This is an academic paper written for my Fall 2018 English 111 class. This is my work and is not to be duplicated. It is uploaded to the an academic registry but has not been published except for in this blog. Enjoy!
Barriers to Mental Health
On and off throughout Maggie’s childhood, she struggled with feeling depressed and unmotivated. Often when she was feeling like this her parent would tell her to cheer up or shake it off. Maggie never felt comfortable talking to her parents about what she was experiencing because they consistently made derogatory remarks about people with mental health problems. She was scared that they would start calling her crazy or say she needed to be “locked up in a looney bin” too.
Maggie’s parents divorced when she was 13 years old, and she experienced her first suicidal thoughts. Her depression had worsened when she had to move over 1,000 miles away from the place she grew up. To cope with the weighty feelings of depression Maggie developed unhealthy coping strategies. She started drinking alcohol with her friends, binge eating, and having under age sex with much older boys. These behaviors intensified in college where Maggie’s drinking led her to being arrested several times for alcohol related offenses. Not only did Maggie’s behavior worsen, her suicidal thoughts increased as well.
Maggie felt ashamed about her depression and inability to manage it. She was afraid of what others might say if they found out. Because of this shame Maggie didn’t seek help from a mental health provider but from her primary care provider instead. After confirming Maggie was indeed experiencing depression, her primary care provider prescribed her depression medications and sent Maggie on her way. Within a week of starting this medication Maggie experienced an increase in her suicidal thoughts, driving her dangerously close to completing suicide one night. The next day, Maggie visited her primary care provider where she was told the “side effects” were all in her head. The only option she was given was to go back off the medication with no guidance on other options.
Throughout the next five years Maggie coped with her depression the best ways she knew how, by overeating and overdrinking. She stopped using sex to cope when she got married. In 2013 Maggie woke up hung over, after a particularly rough night of drinking, and decided enough was enough. She made the decision to end her life by overdose. Maggie could no longer live with her depressive thoughts anymore. She believed that the world would be better off without her, her family would be better off without her, and that she was just a burden on those around her. Fortunately for Maggie, her husband intervened before she could complete her suicide and encouraged her to seek out mental health treatment. Over the next five-years, Maggie received therapy that allowed her to heal from her past and taught her the tools she needed to manage her depression without relying on her unhealthy coping tactics. Today Maggie can thrive without depression controlling her life.
Stories like Maggie’s are not unusual. According to Sickel, “Nearly half of American adults are likely to experience a mental disorder during their lifetime” (1). Unfortunately, unlike Maggie, many of those people will not receive treatment for their mental health disorders. Among the reasons people do not receive proper mental health treatment are: cost, mental health stigma, prescriptions from a primary care provider, lack of mental health knowledge, no access to treatment, and belief that non-professional resources are just as good. These fall into three main categories: acceptability, affordability, and accessibility. Mental health disorders, if left untreated, not only affect the person experiencing them but society as well. It is important that mental health be treated just as important as physical health or the mental health crises will continue to progress and affect everyone.
In “Perceived Barriers to Mental Health Treatment among Individuals with a Past-Year Disorder Onset: Findings from a Canadian Population Health Survey,” Fikretoglu and Liu argue that “few individuals with a new-onset mental disorder access treatment in a timely manner.” (739). This article focuses on their study, which identifies the perceived barriers to accessing treatment in a timely manner. Fikretoglu and Liu used the Canadian Community Health Survey to determine the findings of their study. Their conclusion was that acceptability barriers, how acceptable seeking treatment is, were the most prevalent barriers of all. In the article Fikretoglu and Liu share some limitations that their study had, like sample size and the phrasing of each barrier in the survey. The honesty and objectivity in reporting the findings of their study makes the article accurate. The twenty-nine resources cited at the end of the article validates its contents. If someone wanted to understand the different types of barriers that prevents people from seeking out mental health treatment, this article would be very useful.
Acceptability, or mental health stigma, is the negative perceived beliefs, or attitudes, around mental health. In Maggie’s story she experienced stigma when she heard her parents talking about people being “crazy” or needing to be put in the “looney bin.” Mental health stigma can be noted in the way society talks about mental health and those with mental illness. This can cause those experiencing mental health disorders to feel ashamed or perceive their struggles as unacceptable to those around them. The higher the perceived mental health stigma, the less likely someone is to seek out mental health treatment, no matter how severe their mental health struggles may be. Often this is because they have already witnessed the consequences of mental health stigma like not getting hired for a job, getting fired from a job, deteriorating relationships with friends/family members, being treated differently by medical professionals, and not being able to sustain romantic relationships. It can be difficult for someone to seek treatment if they fear for their job, relationships, and reputation. Fikretogia and Liu found availability barriers to be second in barriers after acceptability barriers. Acceptability barriers were reported “four times as often as availability barriers.” (743)
Availability barriers are barriers that involve the availability of timely mental health treatment. This can include long wait times to see a mental health professional, a mental health professional not being available in the surrounding area, and a mental health professional that accepts insurance not accepting new patients. In the study conducted by Moskos et al., parents who sought out treatment reported access to services as one of the barriers (184). Wait times for mental health treatment can be up to six months in some cases. These wait times are one of the reasons more people are seeking out mental health treatment from their primary care providers instead of a mental health professional. However, that does not necessarily mean people are receiving quality care from their primary care providers. According to Mark Olfson, “Research … has confirmed that the quality of mental health care tends to be lower medical settings than in specialty settings” (561). Another problem that arises when primary care providers are the ones responsible for mental health treatment is that they cannot provide mental health therapy and can only prescribe medications. Medications are not always necessary in the treatment of mental health disorders, but therapy often is. Like in Maggie’s case, primary care providers sometimes prescribe medication without any monitoring or guidance on other mental health treatments. Availability barriers are not the only barriers that encourage people to seek out their primary care physician, accessibility barriers do as well.
Accessibility barriers are all things that can prevent someone from being able to access a mental health professional when there is one available. These include: cost of treatment, child care, lack of knowledge about how to locate a mental health professional, cost of transportation, and no time. Cost of mental health therapy fluctuates depending on the location and expertise of a therapist. If someone is fortunate enough to have health insurance, their policy may only cover part of mental health treatment while some policies don’t cover any of it. In the study conducted by Jones et al., “affordability was the top reason for unmet needs, cited by 39% of (their) patients” (431). People most likely to be affected by mental health barriers are in a lower socioeconomic status. This makes them less likely to have access to transportation or be able to afford to miss work. Sometimes child care can prevent a parent from accessing mental health services even if they can afford it or have transportation. Children are not often welcome in a therapy session. Some parents don’t have another person they can trust to watch their children, or cannot afford to have someone watch their children, during sessions. According to Fikretoglu and Liu, “having one more child aged 6-11 years old in the household was associated with almost a 3 times increased likelihood of perceiving an accessibility barrier” (742). Even if someone can afford or attend mental health sessions, he/she may not know how. Due to the lack of education or the miseducation around mental health some people do not know how or when to access mental health services. This affects their ability to access mental health treatments.
A major shift needs to occur in the medical setting and in society in order to decrease barriers to mental health treatment. Better, more in-depth, education around mental health disorders and treatment has been proven to make major shifts in people receiving proper mental health treatment. Sharp et al. conveys in their study that even something like a mental health education program in a classroom setting can shift people’s perceptions.
The results of this study suggest that a mental health education program that focuses on modifying negative or inaccurate opinions about mental illness, low treatment expectations, and lack of knowledge regarding treatment options may improve attitudes toward seeking professional psychological help, as well as modify some opinions about mental illness (Sharp, Hargrove, Johnson & Deal, 436).
Mental illness is pervasive in society today. Most people will either experience mental illness themselves or knows someone who will. Without properly educating our policy makers, medical professionals, and society, people will continue to experience unmet mental health needs.
Policy makers are an important piece in shifting the perceptions and beliefs around mental health care. They can create laws and policies that make it easier to access mental health care, as well as make it harder to be discriminate because of mental illness. According to Sickel, “Working individuals having a mental illness may experience increased workplace discrimination or pressure due to their health status” (4). Policies preventing mental health discrimination in the work place are necessary throughout the United States, not just in “some states.” Even if discrimination was not an issue it is important that policies require work place flexibility, so employees can access their mental health treatments without the fear of losing their job or income. Mandatory mental health training for all employees, as well as those in charge, could aid in not only understanding those policies but understanding the importance of mental health treatment. Finally, policy makers must be educated so they see the value in mandatory mental health treatment coverage for every health insurance policy. This would only be a start because we must also improve the availability of mental health treatment as well.
According to Jones, Lebrun-Harris, Sripipatana, and Ngo-Metzger, “more than 40% of patients with mental health problems seek care in the primary care setting” (426). Since the primary care setting is often the first-place people seek mental health treatment it is important that the medical community have more mental health information and training. Due to the shortage of mental health professionals in some areas, and long wait times, primary care providers may need to treat patients until they can be seen by a mental health professional. According Olfson, the best model for how such treatment can be implemented is the integrative care model (569). This model consists of collaboration between primary care providers and mental health professionals, but it also includes more mental health education on the primary care level. This would mean that primary care providers would need to work together with mental health professionals to create a viable treatment plan for their patients. This plan may or may not include prescription medication and may or may not include mental health therapy. What the treatment plan includes will be dependent on what the integrative team decides would be best for the patient for them to manage their mental health disorders.
In “Utah Youth Suicide Study: Barriers to Mental Health Treatment for Adolescents.”, Moskos et al. examine barriers to mental health treatment by interviewing family members and friends of Utah youth who died by suicide. These suicide deaths occurred between June 1996 and November 1998 and included youth 13-21 years of age. Trained professionals conducted the interviews which lasted approximately two hours, and the information from those interviews helped to identify the barriers of health. The top five barriers this study discovered were that the youth believed nothing could help, that seeking help was a sign of weakness, they were reluctant to admit to having problems, they denied having problems, and were too embarrassed to get help (183). This study was published 11 years ago so the information could be slightly dated, as are the references. Due to its date the source would be most useful if paired with similar, more recent sources. By doing so the accuracy can be verified. Despite its date this source was valid for the time it was written.
For people to decide to seek treatment, and prevent them from taking their own lives, society must also be educated. Acceptability is one of the top barriers, and in several studies the top barrier, for people seeking mental health treatment. Education of society will not only help diminish mental health stigma but also help people identify they need help. Most of the barriers noted in “Utah Youth Suicide Study: Barriers to Mental Health Treatment for Adolescents” could have been mitigated by more mental health education in society. By educating society not only will people know when they are experiencing mental health problems, but they will also know where to seek treatment. This education will help to show that seeking treatment for mental health symptoms is just as acceptable and intelligent, as seeking treatment for physical health symptoms. Physical symptoms can be the first signs of mental illness that people perceive which leads to them seeking out the primary care provider. According to DeGruy, “Mental distress, symptoms, and disorders are usually embedded in a matrix of explained or unexplained physical symptoms” (1). By educating not only primary care providers, but society as well, people may be able to better identify when they are experiencing symptoms of mental illness even if they are physical symptoms. This will help decrease the amount of people will unmet mental health needs.
Without better education about mental health problems, not only will the rates of unmet mental health needs increase, but suicide rates will increase as well. Many people who attempt suicide succeed, unlike Maggie. Death by suicide not only affects the person who dies but those around them as well. Close friends and family wonder what they could have done to prevent this unnecessary death. Suicide of a close friend or family member can trigger those around them perpetuating the need for mental health care.
Overcoming the barriers to mental health and preventing unnecessary deaths by suicide starts with education. Mental illness is a real health crisis, and without proper treatment it can be just as debilitating, if not more so, than physical illnesses. Unlike physical illness, there is not enough information about how to treat and care for our mental health. There is also not enough acceptance in society about treating mental illness. With education not only can we more easily identify mental health problems, but we can properly treat them as well. This will help dramatically decrease the amount of unmet mental health needs and increase the number of people receiving treatment like the kind that changed Maggie’s life.
DeGruy, Frank. “D Mental Health Care in the Primary Care Setting.” Primary Care: America’s Health in a New Era, National Academies Press (US), 1996.
Fikretoglu, Deniz, and Liu, Aihua. “Perceived Barriers to Mental Health Treatment among Individuals with a Past-Year Disorder Onset: Findings from a Canadian Population Health Survey.” Social Psychiatry and Psychiatric Epidemiology, vol. 50, no. 5, 2015, pp. 739–46.
Jones, Emily., et al. “Access to Mental Health Services Among Patients at Health Centers and Factors Associated with Unmet Needs.” Journal of Health Care for the Poor and Underserved, vol. 25, no. 1, 2014, pp. 425–436.
Moskos, Michelle A., et al. “Utah Youth Suicide Study: Barriers to Mental Health Treatment for Adolescents.” Suicide and Life‐Threatening Behavior, vol. 37, no. 2, 2007, pp. 179–186.
Olfson, Mark. “The Rise of Primary Care Physicians in the Provision of US Mental Health Care.” Journal of Health Politics, Policy and Law, vol. 41, no. 4, 2016, p. 559.
Sickel, Amy E, et al. “Mental Health Stigma Update: A Review of Consequences.” Advances in Mental Health, vol. 12, no. 3, 2014, pp. 202–215..
Sharp, William, et al. “Mental Health Education: An Evaluation of a Classroom Based Strategy to Modify Help Seeking for Mental Health Problems.” Journal of College Student Development, vol. 47, no. 4, 2006, pp. 419–438.