Abstract
Purpose: There is a paucity of data on barriers to mental health treatment utilization among residents of Wards 7 and 8 in Washington, DC, despite exposure to many environmental factors that are associated with poor mental health outcomes and the high prevalence of mental health problems among residents. The objective of this study was to examine barriers to mental healthcare utilization among residents of Wards 7 and 8.Methods: This study included semi-structured, in-depth interviews with five key informants who lived or spent significant time in Wards 7 or 8 in Washington, DC, which are the wards served by Paving the Way MSI, a behavioral health clinic that served as a partner organization in the study.Results: Barriers to mental health treatment utilization existed at a variety of social-ecological levels, including the individual/interpersonal level, the provider/mental health system level, the community level, and the societal level. Major barriers included fear and trust/distrust in the medical system, lack of social support, the model of mental healthcare, lack of patient-centered care, limited access to mental health services, stigma of mental illness and mental health treatment, and poverty.Conclusion: This study highlights the need to address barriers to mental health treatment utilization at multiple social-ecological levels. Future studies should examine perspectives from residents with mental health problems in these wards to gain a more thorough understanding of the barriers to treatment. Funding is needed to support efforts to increase mental health treatment utilization among residents of Wards 7 and 8.
Highlights
Participants described poverty as both a causal factor related to mental health problems and a barrier to mental health treatment utilization
This study demonstrates that barriers to mental health treatment utilization in Wards 7 and 8 exist at a variety of social-ecological levels, including the individual/interpersonal level, the provider/mental health system level, the community level, and the societal level
Many themes that emerged are consistent with other studies, including the role of stigma as a barrier to treatment[12] and the impact that negative experiences with and distrust of the mental healthcare system can have on use of services.[33]
Summary
Among low-income individuals and African Americans, utilization of mental health services is low.[1,2] AfricanAmericans are less likely than whites to receive mental healthcare and treatment[2,3,4,5,6] due to a variety of barriers, including low rates of insurance coverage,[7] lack of a regular healthcare provider,[7] difficulty finding resources for treatment of mental health problems,[8] distrust in the healthcare system,[9] competing health demands,[10] and stigma of mental health and mental health treatment.[9,11,12,13]Mirroring this national trend, adults living in Wards7 and 8 in Washington, DC, who are predominately low-income and African American,[14,15] experience higher rates of mental health problems compared with the rest of the District.[14,15,16,17] This part of Washington, DC is emblematic of distressed, isolated, and historically disadvantaged communities in cities across the a Ollie Ganz et al 2018; Published by Mary Ann Liebert, Inc. Americans are less likely than whites to receive mental healthcare and treatment[2,3,4,5,6] due to a variety of barriers, including low rates of insurance coverage,[7] lack of a regular healthcare provider,[7] difficulty finding resources for treatment of mental health problems,[8] distrust in the healthcare system,[9] competing health demands,[10] and stigma of mental health and mental health treatment.[9,11,12,13].
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