DISSERTATION

10 STRATEGIC POINTS

2
10 STRATEGIC POINTS

2

Factors that Influence Utilization of Public Mental Health Services

RSD-851: Residency: Dissertation
Grand Canyon University

October 5, 2020

10 Strategic Points

My Degree: Ph.D.

Program Emphasis: Industrial Organizational

Ten Strategic Points

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Broad Topic Area

Factors that Influence Utilization of Public Mental Health Services

Lit Review

(Theoretical Framework (Theory)

Gaps

Themes

All Citations

Gaps

A. Basu, Rehkopf, Siddiqi, Glymour, & Kawachi (2016). According to the authors, there is a gap here in the changes being experienced in social policies in recent years. It has created a gap among women with low income in South Texas. Accordingly, the authors used the determination of the differences in income to understand the relationships between health outcomes and welfare reforms as it impacts the less privileged women in comparison to the most affected women.
B. Ly, A. (2019). This study focused on the factors that influence the utilization of mental health among Vietnamese Americans and the barriers to seeking help in Texas. The study had 12 participants including providers and community leaders who were familiar with the target population. The findings of the study indicated that there is a gap here in cultural acceptance of mental health treatment. Hence the need to culturally specify mental health intervention to improve mental health utilization in the community. However, the study was limited by the small sample size; therefore, the findings cannot be generalized. Further studies should include more cultural groups to validate the findings of this research.
C. Kwan, P. P., Soniega-Sherwood, J., Esmundo, S., Watts, J., Pike, J., Sabado-Liwag, M., & Palmer, P. H. (2020). The authors of this study aimed to evaluate the facilitators and barriers to mental health utilization among Pacific Islanders. Semi structure interviews were used to collect information from 12 pacific islanders. Trained community leaders recruited eligible candidates for the study. The study was limited by the small sample size. Five themes arose from the study. There is a gap here in regard to cost of healthcare, mental health stigma and language and culture barriers, which were the themes that emerged concerning barriers affecting the utilization of mental health services. The researchers indicated the need for future studies to include a larger sample size to enable generalization of the findings.
D. Volkert, J., Andreas, S., Härter, M., Dehoust, M. C., Sehner, S., Suling, A., . . . Schulz, H. (2018). The aim of this study was to evaluate various aspects of the utilization of mental health services among the elderly. The study had 3,142 participants aged between 65-84 years. Logic regression approach was used to analyze predisposing, enabling, and need factors among the participants. Similarly, the study found that there is a gap in the factors influencing elderly people to utilize mental health services because they felt they could deal with their situations. The study indicated that more research is needed to validate the results of this study.

Theoretical Foundation

The theoretical foundation of this research will be based on the cognitive theory of psychopathology that was suggested by Aaron T Beck. It states that individual perception is influenced by positive and negative mental health status (DeYoung & Krueger, 2018). This model fits directly into the dissertation because it is helpful at describing how individual’s perceptions of situations including spontaneous thoughts on events influence people’s emotional, behavioral, and psychological reactions in relations to mental health services. The theory emphasizes that the distorted beliefs influence people’s understanding of themselves, their surroundings, and their interaction with others. As such, distorted beliefs influence the way individuals process information.

Similarly, the theory focuses on perception in consideration that mental health is primarily a perception and has neural connections. Where a neural connection is right, then, the other factor that influence individuals’ views on mental health services is their perception. Perception is the understanding of interpretations of a phenomenon, which is influenced by an experience an individual has lived, prior events, culture, values, present circumstances, education, and preconceived notions (Rosli & Goh, 2020). Through the understanding of influences of perception, people’s views regarding the utilization of mental health services is understandable.

Furthermore, this theory connects to the study of mental health utilization through the concepts of perception. A research of the difference in individuals’ utilization of mental health services shows that it is about individual perceptions. Over time, as individual perceptions were grouped together, consequentially, their beliefs about utilizing mental health will be formed. Using example of the LBGT community, their beliefs about utilizing mental health services conforms to an identity that is not agreed upon (Steele et al., 2017). In their view, an individual’s perception grows into the belief that supports non-utilization of mental health services. Knight & Winterbotham (2020), states that perception is an understanding of individual’s decisions to either utilize or not utilize mental health treatment. The use of cognitive theory of psychopathology as the foundation of this study, will provide the possibility of understanding the rational why certain people openly utilize mental health services and why others do not utilize the services. This is because the theory emphasizes that perception can either influence positively or negatively people’s mental health status, which helps in explaining the role of perception in the utilization of mental health services.

Through an understanding of perceptions in the study, it is possible to explain why individuals have different opinion about mental health. Therefore, it will contribute significantly to the knowledge under investigation about mental health utilization and how individuals seek mental health services. Using the cognitive theory of psychopathology, it is possible to extend the theory to the study of mental health. The theory is now built on the research questions. It is used for the study because it provides a framework that considers past studies on mental health with specific emphasis on the seeking behaviors of mental health services.

Review

A. Empathic Approach: The problems of underutilization of mental health services and non-institutionalization of adults has been emphasized as behavioral risk factors. According to Kohn et al. (2018) there is a gap in utilization of mental health services in the United States among the individuals that require treatment and those that actually receive the treatment. Therefore, there is the need to establish and understand what the social determinants of mental disorders are, and align them with the sustainable development goals, and to establish the potential mechanisms and targets for interventions (Kohn et al., 2018). Lund et al., (2018) also expressed the same gap in mental health utilization in Southern Texas, stating that there is need to conduct further research on why individuals utilize or chose to reject mental health services. The authors assert that the number of mental health patients seeking treatment and medication are fewer than those that are actually suffering from the illness (Lund et al., 2018).

Professional Development:

Job Satisfaction:
With some recent issues in the country that have been linked to mental health issues, there is an emergence focus on mental health as a critical area of interest. Problems of mental health has been sidelined for many years, but now, there is the realization to understand the reasons why people utilize or reject treatment. While this is being extensively studied, more attention should be focused been to the patients. According to De Luca et.al. (2016), most chronic health conditions and terminal illnesses tend to result in mental disorders in patients. For various reasons, mental health is now among the priorities of medical practice (De Luca et al., 2016).

Kohn, et al. (2018), examined recent prevalence of mental health disorders including lack of utilization of its services. The outcome was that about 43% of children and adolescents in the country suffer from mental illness, the treatment gap in the group was 64%. Utilizing or rejecting the services is dependent on collaboration of participating in treatment, while both patients and providers work together to make the therapy valuable.

(Kohn, et al., 2016).

Themes

Review of the literature review identified the following themes:

· Mental Health Infrastructure

The mental health infrastructure is the mental health professionals that include psychologists, psychiatrists, counselors, psychiatric nurses, and clinical social workers. The healthcare sector has limited number of mental health providers that increases the challenges of combating increasing mental health patients and conditions. In the U.S the access to competent mental health providers is scarce in rural areas making it difficult for treating mental health illness (Prince, 2015). This infrastructure may impact reasons to accept or reject treatment.
· Reasons for Lack of Access to Mental Health

These include lack of insurance according to Kung, (2004) and Kohn, et al., (2018), lack of mental health professionals (Scripps Media, 2020), (Moore, & Krehbiel, 2016) and even poverty (Grayson, 2016). Research has shown that many people due to poor economic status have left many people without health insurance as they cannot afford it. This limits many average and lower-class families from accessing mental illness services (Children at Risk, 2013). Impoverished people may mislabel mental illness as mere signs of hunger and poor diet instead of mental illness (Children at Risk, 2013).

In the United States, 42% of the population believe that cost and poor insurance coverage are the top barriers that prevents them from accessing mental health care. While only 25% reported that they make decisions between using mental health treatment or paying for daily necessities (National Council for Behavioral Health, 2018). Getting face-to-face services remains a top priority for many Americans who are seeking mental health treatment than getting access to medication. Approximately 38% of Americans, or 96 million, on several occasions have waited longer than a week for mental health treatment services. Distance is another barrier in that about 46% of the population, have experienced or knew someone who has had to travel for over one-hour roundtrip to seek treatment (National Council for Behavioral Health, 2018).

Although many Americans have tried seeking mental health treatment, in addition to the 29% of the population who want to; however, failed to seek the treatment for either themselves or loved ones due to lack of knowing where to go for the services. also indicate that 21% of adults in the US have tried to see a professional but were unable to do so because of reasons outside of their control (National Council for Behavioral Health, 2018).
· People who do have Access to Mental Health

Medicaid, Medicare, Obamacare started covering mental health care after the implementation of the Affordable Care Act. The shortage of healthcare professionals means they are not willing to participate in treating insured patients because the payments are too low (Carroll, 2019).
· Populations that Use Mental Health Services.

Goldman et al. (2018) in their research found out that women who had been exposed to sexual abuse and drug abuse formed the high numbers of people who utilize mental health services among the Hispanic and non-white people in the county.
· Populations that Reject Mental Health Services.

Augsberger et al. (2015) in support of this research argued that mental health services had been underutilized by Asian women living in this county, as a result of both cultural needs and mismatch of the services offered in the health facilities in this Southern State.
· Reasons for Use of Mental Health Services

Behavioral health treatment, such as psychotherapy and counseling (Barrett, et al., 2009). Mental and behavioral health inpatient and outpatient treatment services (Cohen, 2002), (Peteet, 2019), and (North Texas Help, 2020). Substance use disorder (commonly known as substance abuse) treatment (HealthCare.gov, 2020), (Wang, & Xie, 2019) and (England et al., 2015).
· Reasons for Rejection of Mental Health Services

According to National Council for Behavioral Health, (2018), 31% of Americans are worried about being judged for seeking mental health services, and 21% of the population, have lied to people about seeking mental health services. The stigma is accurate among young Americans, who of course worried of being judged by others when they confess of seeking mental health services (National Council for Behavioral Health, 2018).

Problem Statement

It is not known how mental health providers describe the factors that influence utilization of public mental health services

Research Questions

· RQ1: How do mental health providers describe the factors influencing utilization of public mental health services?
· RQ 2: How do mental health providers describe strategies of encouraging patients to utilize public mental health services?

· RQ 3: How do caregivers describe the factors influencing patient’s utilization of public mental health services?
· RQ4: How do caregivers describe strategies of encouraging patients to utilize public mental health services?

Population

Target Population

Sample

· Location – South Texas. USA
· Participants will include people who are members of Mental Health Organizations including:

· Mental Health America (MHA)

· National Alliance on Mental Health (NAMI)
· Target Population:
· Mental Health Providers

Sample: 20 samples that will comprise of interviews with 10 Mental Health Providers and 10 Caregivers.

Describe Phenomena (qualitative) or Define Variables/Hypotheses (quantitative)

To understand factors that influence utilization of public mental health services
· Lack of mental health utilization in Texas.
· High rate of mental health conditions is reported in Southern Texas

· Texas is reported as poorly utilizing its allocated budget funding of mental health care

Methodology & Design

Qualitative Descriptive Study

Rationale for Methodology

Qualitative methodology is justified for my research because it is effective at providing rich data and is neither restrained nor bound by limitations. In addition, it is most appropriate because it is going to provide real life evidences based on interviews with participants who will be healthcare providers and caregivers that have difference experiences at giving primary data (Colorafi & Evans, 2016).
Furthermore, Ondersma, et al., (2017)’s comments on kim et al. (2017)’s topic “Staying Focused on Non‐Treatment Seekers,” described qualitative methodology as appropriate because data can be obtained in order to determine the health seeking behaviors (Ondersma, et al., 2017). This is applicable to my study as I try to determine individuals’ behavioral patterns and why they choose to either utilize or reject mental health treatment.

Qualitative methodology appropriately addressed the problem statement that tries to understand how mental health providers and caregivers describe the contributing factors to individual’s decision to utilize or reject mental health treatment because the methodology will be flexible and effective when collecting data and gathering information from the participants (healthcare providers and caregivers) based on their experiences.
Most of the previous studies that sought to determine the factors influencing health seeking behaviors among people experiencing mental conditions used quantitative research methodology. As a result, the findings of those studies did not explain important relationships and those associated with mental health utilization (Kapadia et al., 2017). Such studies focused extensively on the numerical and statistical elements of the study overseeing important relationships. As a result, this study will use a qualitative methodology to unearth the underlying relationships and themes that have not been studies before. The aim of the research is to determine factors that influence utilization of public mental health services.

A quantitative methodology will not be the most appropriate approach to this study. The findings of a quantitative study may be generalized as information is drawn from random sources (Rahman, 2017). On the other hand, the findings of qualitative research can be generalized as they are drawn from specific sources. In addition, researchers using the quantitative approach operate under assumptions and as a result the information obtained may be biased. On the other hand, qualitative research has little assumption to nil assumption. Quantitative studies are carried out in unnatural environments that make the respondents uncomfortable and therefore cannot provide the appropriate information (Savela, 2018). As a result, these limitations make quantitative methodology inappropriate for the present study.

Purpose Statement

The purpose of this qualitative descriptive case study is to understand how mental health providers describe the factors that influence utilization of public mental health services

Data Collection Approach

· Informed & signed consent by participants

· Visits to mental health providers and mental health facilities

· Interview with mental health providers & caregivers recorded on tape
· Interviews will involve 20 respondents from within Texas.

· Focus group with subset of 6.
· Sampling Method: Purposeful Sampling

· Sources: Interviews, Questionnaires & Focus Group Discussion

Data Analysis Approach

· Data to be collected
· Data will be analyzed for the study.
· Data will be entered into MaxQDA for analysis.

· Peer Debriefer meetings after analysis complete
· Descriptive statistics will be used to summarize collected data.

· Coding will be adopted to answer all questions.

· Will develop a narrative summary.
· Summaries of each participants codes will be emailed to participants for members’ checking. (Code, Definition, Quote for each code)

Summary

The South Texas health care costs is growing at a faster rate than in any other market in the country as it exceeds over $7,000 per person. However, despite the massive government’s healthcare investment and the expenditure in the region, there are still some surprising facts about healthcare in the region. The utilization of public mental health services in the state of Texas is very low while the utilization of private facilities is one-third higher than those at the Mayo Clinic in Rochester (Blosnich et.al. 2016). The Southern state of Texas continue to underutilize its available mental health resources as report indicate that there are discrepancies in the population’s utilization of public mental health services based on the marked differences in the amount of care ordered for patients. In comparisons with similar medical/health care patients Nationwide; generally, the patients in South Texas got much more of everything including more diagnostic testing, more hospital treatment, more surgery, and more home care, however, public mental health services and its resources remained underutilized by its population. For this reason, there is need for more research at several levels including an understanding of the reasons how people choose to utilize more of the private and reject the public mental health services for treatment.

Kohn, et al. (2018), states that generally, there is a gap in mental health treatment in the US resulting from lack of utilization of public mental health services even though there is the prevalence of mental health disorders in the country. My research study is intended to examine how the factors have been identified by mental health providers and caregivers, and how the factors influence individuals’ decision to either use or reject utilization of public mental health services, as well as ask the professionals the strategies they use to encourage patients to accept to use public mental health services for treatment and not reject it especially at the start of treatment and when continuing treatment. The research will be targeting the Southern Texas population for the study where it will systematically help in reviewing evidences that indicates the potential mechanisms causing people to either utilize or reject public mental health treatment in South Texas.

The theories explored in this research include Psychodynamic, Social, Cognitive, Behavioral, Humanistic, and Biological Influences. The one chosen for the theoretical model of the research gap is the cognitive theory of psychopathology that was suggested by Aaron T Beck. It states that individual perception is influenced by positive and negative mental health status (DeYoung & Krueger, 2018). This model fits directly into the dissertation because it is helpful at describing how individual’s perceptions of situations including spontaneous thoughts on events influence people’s emotional, behavioral, and psychological reactions in relations to mental health services. The theory emphasizes that the distorted beliefs influence people’s understanding of themselves, their surroundings, and their interaction with others. As such, distorted beliefs influence the way individuals process information.
References

Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC health services research, 15(1), 542. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1191-7

Ackerman, C. E. (2020). Psychoanalysis: A Brief History of Freud’s Psychoanalytic Theory. Retrieved from https://positivepsychology.com/psychoanalysis/
Basu, S., Rehkopf, D. H., Siddiqi, A., Glymour, M. M., & Kawachi, I. (2016). Health behaviors, mental health, and health care utilization among single mothers after welfare reforms in the 1990s. American Journal of Epidemiology, 183(6), 531-538. doi:10.1093/aje/kwv249
Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a Qualitative Description Approach in Health Care Research. Global Qualitative Research, 4, 233339361774228. https://doi.org/10.1177/2333393617742282

Cherry, K., & Morin, A. (2019). What Is Social Learning Theory? Retrieved from https://www.verywellmind.com/social-learning-theory-2795074
Children at Risk (2013), Fort Bend County Assessment, A Report on the Needs of the Community’s
Children, The George Foundation and The Fort Bend Chamber of Commerce, pp. 23.

Colorafi, K. J., & Evans, B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16-25.
De Luca, S. M., Blosnich, J. R., Hentschel, E. A., King, E., & Amen, S. (2016). Mental health care utilization: How race, ethnicity and veteran status are associated with seeking help. Community mental health journal, 52(2), 174-179. https://link.springer.com/article/10.1007/s10597-015-9964-3

DeYoung, C. G., & Krueger, R. F. (2018). A cybernetic theory of psychopathology. Psychological Inquiry, 29(3), 117-138. doi:10.1080/1047840x.2018.1513680
England, M. J., Butler, A. S., Gonzalez, M. L., Disorders, Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental, Policy, Board on Health Sciences, & Medicine, I. o. (2015). Psychosocial interventions for mental and substance use disorders. Washington, D.C: National Academies Press. doi:10.17226/19013 Retrieved from https://www.nap.edu/19013

Eslami, A. A., Norozi, E., Hajihosseini, M., Ramazani, A. A., & Miri, M. R. (2018). Social cognitive theory as a theoretical framework to predict sustained abstinence 6 months after substance use treatment. Philadelphia, Pennsylvania: Taylor & Francis Ltd. doi:10.1080/14659891.2017.1394382
Grayson, H. C. (2016). Caregiver impact on the relationship between need and utilization for child and adolescent mental health: An examination of factors influencing utilization of mental health services Available from ProQuest Central Student. Retrieved from https://search.proquest.com/docview/1840134079

Knight, B. G., & Winterbotham, S. (2020). Rural and urban older adults’ perceptions of mental health services accessibility. Aging & mental health, 24(6), 978-984.
Kohn, R., Ali, A. A., Puac-Polanco, V., Figueroa, C., López-Soto, V., Morgan, K., . . . Vicente, B. (2018). Mental health in the Americas: An overview of the treatment gap. Revista Panamericana De Salud Pública, 42 doi:10.26633/RPSP.2018.165
Kung, W. W. (2004). Cultural and practical barriers to seeking mental health treatment for Chinese Americans. Journal of Community , 32(1), 27-43. doi:10.1002/jcop.10077
Kwan, P. P., Soniega-Sherwood, J., Esmundo, S., Watts, J., Pike, J., Sabado-Liwag, M., & Palmer, P. H. (2020). Access and utilization of mental health services among pacific islanders. Asian American Journal of , 11(2), 69-78. doi:10.1037/aap0000172
Lund, C., Brooke-Sumner, C., Baingana, F., Baron, E. C., Breuer, E., Chandra, P., . . . Saxena, S. (2018). Social determinants of mental disorders and the sustainable development goals: A systematic review of reviews. The Lancet. Psychiatry, 5(4), 357-369. doi:10.1016/s2215-0366(18)30060-9
Ly, A. (2019). Mental Illnesses and Barriers to Seeking Mental Health Care in the Vietnamese Community in Austin, Texas from The Perspectives of Community Leaders and Providers (Doctoral dissertation). Retrieved from https://repositories.lib.utexas.edu/handle/2152/81247

Moore, J. & Krehbiel, C. (2016). Closing the gap on mental health service disparities through integrated pediatric care. Retrieved from https://www.apa.org/pi/families/resources/newsletter/2016/06/integrated-pediatric-care

Morin, A. & Cherry, K. (2019). How Social Learning Theory Works. Retrieved from https://www.verywellmind.com/social-learning-theory-2795074

National Council for Behavioral Health. (2018). New Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America. PR Newswire Retrieved from https://search.proquest.com/docview/2117336156

North Texas Help. (2020). Types of Mental Health Treatment Settings and Levels of Care. Retrieved from https://www.northtexashelp.com/mental-health-treatment-settings.html

Ondersma, S. J., Martino, S., Svikis, D. S., & Yonkers, K. A. (2017). Commentary on kim et al. (2017): Staying focused on non‐treatment seekers. Addiction, 112(5), 828-829. doi:10.1111/add.13736
Peteet, J. R. (2019). Approaching religiously reinforced mental health stigma: A conceptual framework. Psychiatric Services, 70(9), 846-848. doi: 10.1176/appi.ps.201900005

Picco, L., Lau, Y. W., Pang, S., Abdin, E., Vaingankar, J. A., Chong, S. A., & Subramaniam, M. (2017). Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: Findings from a cross-sectional survey in Singapore. BMJ Open, 7(8), e018228. doi:10.1136/bmjopen-2017-018228
Rahman, M. S. (2017). The Advantages and Disadvantages of Using Qualitative and Quantitative Approaches and Methods in Language” Testing and Assessment” Research: A Review. Journal of Education and Learning, 6(1), 102-112.
Roslee, N. L. B., & Goh, Y. S. (2020). Young adult’s perception towards the formation of stigma on people experiencing mental health conditions: A descriptive qualitative study. International Journal of Mental Health , doi:10.1111/inm.12766
Savela, T. (2018). The advantages and disadvantages of quantitative methods in school’s cape research. Linguistics and Education, 44, 31-44. doi: 10.1016/j.linged.2017.09.004
Seixas, B., Smith, N., & Mitton, C. (2017). The Qualitative Descriptive Approach in International Comparative Studies: Using Online Qualitative Surveys. International Journal of Health Policy and Management, 7(9), 778-781. https://doi.org/10.15171/ijhpm.2017.142
Scripps Media, Inc. (2020). Special Report: Mental healthcare shortage directly impacting South Texas. Retrieved from https://kristv.com/where-do-we-go-from-here/2018/11/15/special-report-mental-healthcare-shortage-directly-impacting-south-texas/

Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Green, D. C., Williams, C. C., & Ross, L. E. (2017). LGBT identity, untreated depression, and unmet need for mental health services by sexual minority women and trans-identified people. Journal of Women’s Health (Larchmont, N.Y. 2002), 26(2), 116-127. doi:10.1089/jwh.2015.5677
Volkert, J., Andreas, S., Härter, M., Dehoust, M. …