Intersectional Invisibility: Exploring Systemic Barriers and Lived Experiences of Mental Health Access for Female Athletes in Male-Dominated Sports Cultures

Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support. This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people's mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. This study is registered as PROSPERO CRD42019135722. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13–16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma – including anti-Black racism and homophobia – may still pose challenges for SMYoC in need of mental health care.

Students who are marginalised based on varying identities, backgrounds and characteristics are highly vulnerable to mental health challenges, but many do not receive appropriate support from healthcare services. Several barriers have been identified, including cultural and systemic factors. Therefore, everyday coping strategies and support in different settings are vital. This study examines the mental health coping strategies and support needs among marginalised students in the United Kingdom (UK). We analysed qualitative and quantitative data from a cross-sectional survey conducted between December 2021 and July 2022. Statistical analysis was conducted on data obtained using the abbreviated version of the Coping Orientation to Problems Experienced Inventory (Brief-COPE). Qualitative content analysis was applied to data collected using open-ended questions. From a subsample of 788 further and higher education students, 581 (73.7%) students (M = 25 years, SD = 8.19) were categorised as marginalised based on ethnicity, sex/gender, sexuality, religious beliefs, first language, birth country, age (i.e., mature students), and having special education needs/disabilities. Marginalised students had significantly higher scores for problem-focused, emotion-focused and avoidant coping strategies/practices compared to other students. Coping strategies included talking to friends and family, practising religion or spirituality, engaging in creative/innovative activities like hobbies, using entertainment as a distraction, waiting to see if things improve and isolating. Students expressed a need for improved or tailored services, additional academic support, and appropriate social support. These included contemporary approaches to support mental health, such as online provisions, regular mentor/personal tutor meetings, lowered academic pressures and opportunities for organised peer support. The findings from this study highlight significant and timely evidence on coping strategies and support needs among a wide range of marginalised student groups in the UK. This study provides important knowledge that is useful to inform personalised culturally appropriate mental health support that can be offered in education settings.

Mental health conditions are highly prevalent and represent one of the leading causes of suffering and disability in the European Region. In 2021, more than 150 million people in the WHO European Region were living with a mental health condition, and only one in three people living with depression received the care they need. To address these gaps in mental health services and support, many of which have been made worse by the COVID-19 pandemic, the WHO European Region launched in September 2021 a PanEuropean Mental Health Coalition (thereafter Coalition). The Coalition aims to target gaps in mental health services by gathering national leaders, professionals, members of civil society, representatives of international organizations and experts to collaborate on bringing mental health out of the shadows and into the mainstream. Key priorities for the Coalition include transforming mental health services and integrating mental health into emergency response and recovery efforts, as well as promoting mental health and preventing mental ill health across the life course. The WHO European Region organized the first meeting of the Coalition in May 2022 to begin the development of six working packages, including Work Package III: Mental Health and wellbeing of older adults. A mapping exercise of existing high-quality tools, resources, and guidelines relevant to the mental health and wellbeing of older adults for the WHO European Region was commissioned in Summer 2022 by the Coalition. This paper is a modified version of the mapping exercise. This research highlights the overarching challenge facing older adult mental health services, beyond chronic and systemic constraints of underfunding and staff shortages. A contrast exists between the specific and often complex mental health needs of this diverse group, and the systemic and individual barriers which currently prevent their mainstream access to high quality care. Barriers include, amongst others: - fragmented care pathways with other sectors of the health system, such as acute care; - professional and institutional biases including ageist and discriminatory attitudes from health and social care workers; - difficulties with access and/or acceptability of online/digital psychological interventions; - generic adult mental health services which do not target their specific needs, partly due to the lack of involvement of older people in shaping their services in line with their individual preferences; - quality standards and indicators still tend to equate mental health services with dementia care, though slow improvements are ostensible. Individual barriers requiring behaviour change, such as the internalised stigma common among older people that mental health support provides little benefit, even though evidence points to the contrary, will be more difficult to shift. Policies to encourage social participation, both to enhance wellbeing and reduce a risk factor for mental illness in old age, could be prioritised. Some promising case studies are worthy of note; these are highlighted throughout the paper.

BackgroundAustralian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people’s mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people’s experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful.MethodWe conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants’ experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants’ understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking.ResultsThematic analysis highlighted that, through the lens of participants, young people’s mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people’s existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs.ConclusionsWe propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people’s mental health development which comprises: 1) maximising young people’s emotional investment (engagement); 2) developing young people’s mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).

BackgroundA growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources.ObjectiveIn this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields.MethodsThe review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical s, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care.ResultsThere is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce.ConclusionsThere is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.

Linnemayr, Sebastian PhD; Barreras, Joanna L. PhD; Izenberg, Max MSc; Brooks, Ronald A. PhD; Gonzalez, Ana BA; MacCarthy, Sarah DSc Author Information

The COVID-19 pandemic has taken a significant mental and emotional toll on critical care nurses. High patient acuity, staffing shortages, and increased care needs both in the hospital and in the community are contributing to increases in depression, anxiety, and overall burnout. Nurses who perceive, internalize, anticipate, and experience stigma may be hesitant to engage in mental health care and self-stewardship. Resultingly, stigma is a detriment to the mental health and overall well-being of critical care nurses. The American Nurses Association recognizes this stigma and is committed to dismantling stigma as a barrier to mental health care. Nurses may fear social and professional consequences associated with receiving mental health care. Nursing leaders and organizations can take steps to reduce stigma related to mental health care and support self-stewardship among critical care nurses.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.

The stigma of mental illness can often lead to the afflicted individual not receiving the professional help they need and thereby worsening their condition, which has serious consequences both for themselves and their loved ones. Moreover, stigma surrounding mental illness varies from culture to culture. This research study highlighted the significance of studying stigma and long-term coping with a loved one’s mental health issues across cultures. Differences in perceptions of mental health based on the type of culture and (in)experience of growing up with someone who had mental health issues were tested. I predicted that there were main effects of both culture and exposure, such that participants from collectivist cultures would have more negative perceptions towards mental health and those who did not grow up with someone who had mental health issues would have more negative perceptions towards mental health. I also predicted an interaction: while individualists would have relatively positive perceptions regardless of experience, collectivists would have negative perceptions where there is no experience but relatively positive perceptions if there is experience growing up with someone who had mental health issues. Additionally, I tested that these effects were held when controlling for socioeconomic status, mental health education, mental health support, and gender. The results of the study only supported a main effect of culture on anger. Additional analyses found that there were interaction effects among culture and mental health support and culture and mental health familiarity for both personal responsibility and anger. Overall, while the study did not bridge the gap between cultural stigma and coping, it did contribute to the literature by indicating how strongly culture and stigma influence mental health perceptions, and how individuals with past experiences of mental illness compared to those without past experiences of mental illness.

AimsChildren and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether and how ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students.MethodsWe used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children’s Anxiety and Depression Scale (RCADS).ResultsOur analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support and 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, the cumulative ACE score was significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI) 1.29–1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI 1.37–1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI 1.17–1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI 0.84–0.93) as well as perceived unmet need (aOR=1.32; 95% CI 1.21–1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI 0.78–0.91).ConclusionsAlthough it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible, and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

BackgroundIntegration of maternal mental health into primary health care is considered a strategy to improve access to mental health support in low- and middle-income countries (LMICs). Health care workers’ (HCWs) and traditional practitioners’ (traditional healers, herbalists, traditional birth attendants, spiritual healers, prophets, and community health volunteers) perceptions of the availability and management of adolescent mothers’ maternal mental health care were explored in rural Malawi. Recognizing and identifying the barriers associated with access to maternal mental health support is essential to improving the mental health of adolescent mothers.MethodsA descriptive qualitative design (DQ) was used to explore HCWs’ and traditional practitioners’ perceptions of maternal mental health services for adolescent mothers. In-depth interviews were conducted with HCWs (n = 6), and three focus group discussions were conducted with 30 community-based traditional practitioners. Participants were purposefully recruited because they provide formal or informal health services to adolescent mothers during the postnatal period at Mitundu Rural Hospital and its catchment area in Lilongwe District, in Malawi. Interviews were analyzed using reflective thematic analysis and inductive thinking.ResultsThematic analysis found four themes to describe access to maternal mental health care for adolescent mothers. Participant perceptions were themed around health system challenges and how cultural background and beliefs influence access to mental health care and support. The themes were: (1) Inadequate staff development; (2) Limited resources (medication and infrastructure); (3) Limited policy and guidelines implementation; and (4) Cultural background and belief influence on help-seeking. HCWs suggested improving pre-service and in-service training to improve mental health assessment of mothers, while traditional practitioners wanted to increase their awareness of mental health issues.ConclusionParticipants emphasized that multifaceted factors influenced access to mental health support. These factors affect the assessment, treatment, and support of adolescent mothers and help-seeking by mothers. Therefore, strengthening the healthcare system and empowering providers with the knowledge and skills to recognize at-risk mothers and provide timely support is essential.