Australian general practice and the meeting of needs for mental health care

Background: This report, drawing on a national epidemiological survey conducted in 1997, examines the role of Australian medical general practitioners (GPs) in responding to needs for mental health care. Methods: We analysed data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB). The NSMHWB employed clustered probability sampling of all Australian adults, and 10,641 participants were interviewed. The field questionnaire included modules of the Composite International Diagnostic Interview, and instruments assessing disability, service utilisation and perceived needs for care. Results: Eighty-four percent of people with a mental disorder consulted a GP in the year prior to survey, but only 29 % consulted in relation to a mental health problem. GP services were seen as more responsive to needs for medication, counselling and information than needs for social interventions and skills training. People with perceived needs for counselling were more likely to consult with other providers, either as alternative or additional consultations to those with a GP. Counselling needs were reported as less well met when people saw a GP alone than when consulting other service providers. Conclusions: Many people with mental health problems attend primary medical care practitioners without presenting these problems to their physicians. When they do present, perceived needs for medication are rated as well met, but there is substantial unmet perceived need for interventions in social and occupational domains. Perceived needs for counselling are less well met where the GP is the sole provider. To close these identified gaps calls for improvements in primary care physicians' skills and effective collaborative models with other providers. Accepted: 18 May 2001     

The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe

The pathways to care for mental illness are diverse and are dependent on sociocultural and economic factors. The objective of this study was to describe the pathways to primary care for patients with common mental disorders in Harare. One hundred and nine consecutive patients with conspicuous psychiatric morbidity identified by general nurses in three primary health care clinics (PHC) and by four traditional medical practitioners were interviewed with the Pathways to Care Schedule. Other than those patients with an acute illness, most patients consulted more than one care provider; three-quarters of those with a history of prior consultations had consulted both traditional and biomedical care providers. Biomedical care providers were the most common first care provider consulted; if this treatment failed, then patients tried other biomedical or traditional care providers. Different factors operated in the decision-making process in choosing between consulting biomedical and traditional care providers. Traditional care providers provided explanations more often than biomedical care providers; explanations given were most often spiritual. Injectable treatments were often prescribed for mental illness, especially by private general practitioners (GPs). Such treatments, and many oral treatments, were non-specific. Dissatisfaction with consultations was most commonly due to lack of symptomatic improvement. The costs of consultation were highest for private GPs, general hospitals and traditional healers; faith-healers, PHCs and hospital psychiatric departments were the cheapest.     

Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions

Purpose

Accessibility and availability of mental health care services are necessary but not sufficient for people to seek help for psychological problems. Attitudes and stigma related to help seeking also determine help seeking intentions. The aim of this study is to investigate how cross-national differences in attitudes and stigma within the general population are related to professional and informal help seeking intentions in low and high suicide rate regions.

Methods

By means of a postal structured questionnaire, data of 2999 Dutch and Flemish respondents between 18 and 65 years were gathered. Attitudes toward help seeking, perceived stigma, self-stigma, shame and intention to seek help were assessed.

Results

People in the Netherlands, where suicide rates are low, have more positive attitudes toward help seeking and experience less self stigma and shame compared to the people in Flanders, where suicide rates are relatively high. These attitudinal factors predicted professional as well as informal help seeking intentions. Perceived stigma was negatively associated with informal help seeking. Shame was positively associated with higher intention to use psychotropic drugs and perceived stigma was negatively associated with the intention to seek help from a psychotherapist in Flanders but not in the Netherlands.

Conclusion

Help seeking for psychological problems prevent these problems to aggravate and it is assumed to be a protective factor for suicide. Our results stress the importance of the promotion of positive attitudes and the reduction of stigma within the general population to facilitate help seeking from professional providers and informal networks. Focusing on these attitudinal factors is believed to be a key aspect of universal mental health and suicide prevention policies.     

Youths’ Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys

Youths’ experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths’ interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n?=?20 girls, n?=?11 boys; 12 to 21 years old [M?=?16.97, SD?=?2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n?=?26), anxiety (n?=?22), eating disorders (n?=?9), autism spectrum disorder (n?=?2), or conduct disorder or oppositional defiant disorder (n?=?2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., “Could you describe what was happening in your life when you first felt you would need support for your mental health?”). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed.

     

The Concept of Maternal Love

Background: Little is known about gender differences in mental health, related help-seeking behavior and social support in UK military personnel. Methods: 1714 UK military serving personnel and ex-service veterans were randomly selected if, in a cohort study, they endorsed experiencing a subjective stress, emotional, alcohol or mental health problem in the previous three years. Following exclusions, the final sample size was 1448 (participation rate 84.5%; women n = 219). Structured telephone interviews assessed anxiety, depression, PTSD symptoms, alcohol use, help-seeking and social support occurring both currently and in the past three years. Outcomes were assessed using weighted unadjusted and adjusted logistic regression analyses. Results: Mental health problems assessed at interview were broadly similar for men and women; for both genders, levels of social support were high. One-fifth of respondents screened positive for probable mental disorder or alcohol misuse; although rates of mental disorder symptoms did not differ by gender, women were significantly less likely than men to report alcohol misuse. Women were significantly more likely to have sought help from formal medical sources but significantly less likely to access informal support such as friends, family or unit welfare sources; reasons for seeking formal medical support were similar for men and women except for problem recognition and acting on advice from others, which were both significantly more common among women. Conclusion: For military personnel with a history of mental ill-health, women should make greater use of informal support networks while for men, engagement with formal medical help sources should be encouraged.     

Prevalence and correlates of service utilization and help seeking in a national college sample of female rape victims

This study examines prevalence and correlates of help seeking for emotional problems among undergraduate female rape victims. A national college sample of women endorsing a lifetime history of rape (N = 228) were interviewed in 2006 to assess demographic characteristics, rape history, rape characteristics, psychopathology, and substance abuse. Participants were asked if they ever sought help for emotional problems, and what type(s) of services were sought (medical professional, religious figure, or mental health professional). Prevalence of help seeking was 52%. Of help-seekers, 93% went to a mental health professional, 48% went to a medical doctor, and 14% sought religious counsel. Only PTSD was related to ever seeking help (OR = 2.35). Findings suggest that university-based mental health and medical facilities should be well prepared to identify and treat PTSD and other rape-related sequelae. Health promotion campaigns are needed to target substance abusing and depressed rape victims, who were less likely to seek help.     

Association Between Employment and Mental Health Service Use Among Justice-Involved Individuals

Using a nationally representative sample of justice-involved persons (N?=?1525), the present study examined the extent to which employment status was associated with mental health service use by various service providers. The findings indicate that the rate of mental health service use by general health care providers among the unemployed was higher than that of the employed. Factors associated with mental health service use varied by type of provider. Our findings suggest that employment may be critical for justice-involved people in enhancing their mental health status, which could result in their successful community integration.     

Staff in mental health agencies: coping with the dual challenges as providers with psychiatric disabilities

As persons with psychiatric disabilities have moved into provider positions in mental health they have developed coping skills to help maintain themselves in their jobs. This paper reports on a qualitative study of 12 service providers with psychiatric disabilities who identified the coping strategies that helped them in managing their dual roles. These coping methods were grouped together into categories of personal factors that included attitudes, cognitions, and behaviors, and external factors, meaning formal and informal supports.     

Narrating uncertainties about treatment of mental health conditions

Background  

Integration of patient views in mental health service planning is in its infancy despite service provision being clearly dominated by narratives from professional consultations and medical records. We wished to clarify perceptions of uncertainty about mental health conditions from a range of provider and user perspectives (patients, carers, parents, mental health service providers) and understand the role of narratives in mental health research.     

Correlates of a perceived need for mental health assistance and differences between those who do and do not seek help

Background: This study examined prevalence of perceived need for mental health assistance, characteristics of people with a perceived need, and how persons with a need who sought help were different from those who did not. Methods: A national random phone survey (n = 1,394) was conducted in Israel, which included questions about (1) perceived need for mental health assistance and (2) help seeking. Results: Prevalence of life-time and recent perceived need for males was 21% and 10.7%, and for females 31% and 15.1%. Of those with a perceived need, 31.4% of males and 41.6% of females had gone for help. Based on logistic regression models, the variables associated with need were being female, divorced, having a chronic physical disease, and low income (for males only), while predictors of help seeking were living in a big city and not being a recent immigrant. The major sources of help in descending order were: mental health professionals (46%), family physician (25%), family or friends (19%), and other (10%). Conclusions: A majority of people who feel that they need help for mental health problems do not get help. Accepted: 28 August 1998     

Relationships between adult emotional states and indicators of health care utilization: Findings from the National Health Interview Survey 2006–2014

ObjectiveAdults with serious psychological distress have a high likelihood of mental health problems severe enough to cause serious impairment in social and occupational functioning requiring treatment. These adults visit doctors frequently yet have poor health compared to adults without serious psychological distress. This study examined associations between emotional states of serious psychological distress in relationship to healthcare utilization indicators. A guiding hypothesis was that somatization underlying emotional states contributes to excessive healthcare seeking among adults with serious psychological distress.MethodsUsing 2006–2014 National Health Interview Survey, in adults with serious psychological distress (n = 9271), the six states: unable to make efforts, nervousness, hopelessness, sadness, worthlessness and restlessness were assessed in multivariate models in relation to four healthcare utilization indicators: change in the usual place of healthcare, change due to insurance, having seen a healthcare provider in the last 6 months and having 10 or more doctor visits in the last 12 months. Models were adjusted for sociodemographic variables, having seen a mental health provider, and health conditions.ResultsAdults feeling unable to make efforts were more likely to seek healthcare in the last 6 months and at least ten times in the last twelve months. Adults feeling hopeless were less likely to be heavy healthcare utilizers.ConclusionsPredisposing medical conditions do not fully explain healthcare utilization in adults with serious psychological distress. Educating healthcare providers about the emotional states motivating healthcare seeking, and integrating mental healthcare into primary care, may improve the health of adults with serious psychological distress.     

养育方式对青少年心理门诊患者应对方式的影响

目的:了解青少年心理门诊患者的应对方式与父母养育方式的关系. 方法:对107例青少年心理门诊患者(研究组)和104名正常青少年(对照组)进行应对方式和父母养育方式的测评,比较两组之间的差异,并对应对方式和父母养育方式作相关分析. 结果:研究组解决问题、求助的应对方式的评分显著低于对照组,而自责、退避、幻想的方式的评分显著高于对照组;研究组父母养育方式中,父母情感温暖因子评分显著低于对照组,而父母惩罚严厉、拒绝否认因子评分显著高于对照组(P<0.05或P<0.01).相关分析中,积极的应对方式与父母正性的情感因子呈正相关(P<0.05或P<0.01),而消极的应对方式则与父母负性的情感因子呈正相关(P<0.05或P<0.01). 结论:青少年心理门诊患者多采用消极的应对方式,且明显受到父母养育方式的影响.     

Help-seeking for mental health problems among young physicians: is it the most ill that seeks help?

Abstract Objectives The aims of this study were to assess the prevalence of self-reported mental health problems and help-seeking among young physicians, and identify predictors of seeking help. Methods A prospective cohort sample of Norwegian medical students (N=631) were assessed in their final semester (T1), and in the first (T2) and fourth (T3) postgraduate year. The average observation period was 3.6 years. Results The prevalence of mental health problems that needed treatment over the preceding year was observed to have increased from 11% at T2 to 17% at T3. There was no increase in help-seeking. Longitudinally, 34% reported that they needed treatment on one or several occasions. Adjusted predictors of help-seeking were perceived level of mental health problems and a reality weakness personality trait. Conclusion Those who sought help had higher levels of emotional distress than those who did not. However, higher reality weakness scores predicted lower help-seeking and, therefore, may be a risk factor for avoiding necessary care.     

Treatment seeking for depression in Canada and the United States

OBJECTIVE: Cross-country comparisons of patterns of mental health treatment seeking provide insights into the impact of contextual factors on mental health service use. This study aimed to compare prevalence and predictors of mental health treatment seeking among adults with major depression in Canada and the United States. METHODS: Data for 751 participants with a probable major depressive episode in the past 12 months were drawn from the 2002-2003 Joint Canada/United States Survey of Health: 304 were from Canada and 447 were from the United States. Probable major depressive episodes were ascertained by the Composite International Diagnostic Interview-Short-Form. Patterns of contacts with mental health and general health providers for mental health reasons were compared. RESULTS: Prevalence of contacts with any provider for mental health problems was similar among participants with a probable major depressive episode in Canada and the United States (181 Canadians, or 56 percent, compared with 245 Americans, or 52 percent). Canadian participants were more likely than those in the United States to seek treatment for mental health problems from family doctors and general practitioners, and among participants who sought such treatment, Canadians were more likely to also seek treatment from mental health professionals. In both countries, racial or ethnic minorities were less likely than Caucasians to seek treatment. Depression severity was more closely associated with treatment seeking in Canada than in the United States. CONCLUSIONS: Although studies from the early 1990s showed higher rates of treatment seeking for depression in Canada than in the United States, the more recent data presented here do not show such a gap. However, differences persist in the use of various providers. Compared with the United States, Canada had a closer match between depression severity and treatment, which suggests more efficient allocation of mental health care resources for treatment of depression in Canada.     

The role of providers in mental health services offered to American-Indian youths

OBJECTIVE: American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions. METHODS: A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed. RESULTS: Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type. CONCLUSIONS: The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.     

Twelve-month and lifetime health service use in Te Rau Hinengaro: The New Zealand Mental Health Survey

OBJECTIVE: To estimate the 12 month and lifetime use of health services for mental health problems. METHOD: A nationwide face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are 12 month and lifetime health service use for mental health and substance use problems. RESULTS: Of the population, 13.4% had a visit for a mental health reason in the 12 months before interview. Of all 12 month cases of mental disorder, 38.9% had a mental health visit to a health or non-health-care provider in the past 12 months. Of these 12 month cases, 16.4% had contact with a mental health specialist, 28.3% with a general medical provider, 4.8% within the human services sector and 6.9% with a complementary or alternative medicine practitioner. Most people with lifetime disorders eventually made contact if their disorder continued. However, the percentages seeking help at the age of onset were small for most disorders and several disorders had large percentages who never sought help. The median duration of delay until contact varies from 1 year for major depressive disorder to 38 years for specific phobias. CONCLUSIONS: A significant unmet need for treatment for people with mental disorder exists in the New Zealand community, as in other comparable countries.     

Mental health literacy,treatment preferences,and barriers in Salvadorian parents

Parents are pivotal in accessing treatment for their children, yet we know little about youth mental health literacy in parents. This is particularly the case in developing countries such as El Salvador, where good parent mental health literacy about children’s psychological problems may play a pivotal role in being able to navigate treatment access in an already underfunded and poorly resourced system. This study examined parent mental health literacy about child anxiety disorders in El Salvador; parent perceptions and preferences for treatment-seeking; and perceived barriers to accessing mental health treatment. Parents (N?=?271) of youth aged 4–17 in El Salvador answered questions about three vignettes depicting different childhood anxiety disorders. The majority of parents did not recognize specific youth anxiety disorders. Less than 5% of parents identified the vignettes as a mental health problem, most commonly attributing symptoms to personal weakness or stress. Parents endorsed generally positive views about seeking treatment, preferring non-pharmacological mental health treatments, informal support from grandparents and religious leaders, and handling the problem personally. The most common barriers to treatment-seeking were related to cost and service availability. Improving parent mental health literacy may assist with treatment-seeking. Results have implications for mental health policy decisions and service implementation in El Salvador.     

Barriers to Mental Health Help Seeking at School for Asian– and Latinx–American Adolescents

Adolescents are most likely to receive mental health services in schools compared to other settings; however, few studies have examined barriers to mental health help seeking at school for ethnic minority adolescents. The current mixed-methods study utilized surveys and semi-structured interviews to explore the mental health literacy (MHL), stigma toward mental illness, and perceived barriers toward help seeking at middle or high schools among 55 adolescents (81.8% female; 50.0% Asian–American, 44.6% Latinx–American, 5.4% Asian/Latinx bi-racial; M age = 17.13 years, SD = 2.33). Participants’ MHL was assessed using case vignettes that depicted adolescents with symptoms of depression or bulimia. Overall, 83.9% of participants correctly recognized depression and 57.1% correctly recognized bulimia from the vignettes. Stigma correlated with perceived helpfulness of the formal service providers (r = − .37, p < .01). Qualitative analysis of participant interviews revealed important knowledge, attitudinal, and practical barriers that inhibit Asian– and Latinx–American adolescents from seeking help for mental health problems at school. The current work has implications to assist school personnel and mental health providers in understanding and reducing barriers to help seeking for Asian– and Latinx–American adolescents.     

Mental disorders and help seeking in a rural impoverished population

OBJECTIVE: This study examined the impact of an in-home screening and educational intervention on help seeking among rural impoverished individuals with untreated mental disorders. The effect of including a significant other in the intervention and reasons for not seeking help were explored. METHOD: The sample was randomly selected from households in nine rural counties in Virginia. The short form of the CIDI was used to screen 646 adult residents. Respondents who screened positive were randomly assigned to one of three groups: 1) no intervention, 2) an educational intervention, or 3) the educational intervention with a significant other. A list of local sources of health and mental health care was distributed. At one-month post interview, respondents were telephoned to inquire about help seeking. RESULTS: Almost one-third (32.4%) of these respondents screened positive for at least one disorder. Five hundred and sixty-six (87.6%) were successfully followed up, and thirty-three of the 566 (5.8%) reported that they had sought professional help since the interview. Eighty-four subjects who screened positive and received the educational intervention reported in follow up that they had discussed the interview with a friend or family member, but only eleven (13.1%) received encouragement to seek treatment. The predominant reason endorsed for not seeking help was "felt there was no need," even among respondents who were informed that they had a disorder. CONCLUSIONS: A significant proportion of this rural impoverished sample screened positive for a mental disorder. Few individuals sought professional help and significant others did not encourage them to seek treatment. The implication of these results for investigators and service providers is that motivating individuals to seek mental health services is a complex process; more attention must be devoted to the development of culturally relevant methods for facilitating help seeking.