Stigma and other barriers to health and social care services among youth in Greater London

Abstract

Background/Objectives : Despite the evidence supporting early intervention as a means of mitigating onset of more severe psychopathology, most children in the United Kingdom do not receive treatment for their mental illness. Delays to service use are common and often only occur once the youth has already experienced significant impairment, clinical symptoms and stigma, the effects of which can be difficult to reverse. Stigma may directly impact access to mental health care and indirectly influence mental health problems. Stigma, however, may influence access in different ways for youth with various presentations of clinical symptoms and socio-demographic characteristics and may be greater for those youth with the highest level of risk. This study describes the patterns of formal and informal care utilised by youth and identifies facilitators and barriers to receiving services and treatments among youth. Additionally, we examine the relationship between variations in patterns of care and barriers to mental health care, specifically stigma, by clinical profile, socio-demographic and community characteristics. Methods : This study used a retrospective longitudinal design, nested within an ongoing prospective study to recruit a community sample of youth from Greater London over-representing youth from deprived inner-London areas. Clinical profile was determined via psychotic like experiences (PLEs), internalising/externalising mental health problems and early developmental delays. The „Services Assessment for Children and Adolescents“ was used to ascertain type, nature, frequency and duration of services used, treatments received, setting in which the service occurred (including a range of informal and formal care), reasons for service use, and referrals via phone interview with the parent. The interview also inquired about social cohesion, social capital, parental awareness of symptoms, availability of services, and socio-demographic variables which might facilitate access to care or mediate or moderate the effects of stigma. Multivariable regression models were used to examine the independent effects of stigma and other barriers on pattern of care. Models tested for confounding, interaction and moderation effects. Results : Initial findings will be presented based on interviews with 100 parents. Specifically, we will describe findings on the prevalence of care patterns and reported barriers to care by clinical profile. Predictors of care patterns and impact of stigma will be presented. Discussion/Conclusions : This study sheds new light on the potential effects of stigma on access to mental health care and social support. This study overcomes limitations associated with previous ‘pathways to care’ studies by examining a wide range of service systems, assessing service use among a community sample in a naturalistic way (rather than recruiting from a service setting), and by incorporating a dimensional perspective rather than a categorical perspective by assessing risk of schizophrenia. Future research should continue to investigate and implement strategies which reduce stigma and other barriers which impede access to services and to work toward the development of a service system which better meets the needs of youth and their families.