health Needs Assessment: A Community-Based Partnership in a Small Mid-Western Community

The overall goal of this assessment was to verify the mental health needs of Hmong living in a mid-west community in order clarify the format, content, and feasibility of providing mental health services for Hmong in the future. Using a Community-Based Participatory Research (CBPR) model, we held four focus groups with 36 men, women, adolescents and professionals, all of Hmong descent, as well as interviewed 28 individual medical, mental health, education, and social service providers in the Eau Claire community. Our Hmong sample was frequently unclear about what “mental” health meant, indicating a low level of mental health literacy. Results confirmed that there are significant mental health needs in this refugee and immigrant population. Participants described problems consistent with depression, post-traumatic stress disorder (PTSD), anxiety disorders, somatoform disorders, and severe social stress and acculturation difficulties in every generation. Elder people and male adolescents were described as the most disaffected and in need of immediate services. It will be critical to address mental health literacy before designing future interventions. Treatment suggestions were provided with the intention of removing barriers and incorporating culturally sensitive methodologies, while continuing to work closely with our local mental health providers and Hmong leadership.     

Balance theory as a model for coordinating delivery of rural mental health services

The chaotic nature of rural mental health services is due, at least in part, to a lack of consistent theory guiding their purpose and structure. The failure to plan mental health care systematically for rural areas is a result of diverse opinions and policies grounded in changing social, political, and economic conditions. The Balance Theory of Coordination (Litwak & Meyer, 1966) offers a viable perspective to guide service system development and evaluation. This article identifies current difficulties in the rural mental health systems, offers balance theory as a basis for further work, and posits a model for case management rooted in balance theory. The intent is to stimulate research and theory development for rural mental health systems.     

走进大自然：自然体验及其积极效应

自然体验是指个体通过各种感官感知自然或与源于自然界的刺激互动。学者通常使用问卷测量法、自然指标法或实验操纵法来量化操纵人们的自然体验,发现接触自然可以在心理、生理和行为等方面产生积极效应。且这些积极效应会受到物理环境、个体以及社会因素的影响。未来应突破“城市——自然”二元对立思想并加强积极效应的纵深研究;拓展研究群体;促进相关研究成果的实际应用。     

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.     

Well-being and Need for Support of Adolescents with a Chronically Ill Family Member

This study investigates whether there are differences in the well-being, need for help and use of support services between adolescents with and without a chronically ill or disabled family member. It also examines the role played by the type of illness, the relationship to the family member and the nature and intensity of the help provided by the adolescent. A Dutch sample of 1581 adolescents (average age 14.6?years) completed a questionnaire in 2010 about mental health problems, pro-social behavior, need for and use of support and the illness of family members and any care tasks performed by the respondent. Young people with a sick family member had more mental health problems than their counterparts without a chronically ill family member. They also reported a greater need for and use of help and support. Performing domestic tasks was found to be a predictor for overall mental health problems. The intensity of the help given was related to the need for help by the adolescent. It is concluded that growing up with a chronically ill family member and spending a lot time performing (domestic) tasks are risk factors for adolescent mental health problems and adolescents’ need for help. Special attention is warranted for those who need support but who do not translate that need into reality by seeking help.     

Poverty and Mental Health: Underclaiming of Welfare Benefits

The study undertaken by a local MIND welfare benefits service found that 51% of people attending a local mental health resource centre were not receiving the welfare benefits to which they were entitled. Being in receipt of correct benefit entitlement was found to be unaffected by: whether a person had a long history of using mental health services; whether they had a care manager; or whether they had previously been given benefits advice. Women were less likely to be receiving their correct benefit entitlement than men. It is argued that the only way to guarantee that people receive their full benefit entitlement is to ensure that highly trained and experienced welfare benefits advisers are readily accessible to all people who use mental health services.     

Family therapists as front line mental health providers in war-affected regions: using reflecting teams, scaling questions, and family members in a hospital in Central Africa

This paper will illustrate the utilization of systemic family therapy services inside a hospital in a war-affected region of the Central African Republic. Through an international non-governmental organization (NGO), the author, a family therapist, provided counselling supervision and services to hospital staff and patients in an area of open conflict in the northern region of the country. In circumstances of chronic insecurity fuelled by both government and rebel forces, families displaced in this region are vulnerable to numerous health conditions and social problems. Family therapy techniques and ideas were used to work with individuals, couples and families presenting with health and social problems resulting from HIV-TB, infections, chronic malnutrition, acute poisoning and beliefs about sorcery. Case examples illustrate the systems consultation model used with the mental health team in order to expand and promote the sustainability of patient mental healthcare in this underserved region.     

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross‐sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.     

Examining Factors Associated with Primary Care and Continuity of Care Among Adults with Severe Mental Illness

A number of studies have consistently reported that there is a greater prevalence of mental illness among the most socioeconomically disadvantaged. At the same time, there is evidence that services are not optimally accessed by the most socioeconomically disadvantaged; the most in need of care are also the most likely to have unmet healthcare needs. Of people with mental illnesses, those with severe mental illnesses (SMI) are the most at risk of poverty and the least likely to have optimal care. In the past, specialized community mental health services have been identified as the primary provider for people with SMI. However, there is growing interest in using the primary care setting as the main source of mental health care where both medical treatment and psychotherapy can be accessed. In this paper, we examine factors related to primary care use (and in turn, pharmacologic and psychotherapies) for people who are socioeconomically disadvantaged and who have a SMI.     

At the crossroads: managed mental health care,the ethics code,and ethnic minorities

Mental health clinicians are facing an increasing number of ethical problems related to the delivery of managed mental health care services to ethnic minorities. The authors argue that (a) economic pressures have led to the development of the managed health care movement; (b) the combination of such economic pressures and the development of that managed care movement have influenced the promulgated ethical standards of the American Psychological Association; and (c) those influences may have a negative impact on the mental health services available to ethnic minority individuals and communities. The authors review some of the specific potential threats to mental health services for minorities in the face of such health management policy and psychologists' professional standards.     

Development of the Uni Virtual Clinic: an online programme for improving the mental health of university students

ABSTRACT

There is growing recognition of the importance of addressing the mental health needs of young people attending university. Anonymous, scalable, and evidence-based online interventions can help to reduce burden on university services and increase access to care for marginalised or disconnected students. This paper reports the participatory design methods used to develop the Uni Virtual Clinic (UVC), a comprehensive online programme that was designed to prevent and treat mental health problems and related issues in university students. Data evaluating the participatory design process is also presented. The potential for the implementation of the UVC within university-based counselling services is strong, and has potential to reduce the prevalence of mental disorders in a high-risk group of young people.     

How stigma interferes with mental health care

Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may impede treatment participation: It diminishes self-esteem and robs people of social opportunities. Given the existing literature in this area, recommendations are reviewed for ongoing research that will more comprehensively expand understanding of the stigma-care seeking link. Implications for the development of antistigma programs that might promote care seeking and participation are also reviewed.     

Perceptions of South Florida Hispanic and Anglo Catholics: From Whom Would They Seek Help?

Hispanic and Anglo Catholics in South Florida who attended Sunday services (N = 473) were surveyed to determine their help-seeking preferences for moral concerns, mental disorders, and practical life/family problems. Respondents were asked to indicate whether they would seek help from a priest; a priest with a degree and license in one of the helping professions (clinical social work, psychology, psychiatry, or mental health counseling); a layperson with a degree and license in one of the helping professions (clinical social work, psychology, psychiatry, or mental health counseling); or if they believed they could deal with the situation without external assistance. The findings suggest that Anglo Catholics prefer assistance from a person who was credentialed in one of the helping professions, whereas Hispanic Catholics would seek help from a priest with or without a background in the helping professions.     

Gaps and Barriers in Services for Children in State Mental Health Plans

Significant gaps exist in children’s mental healthcare, and barriers prevent access to existing services. Current federal initiatives call for state governmental agencies to recognize and resolve deficits in their systems of care. Previous work has acknowledged some of the problems in meeting the mental health needs of children within a system of care. This current project sought to discriminate between gaps (e.g., non-existent services) and barriers (e.g., problems that prevent access to existing services) within state mental health care plans. Because acknowledging barriers and gaps in mental health services is a step towards systems improvement, the present project describes how state governments recognize the limits of their children’s mental health care systems. We analyzed state mental health plans submitted to the federal government in applications for block grant funds. Results illustrate that a varied number of gaps and barriers are acknowledged in state plans. Overall, 90% of state plans discussed barriers and 84% of state plans discussed service gaps. The gap most frequently recognized was lack of providers (74%), while lack of funding (52%) was the most common barrier. This project points to some recognition of system limits in the states and reflects potential efforts to create policies for system improvement for children and families.     

1996至2016年中国老年人心理健康变迁的横断历史研究

为探究中国老年人心理健康水平随年代的变迁,运用横断历史研究方法对1996至2016年间160篇采用90项症状自评量表（SCL-90）的研究报告进行元分析。研究发现：（1）SCL-90各因子与年代均呈显著正相关,说明我国老年人心理健康水平在逐年下降。（2）SCL-90各因子与3项社会指标（离婚率、死亡率和犯罪率）有显著正相关。（3）不同性别老年人的心理健康水平均呈逐年下降趋势,但心理健康水平得分的性别差异并不显著。（4）城市老年人的心理健康水平呈逐年下降的趋势,而农村老年人的心理健康水平则呈逐年上升趋势。     

New Development in Legal Advocacy

Mental health service users are voicing the need for advocacy which is responsive to the social oppression they encounter in their lives, and within services. The Kent Law Clinic provides free, independent legal representation for people with a mental illness or a learning difficulty. This article describes the development of the Clinic and some of its work.