Access to mental health care in an inner-city health district. II: Association with demographic factors

BackgroundIn addition to clinical and service factors, planners need to take account of the influence of demographic variables, especially ethnicity, on access to mental health care.MethodEstimated prevalence rates were calculated from epidemiological surveys undertaken in three settings: psychiatric services, primary care and the general population. Associations between demographic factors and service use were examined using the pathways to care model.ResultsConsiderable differences in access to mental health care were found, particularly according to ethnicity. The major impediment to Asians accessing care occurred at the interface between primary and secondary care, whereas the most striking feature for Blacks was the poor level of case recognition by GPs.ConclusionsIn order to improve the uptake of mental health care, new initiatives should target those who are most likely to be unwell but least likely to access services. Purchasers and providers need to address differential patterns of use when developing and reviewing services.

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Mental Health and Service Use of Migrants in Contact with the Public Psychiatry System in Paris

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249397 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9397

Author(s):

Andrea Tortelli ◽

Florence Perquier ◽

Maria Melchior ◽

François Lair ◽

Fabien Encatassamy ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Asylum Seekers ◽

Service Use ◽

Pathways To Care ◽

Treatment Level ◽

Stable Housing ◽

Increased Risk ◽

Provision Of Care

Background: Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed. Methods: In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers. Results: We found higher treatment rates among migrants than among natives (p < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02–1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38–0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum. Conclusions: Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.

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Identifying and measuring service use data for youth in need of mental health care

Psychiatrische Praxis ◽

10.1055/s-0031-1277749 ◽

2011 ◽

Vol 38 (S 01) ◽

Author(s):

M Woolderink ◽

A Paulus ◽

S Evers

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Service Use

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Treatment gap and mental health service use among Syrian refugees in Turkey

European Journal of Public Health ◽

10.1093/eurpub/ckz185.579 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Cited By ~ 1

Author(s):

D C Fuhr ◽

C Ataturk ◽

M McGrath ◽

Z Ilkkursun ◽

A Woodward ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Service Use ◽

Mental Health Problems ◽

Mental Health Service Use ◽

Continuing Care ◽

Syrian Refugees ◽

Depression And Anxiety ◽

Treatment Gap

Abstract Introduction Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey. Methods A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. Results The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported. Conclusions To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness. Key messages This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.

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Direct medical mental health care costs of schizophrenia in France, Germany and the United Kingdom – Findings from the European Schizophrenia Cohort (EuroSC)

European Psychiatry ◽

10.1016/j.eurpsy.2008.12.013 ◽

2009 ◽

Vol 24 (4) ◽

pp. 216-224 ◽

Cited By ~ 21

Author(s):

Dirk Heider ◽

Sebastian Bernert ◽

Hans-Helmut König ◽

Herbert Matschinger ◽

Theresa Hogh ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

United Kingdom ◽

Mental Health Care ◽

Service Use ◽

Unit Cost ◽

United States Dollar ◽

The United Kingdom ◽

Day Clinic ◽

Use Of Services

AbstractObjectivesTo quantify and compare the resource consumption and direct costs of medical mental health care of patients suffering from schizophrenia in France, Germany and the United Kingdom.MethodsIn the European Cohort Study of Schizophrenia, a naturalistic two-year follow-up study, patients were recruited in France (N = 288), Germany (N = 618), and the United Kingdom (N = 302). Data about the use of services and medication were collected. Unit cost data were obtained and transformed into United States Dollar Purchasing Power Parities (USD-PPP). Mean service use and costs were estimated using between-effects regression models.ResultsIn the French/German/UK sample estimated means for a six-month period were respectively 5.7, 7.5 and 6.4 inpatient days, and 11.0, 1.3, and 0.7 day-clinic days. After controlling for age, sex, number of former hospitalizations and psychopathology (CGI score), mean costs were 3700/2815/3352 USD-PPP.ConclusionsService use and estimated costs varied considerably between countries. The greatest differences were related to day-clinic use. The use of services was not consistently higher in one country than in the others. Estimated costs did not necessarily reflect the quantity of service use, since unit costs for individual types of service varied considerably between countries.

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Adult experts’ perceptions of telemental health for youth: A Delphi study

JAMIA Open ◽

10.1093/jamiaopen/ooy002 ◽

2018 ◽

Vol 1 (1) ◽

pp. 67-74 ◽

Cited By ~ 2

Author(s):

Abigail Howard ◽

Mindy Flanagan ◽

Michelle Drouin ◽

Maria Carpenter ◽

Elizabeth M Chen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Lived Experience ◽

Delphi Study ◽

Instant Messaging ◽

Youth Mental Health ◽

Pathways To Care ◽

Telemental Health ◽

Knowledge Barriers

Abstract Objectives Our objectives were to measure experts’ opinions and develop consensus via the Delphi process on the barriers, applications, and concerns associated with telemental health (TMH) for youth. Materials and methods We delivered 3 online surveys over 2 months in Summer, 2016–2025 adult experts, including adults who experienced youth depression or suicidality, parents of youth with lived experience, and professionals (ie youth mental health researchers, clinicians/staff, or educators). We used the Delphi method to construct Likert and open-ended questions, developing expert consensus over 3 iterative surveys on the barriers and benefits of TMH for youth. Results Adult experts identified stigma and knowledge barriers to youth mental health care. Although TMH is perceived as beneficial for screening, education, follow-up, and emotional support, no single delivery method (eg websites or instant messaging) was deemed universally beneficial. Discussion Adults are the developers, administrators, and gatekeepers of youth mental health care. Although adult experts see potential for TMH to supplement traditional therapy via familiar technologies, there is no consensus on the technologies by which TMH should be delivered. However, there is consensus that family members and friends provide potential pathways to care; thus, an online TMH toolkit for youth would be beneficial for both caretakers and practitioners. Conclusion Telemental health may not overcome barriers for crisis management but adult experts agreed that TMH had potential benefits for youth. Health care organizations should conduct research and provide training and education to youth caretakers and practitioners on potential barriers and benefits of TMH technologies for youth.

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Access to Australian Mental Health Care by People from Non-English-Speaking Backgrounds

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2001.00882.x ◽

2001 ◽

Vol 35 (2) ◽

pp. 174-182 ◽

Cited By ~ 16

Author(s):

Jane Pirkis ◽

Philip Burgess ◽

Graham Meadows ◽

David Dunt

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Mental Health Problems ◽

Population Based ◽

Perceived Needs ◽

Health And Wellbeing ◽

Needs For Care ◽

English Speaking ◽

Access Services

Objective: This study aimed to examine access to mental health care for people from non-English-speaking backgrounds relative to that of people from English-speaking backgrounds, in the context of the mental health status of both groups; and to consider whether, if they perceive that they have needs for care, these needs are met. Method: The study used data from the population-based Australian National Survey of Mental Health and Wellbeing, conducted in 1997. Results: People from non-English-speaking backgrounds and English-speaking backgrounds were equally likely to experience anxiety disorders and affective disorders, but the former were less likely to experience substance-use disorders and any mental disorder. When those with each disorder type were considered alone, people from non-Englishspeaking backgrounds and English-speaking backgrounds were equally likely to use services for mental health problems. When those with perceived needs for care were considered in isolation, there was no difference between birthplace groups in terms of their likelihood of reporting that their needs were fully met. Conclusions: The study had several limitations (i.e. lack of detail on specific ethnic groups and exclusion of potential respondents who could not speak English), which mean that these findings should be interpreted with caution. There is a need to build on this populationbased work, by oversampling people from particular non-English speaking communities and ensuring that those who do not speak English are included in population samples. Such work will further clarify the relative ability of people from non-English-speaking backgrounds to access services, and the extent to which their needs are met.

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Pathways to mental health care in Nepal: a 14-center nationwide study

International Journal of Mental Health Systems ◽

10.1186/s13033-021-00509-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Anoop Krishna Gupta ◽

Sulochana Joshi ◽

Bikram Kafle ◽

Ranjan Thapa ◽

Manisha Chapagai ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Mental Health Professionals ◽

Clinical Presentation ◽

Service Providers ◽

Mental Illnesses ◽

World Health ◽

Pathways To Care ◽

Duration Of Untreated Illness

Abstract Background Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. Methods This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. Results Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. Conclusions Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

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From research to practice: Implementing an experimental home treatment model into routine mental health care

European Psychiatry ◽

10.1192/j.eurpsy.2020.91 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

N. Stulz ◽

W. Kawohl ◽

M. Jäger ◽

S. Mötteli ◽

U. Schnyder ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Service Use ◽

Controlled Trial ◽

Routine Care ◽

Home Treatment ◽

Study Phase ◽

Hospital Bed ◽

Bed Days

Abstract Background In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. Methods We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. Results Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients’ care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. Conclusions HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.

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Mental Health Care for Ethnic Minority Individuals and Communities in the Aftermath of Disasters and Mass Violence

CNS Spectrums ◽

10.1017/s1092852900019477 ◽

2005 ◽

Vol 10 (2) ◽

pp. 132-140 ◽

Cited By ~ 45

Author(s):

Fran H. Norris ◽

Margarita Alegria

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Help Seeking ◽

Service Use ◽

Cultural Psychology ◽

Evaluation Research ◽

Ethnic Disparities ◽

Community Action ◽

Mass Violence

ABSTRACTFindings from research on psychiatric epidemiology, disaster effects, discrepancies in service use, and cross-cultural psychology are reviewed to generate guidelines for culturally responsive postdisaster interventions. Ethnicity and culture influence mental health care at various points: on need for help; on availability and accessibility of help; on help-seeking comfort (stigma, mistrust), and on the probability that help is provided appropriately. There are aspects of disaster mental health practice that may ameliorate many of barriers that contribute to ethnic disparities in service use. It is proposed that interventions should give greater attention to socially engaged emotions and functioning. To promote disaster recovery, practitioners are advised to: assess community needs early and often; provide easily accessible services; work collaboratively and proactively to reduce stigma and mistrust and engage minorities in care; validate and normalize distress and help-seeking; value interdependence as well as independence as an appropriate developmental goal; promote community action; and advocate for, facilitate, or conduct treatment and evaluation research. Notwithstanding the pain and stress they cause, disasters create opportunities to de-stigmatize mental health needs and build trust between providers and minority communities.

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