Barriers to Mental Health Care for Low-Income Clients As Perceived By Counsellors

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

ObjectivesApproximately 70% of people in British Columbia’s provincial prisons have mental health and/or substance use disorders. Many serve short sentences, and cycle frequently between corrections and community. This study examines mental health (MH) services access and reincarceration among people with a mental illness released from British Columbia’s provincial prisons.
 ApproachA 20% random sample of the general population of British Columbia (BC) (N=1,089,682) contained within BC’s Provincial Overdose Cohort was used. People who had a record of release from a provincial correctional centre between January 1 2015- December 31st 2018, and a mental illness diagnosis in the year prior to release were eligible for inclusion (N=3,907). MH services access was determined using primary care, hospitalization and emergency department records, and reincarceration and additional covariates were retrieved from linked provincial health and corrections records. Hazards of MH services access and reincarceration were calculated using state arrival extended cox proportional hazards models.
 ResultsOf the 3907 releases, 45.9% (N=1795) had MH services access following release, while 40.5% (N=1584) ended in reincarceration without MH services access. The remaining releases were censored prior to observing either outcome. Of those with MH services access, 59.4% (N=1067) ended in subsequent reincarceration. The hazard of reincarceration was elevated for people with concurrent substance use disorder, among both people who did (HR: 1.33 (95%CI: 1.13-1.57) and did not (HR: 1.55(95%CI: 1.22-1.81)) access MH services prior to reincarceration. MH services access had a protective effect on reincarceration (HR: 0.64 (95%CI:0.42-0.99)). Timeliness of MH services access was protective, such that each additional month that passed between release and subsequent MH services access was associated with a 5% increase in the hazard of reincarceration (HR: 1.05(95%CI: 1.02-1.08)).
 ConclusionMental health services access upon release from prison reduces risk of reincarceration. The timeliness of services access plays a critical role in reducing return to reincarceration. Efforts targeted at increasing accessibility of timely mental health services for this population can support increase individual well-being an reduce reincarceration.

School-Based Health Centers, Depression, and Suicide Risk Among Adolescents.

In the city of New Orleans, a number of social, cultural, economic, and historical factors have affected the availability and accessibility of mental health services. To assist individuals suffering from mental illness in the city of New Orleans, various agencies, programs and databases have been implemented to promote easy access to the available mental health services. This study explores the ease of accessing available mental health services through telephone contact. The telephone was used as the main source of contact in this study to emulate the experience that a potential mental health client would undergo when trying to find treatment. National, state, and local mental health provider databases were used to compose a list of mental health agencies in the New Orleans area. One hundred and twenty-seven facilities were identified as mental health treatment agencies. Each agency was contacted by phone and requested to participate in the study by completing a 15-item questionnaire regarding the availability and accessibility of mental health services. Seventy-nine percent [n= 101] of the agencies contacted by phone did not answer or had an automated voicemail service. Descriptive information regarding the availability and accessibility of mental health services, types of services, and treatment populations are reported and discussed. This research addresses the disparities between the burden of mental disorders, resources and accessibility.

Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.

The information about Urban Mental Health Services has been nearly nonexistent in India, although the developed countries have been focusing on programmes for “Healthy Cities”. The initiative taken as part of the WHO-ICMR Pilot Project on Urban Mental Health Services, with a public health perspective is being shared. The objectives of the Health Services Research (HSR) Arm of the project were to study the distribution and the availability of tertiary Mental Health Services, availability of human resources, average service load, mental health service gap, and perceptions of the users and the service providers, regarding the barriers in accessibility of mental health services, unmet service needs and strategies for improvement.The Research Methods involved Mapping Exercises with estimation of Service Loads and Qualitative Research Methods (QRM) like In-Depth Interviews (IDIs), Key Informant Interviews (KIIs), Free Listing and Focused Group Discussions (FGDs). The results indicate uneven availability of mental health services, human resource deficit specially for non-medical mental health professionals and mental health service gap (82% to96%). The average service load in the specialist mental health services is largely carried by the Govt. sector (half to two thirds), followed by the private sector (one third to half), with only a small portion by the NGO sector. The average mental health service load in the primary care general health services is largely carried by the private sector, with significant contribution from the non-formal service providers. The barriers to access, unmet needs and possible strategies as perceived by the community, users and service providers have been identified. The findings are discussed in the context of the mental health programmes and the public policy issues. The implications of the conclusions which suggest that Urban Mental Health Services are far from complete are highlighted.

Mental health problems in adolescence can profoundly jeopardize adolescent current and future health and functioning. We aimed to describe existing recommendations and services regarding the delivery of primary mental health care for adolescents in 31 European countries. Data on the availability and accessibility of primary mental health services were collected, as part of the Horizon 2020-funded project Models of Child Health Appraised. One expert from each country answered a closed items questionnaire during years 2017-18. All 31 participating countries had some policy or recommendations regarding the availability and accessibility of primary mental health services for adolescents, but their focus and implementation varied largely between and within countries. Only half of the participating countries had recommendations on screening adolescents for mental health issues and burdens. Merely a quarter of the countries had ambulatory facilities targeting specifically adolescents throughout the whole country. Just over half had some kind of suicide prevention programs. Same-day access to primary care in case of -health emergencies was possible in 21 countries, but often not throughout the whole country. Nineteen countries had strategies securing accessible mental health care for vulnerable adolescents. Overall, around half of European countries had strategies securing access to various primary mental health care for adolescents. They frequently did not guarantee care over the whole country and often tackled a limited number of situations. EU countries should widen the range of policies and recommendations governing the delivery of mental health care to adolescents and monitor their implementation.

Even though the policy of deinstitutionalization of mental health services purports to improve access to community-based services, there is a paucity of research that evaluates the impact of this policy on the general community. The research in this study builds on an empirical analysis of 40 years of the process of deinstitutionalization of mental health services in Canada (Sealy & Whitehead, 2004). An experimental design is simulated through the use of a derived construct—earlier vs. later deinstitutionalization—in order to test whether the policy of deinstitutionalization has achieved the goal of improving the accessing of mental health services by people with increased levels of psychological distress, while taking into consideration various social correlates. Data about the accessing of mental health services were obtained in the National Population Health Survey (Statistics Canada, 1996, 2001). Results identify that provinces that implemented deinstitutionalization earlier show improved access of community mental health services and fewer social inequalities of access. Nevertheless, the majority of people who have higher levels of psychological distress have not accessed mental health services.

Although experiencing lower levels of mental health compared to the general population of Canada, Black Canadians are less inclined to seek help from mental health services. Thus, the aim of this scoping review is to systematically document the current literature on the barriers in accessing mental health services among Black Canadians. Following PRISMA guidelines, a systematic search of the existing literature was conducted using PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, and Scopus on September 8, 2024. The final dataset consisted of 20 studies published between 1998 and 2023. Findings were synthesized using the sociobehavioural model of health service use to define the subtypes of barriers and the construct of Mental Health Literacy to guide the thematic analysis of the extracted data. Barriers impacting Black Canadians' access of mental health services included language barriers, difficulties in navigating the mental healthcare system, wait times, the quality of resources, and the lack of mental health services in their communities. Themes identified as barriers of use were Mental Health Literacy, Negative Perceptions of the Mental Healthcare System, and Discrimination. Challenges discussed in this review implicate the importance of a multitargeted approach to increasing the access and usage of mental health services among Black Canadians. This review also provides a foundation for research and practice that aims to investigate and develop strategies to promote the mental health of the Black population in Canada. Accordingly, we identify gaps in research-regarding the mental health perceptions, beliefs, and experiences of Black Canadians, required to properly develop interventions that increase mental health service access.

Aims:To explore the availability, access and utilization of mental health services during COVID-19 pandemic restrictions (1st wave) in patients registered at psychiatry facilities across India and to assess difficulties faced by caregivers of these patients.Methodology:It was a multi-centric study carried at 4 centres across India, providing mental health services. It used convenience sampling method, wherein we recruited a total of 500 subjects from all centres over a period of 6 months using predefined inclusion and exclusion criteria. A semi structured performa to explore the availability, access and utilization of mental health services and difficulties faced by caregivers during COVID-19 pandemic.Results:Of the 500 subjects recruited, 54.6 % were males, 80.4% were Hindus and 56% were from rural areas. The subjects reported that 75.3% had problems accessing the mental health services, owing to closure of OPD services (83.2%), non-availability of doctors (63.5%), poor availability of transport (61.9%). It was reported that 16.3% changed their psychiatrist and had to contact GPs (16.5%), their illness worsened in 66.1% of the cases, 68.8% faced difficulties in availing psychotropic medications. The caregivers of these subjects reported that 80.3% of them faced difficulties during lockdown which was attributed to non-availability of doctors (67.5%) and medication (33.6%).Discussion:This sub-sample of registered OPD patients at 4 treatment facilities across India, showed that three fourth of subjects had problems accessing OPD, which was largely due to closure of routine OPDs and non-availability of doctors as well as transport facilities due to pan India lockdown. One sixth of patients had to change their psychiatrist and resort to GPs for consultation. In two third of cases the symptoms worsened and around same numbers did not get psychotropic medications during lockdown. Three fourth of caregivers of patients reported difficulties due to non-availability of doctors and medications.Conclusions:COVID-19 pandemic related restrictions affected the availability, access and utilisation of mental health services negatively and lot of difficulties were also faced by caregivers of these patients.

The World Health Organization declared COVID-19 as a pandemic in March 2020. COVID-19 has since caused a significant increase in mental health problems at national and global levels. This study assessed the views of key mental health stakeholders regarding the state of mental health service provision in Malawi and the pandemic's impact on the sector. The study utilised a qualitative approach through key informant interviews (KIIs) conducted using a semi-structured interview guide. The interviews were audio recorded in English language and were manually transcribed for thematic analysis by generating codes re-classified into themes, sub-themes and quotes. The results are categorised into five themes. Firstly, the availability of mental health services. All experts confirmed the lack of availability of the mental health services especially at the lower levels of care. Currently, only 0.3% of facilities offer mental health services in Malawi. Moreover, although mental health services are part of the essential health care package and, therefore, are supposed to be provided for free in public facilities at all levels, the services are centralised and only functional at a tertiary level of care in public facilities. Secondly, funding sources for mental health in public and private facilities. We learnt that public facilities depend on donor sources and there is lack of prioritisation in budget allocation for mental health services. Whereas private facilities, their major source of funding is user fees. Thirdly, government's response in the provision of mental health services during COVID-19. Almost all experts echoed that government took a proactive approach to address the mental health needs of its population during the pandemic. There was increased collaboration between the government and the private sector to provide psychosocial and counselling services to health workers working directly with COVID-19 patients in isolation centres. Furthermore, to increase awareness of the general population on where to seek counselling services. Lastly, challenges in the provision of mental health services were highlighted and how the pandemic acerbated the challenges including shortage in human resources for health and inadequate funding. This study underscores the urgency of addressing mental health challenges in Malawi. Policymakers must prioritize the decentralization of mental health services, explore funding opportunities, and build on the successful collaboration with the private sector. These measures will not only enhance the accessibility and quality of mental health services but also ensure that mental well-being is a central component of public health efforts in Malawi.

Background: Mental health in Puerto Rico is a complex and multifaceted issue that has been shaped by the island’s unique history, culture, and political status. Recent challenges, including disasters, economic hardships, and political turmoil, have significantly affected the mental well-being of the population, coupled with the limitations in the accessibility of mental health services. Thus, Puerto Rico has fewer mental health professionals per capita than any other state or territory in the United States. Objective: This comprehensive review examines the impact of disasters on mental health and mental health services in Puerto Rico. Given the exodus of Puerto Ricans from the island, this review also provides an overview of mental health resources available on the island, as well as in the continental United States. This review identifies efforts to address mental health issues, with the intent of gaining a proper understanding of the available mental health services, key trends, as well as observable challenges and achievements within the mental health landscape of the Puerto Rican population. Design: A comprehensive search using the PRIMO database of the University of Central Florida (UCF) library database was conducted, focusing on key terms related to disasters and mental healthcare and services in Puerto Rico. The inclusion criteria encompassed studies on Puerto Rican individuals, both those who remained on the island and those who migrated post-disaster, addressing the mental health outcomes and services for adults and children. We included peer-reviewed articles published from 2005 onwards in English and/or Spanish, examining the impact of disasters on mental health, accessibility of services, and/or trauma-related consequences. Results: In this scoping review, we identified 39 studies addressing the mental health profile of Puerto Ricans, identifying significant gaps in service availability and accessibility and the impact of environmental disasters on mental health. The findings indicate a severe shortage of mental health services in Puerto Rico, exacerbated by disasters such as Hurricanes Irma and Maria, the earthquakes of late 2019 and early 2020 that followed, and the COVID-19 pandemic, resulting in substantial delays in accessing care, and limited insurance coverage, particularly in rural regions. Despite these challenges, efforts to improve mental health services have included substantial federal funding and community initiative aimed at enhancing care availability and infrastructure. Limitations include the use of a single database, language restrictions, and potential variability in data extraction and synthesis. Conclusions: This scoping review highlights the significant impact of disasters on mental health in Puerto Rico and the challenges in accessing mental health services exacerbated by disasters. Despite efforts, significant gaps in mental healthcare and services persist, emphasizing the need for more rigorous research and improvements in infrastructure and workforce to enhance mental health outcomes for Puerto Ricans both on the island and in the continental United States.

Police officers face many challenges in their profession. These challenges can impact an officer physically, mentally, and emotionally. Although male and female police officers face many of the same struggles within the profession, there are notable differences. Some challenges female police officers face more frequently are sexual discrimination, sexual harassment, and isolation which can cause stressors such as anxiety, depression, and other mental health issues. As such, mental health services that are offered should take into consideration specific gender needs. This study examined the availability of mental health services for female police officers and their experiences when contemplating participation in such services. In this qualitative study, 10 female police officers were interviewed about their work experiences, mental health service needs, and the mental health services available to them. The data were thematically analyzed across participant responses. The interviews yielded various mental health service availability on a national level with no specific focus on gender needs.

This study sought to examine psychiatrists' perceptions of gaps in the availability of mental health and substance use services and their ability to spend sufficient time and provide enough visits to meet patients' clinical needs. A cross-sectional probability survey of U.S. psychiatrists was fielded during September through December 2013 by using practice-based research methods, including distribution by priority mail. Psychiatrists (N=2,800) were randomly selected from the American Medical Association Physician Masterfile, and 1,188 of the 2,615 (45%) with deliverable addresses responded. Of those, 93% (N=1,099) reported currently treating psychiatric patients, forming the sample for this study. Thirty percent or more of psychiatrists reported being unable to provide or find a source for each of the following services in the past 30 days: psychotherapy, housing, supported employment, case management or assertive community treatment, and substance use treatment. Approximately 20% reported being unable to provide or find a source for inpatient treatment, psychosocial rehabilitation, general medical care, pharmacologic treatment, and child and adolescent treatment. Approximately half (52%) of psychiatrists reported not having enough time during patient visits, affecting 28% of patients. More than one-third (37%) reported being unable to provide enough visits to meet patients' clinical needs, affecting 24% of patients. Psychiatrists reported constrained availability of a range of mental health, substance use, and general medical services. In order for the Affordable Care Act to realize the promise of increased access to care, the infrastructure for mental health and substance use treatment, workforce, and services delivery may require significant enhancement.

This is a collection of policy briefs created and disseminated over the course of PRIME's grant period of eight years.Contained in this collection are the following policy briefs:PRIME Policy Brief 2. May 2013. Scale up of services for mental health in low-income and middle-income countries. Julian Eaton, Layla McCay, Maya Semrau, Sudipto, Chatterjee, Florence Baingana,Ricardo, Araya, Christina Ntulo,Graham, Thornicroft, Shekhar Saxena. PRIME Policy Brief 3. May 2013. Human Resources for mental health care: current situation and strategies for action. Ritsuko Kakuma, Harry Minas, Nadja van Ginneken, Mario R Dal Poz, Keshav Desiraju, Jodi E Morris, Shekhar Saxena, Richard M Scheffler. PRIME Policy Brief 4. November 2013.The acceptability and feasibility of task sharing for mental healthcare in low and middle income countries: a systematic review. Prianka Pamanathan, Mary J De Silva. PRIME Policy Brief 7. December 2014. Setting priorities for mental health care in Nepal: a formative study by Mark J D Jordans, Nagendra P Luitel, Mark Tomlinson and Ivan Komproee. PRIME Policy Brief 8. January 2015. Demand and access to mental health services: a qualitative formative study in Nepal by Natassia F Brenman, Nagendra P Luitel, Sumaya Mall and Mark J D Jordans. PRIME Policy Brief 9. March 2015. Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders by Catherine O Egbe, Carrie Brooker-Sumner, Tasneem, Kathree, One Selohilwe, Graham Thornicroft and Inge Petersen. PRIME Policy Brief 10. October 2015: British Journal Of Psychiatry Supplement. Integration of mental health into primary care in low- and middle income countries: the PRIME mental health care plans. PRIME Policy Brief 11. October 2017. A collaborative integrated package for common mental disorders as part of chronic care in South Africa.by Inge Petersen, Arvin Bhana, Lara Fairall, One Selohilwe, Tasneem Kathree, Emily Baron, Sujit D Rathod, Crick Lund. PRIME Policy Brief 12 November 2017 Proactive community case-finding to facilitate treatment seeking for mental disorders in Nepal by Mark JD Jordans, Brandon A Kohrt, Nagendra P Luitel, Crick Lund & Ivan H Komproee PRIME Policy Brief 13. May 2018. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews by Crick Lund, Carrie Brooke-Sumner, Florence Baingana, Emily Claire Baron, Erica Breuer, Prabha Chandra, Johannes Haushofer, Helen Herrman, Mark Jordans, Christian Kieling, Maria Elena Medina-Mora, Ellen Morgan, Olayinka Omigbodun, Wietse Tol, Vikram Patel, Shekhar Saxena. PRIME Policy Brief 13. July 2018. Bridging the gap: the way forward for intersectoral provision of mental health services.by Carrie Brooke‑Sumner, Crick Lund & Inge Petersen. PRIME Policy Brief 16. August 2018. Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal. Nagendra P Luitel, Mark J D Jordans, Brandon A Kohrt, Sujit D Rathod & Ivan H Komproee PRIME Policy Brief 17. August 2018.Validation of the Brief Mental Health Screening Tool (BMH) Arvin Bhana, Ntokozo Mntambo, Gugu Gigaba, Merridy Grant, Dianne Ackerman, Zamasomi Luvuno, Ellen Ntswe & Inge Petersen. Implementation of PRIME mental health care plan in Sehore district, Madya Pradesh, India: outcomes and learnings. Scaling up mental health services in Madhya Pradesh through the ‘Mann-Kaksha’ model.