Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

Mental health services and psychiatric professional values have shifted in the past several decades toward a model of client autonomy and informed consent, at least in principle. However, it is unclear how much has changed in practice, particularly in cases where client behavior poses ethical challenges for clinicians. Drawing on the case of clients’ sexual behavior and contraception use, we examine whether sociological theories of “soft” coercion remain relevant (e.g., therapeutic social control; Horwitz 1982) in contemporary mental health treatment settings. Using structured interview data from 98 men and women with serious mental illness (SMI), we explore client experiences of choice, coercion, and the spaces that lie in between. Patterns in our data confirm Horwitz’s (1982) theory of therapeutic social control but also suggest directions for updating and extending it. Specifically, we identify four strategies used to influence client behavior: coercion, enabling, education, and conciliation. We find that most clients’ experiences reflect elements of ambiguous or limited autonomy, wherein compliance is achieved by invoking therapeutic goals. However, women with SMI disproportionately report experiencing intense persuasion and direct use or threat of force. We argue that it is critical to consider how ostensibly noncoercive and value-free interventions nonetheless reflect the goals and norms of dominant groups.

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Barriers to Practitioners' Endorsement of a Recovery Perspective

Research Anthology on Mental Health Stigma, Education, and Treatment ◽

10.4018/978-1-7998-8544-3.ch050 ◽

2021 ◽

pp. 861-879

Author(s):

Debra Kram-Fernandez

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Health Treatment ◽

Behavioral Theory ◽

Meaningful Life ◽

Health Treatment ◽

Surgeon General ◽

History Of ◽

Cognitive Behavioral Theory ◽

The Impact

This chapter is concerned with the impact of practitioner biases on the experience of a meaningful life for individuals who live with serious mental illness (SMI). Professional biases, systemic biases that originate in societal fear and lack of knowledge, and internalized stigma taken on by the consumer affect life decisions. Following a history of treatment initiatives experienced by consumers as abusive, it is important to understand how a system envisioned to protect and treat was often experienced as harmful. In the 1980s a movement emerged to transform the nature of mental health treatment to a client-centered, recovery-oriented model. In 1999, the Surgeon General proclaimed that all agencies serving this population should be recovery oriented. Yet, the shift to this approach to understanding people with SMI has not been complete. While there are many explanations why practitioners may not fully embrace this perspective, this chapter introduces the concept of “schemas” from cognitive behavioral theory as a way of examining professional biases in the field of SMI.

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Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100710 ◽

2019 ◽

Vol 53 (11) ◽

pp. 707-721 ◽

Cited By ~ 14

Author(s):

João Mauricio Castaldelli-Maia ◽

João Guilherme de Mello e Gallinaro ◽

Rodrigo Scialfa Falcão ◽

Vincent Gouttebarge ◽

Mary E Hitchcock ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Illness ◽

Health Literacy ◽

Mental Health Treatment ◽

Mental Health Literacy ◽

Elite Athletes ◽

Mental Health Symptoms ◽

Health Treatment ◽

Health Symptoms

ObjectiveTo summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes.DesignSystematic reviewData sourcesPubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018.Eligibility criteria for selecting studiesQualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language.ResultsStigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health.ConclusionThere is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes’ environments that encourages athletes to seek treatment.

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Individuals with currently untreated mental illness: causal beliefs and readiness to seek help

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796017000828 ◽

2018 ◽

Vol 28 (04) ◽

pp. 446-457 ◽

Cited By ~ 11

Author(s):

S. Stolzenburg ◽

S. Freitag ◽

S. Evans-Lacko ◽

S. Speerforck ◽

S. Schmidt ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Childhood Trauma ◽

Mental Health Treatment ◽

Help Seeking ◽

Causal Beliefs ◽

Professional Help ◽

Health Treatment ◽

Causal Explanations ◽

Perceived Need

Aims.Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future.Methods.In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire – Depression), and whether respondents had previously sought mental healthcare.Results.Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help.Conclusions.While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.

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