Barriers and facilitators for treatment-seeking in adults with a depressive or anxiety disorder in a Western-European health care setting: a qualitative study Full Text

Participation nor refusal influenced the diagnostic and treatment procedures of the outpatient clinic and participants and interviewers were unacquainted. The interviews lasted 1 h on average (range 44 – 85 min) and were conducted at outpatient clinic locations or at participant’s homes dependent on the participant’s preference. Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide.

examples of barriers to treatment

Our main theme ‘personal social system’ corresponds to the NEM’s personal support system, which includes family, friends, work and voluntary organizations. Lastly, the ‘individual aspects’ found in our study largely correlate with the individual system of the NEM. Positive attitudes toward mental health care were also reported; two participants mentioned a positive image of psychologists because of their work in the health care sector, facilitating their way to care.

Lack of mental health policy

Furthermore, the lack of awareness about mental health issues may contribute to the stigmatisation of people with substance use-related problems, thereby prompting people using substances to hide their condition . These findings are substantiated in related studies where HIV-related stigma has been linked to a lack of disclosing HIV status, heightened mental distress, and inability to establish new support systems . In addition to hindrances early in the treatment-seeking process, subsequent barriers could be addressed by health care providers. Mental health care institutions should thoughtfully try to diminish practical barriers –in particular waiting time- encountered directly prior to treatment. Health care professionals should be sensitive to psychological problems, also in patients with physical symptoms, and be aware of stigma and mental health illiteracy in their patients. Finally, both the general practitioner and mental health care organisations should feel responsible to clarify what to expect from mental health treatment and exercise shared decision-making.

examples of barriers to treatment

This finding is consistent with findings in earlier research done in South Africa and internationally that stigma is one of the most significant treatment barriers facing people using substances . This barrier theme forms a confluence with other systems in Bronfenbrenner’s socio-ecological model. For instance, Due to the negative labelling/perceived stigma of community fairbanks recovery center SUD in the community, people using substances anticipate rejection by their families and friends and doubt whether they will receive unprejudiced or appropriate healthcare from treatment centres. Notwithstanding these limitations, the results clearly show that low perceived need for treatment is an extremely important barrier for seeking treatment worldwide.

One study found that 94 million Americans have had to wait longer than one week for mental health services. One week may not sound bad at first, but for every one day of wait time, 1 percent of patients give up seeking care altogether. When employees lack access to needed mental health care, they’re less likely to work effectively and more likely to seek pricey medical care that may not address their needs. Employers bear the financial weight of inadequately treated mental health conditions, often without realizing it.

For instance, one female restarted antidepressant medication by herself with approval from the general practitioner when she developed symptoms again. This participant had a smooth pathway to care, as she also recognized her symptoms at an early stage and experienced no stigma. Participants held beliefs that having a mental illness or having to go to a therapist is a sign of weakness.

Respondents who endorsed more than one reason for not seeking help or drop out were coded positively on each reason reported. Yet, despite these clear and evidence-based statistics, there are several major barriers that stand in the way of people obtaining help for a mental illness. A recent study demonstrated that lack of awareness, social stigma, cost, and limited access are some of the most prominent factors standing in the way of people pursuing mental health treatment. Previous research on barriers and facilitators regarding treatment-seeking of adults with depressive and anxiety disorders has been primarily conducted in the Anglosphere.

Newly referred patients who during their first appointments were diagnosed with a DSM-IV anxiety and/or depressive disorder were invited in a face-to-face session by their therapist to participate in this study. The therapist explained the study aim and procedure and referred to the researchers for additional information. Of those who were willing to participate, contact details were shared with the researchers. After the information was provided, the participant received an invitation for the face-to-face research interview.

Questions were answered on a 4-point Likert scale with options “strongly disagree – 0”, “disagree – 1”, “agree – 2” and “strongly agree – 3”. Three independent experts confirmed the face validity of the questionnaire’s content and the researcher pilot tested the questionnaire with 12 peer educators, a subset of the study sample. Also, because the questionnaire was developed to measure characteristics in a different region of the world, some of the items became irrelevant in the South African context, especially with issues relating to culture.

Stigma and discrimination from the community

The stigma is coming from everywhere, coming from peers, it’s coming from families, it’s coming from community leaders …. The procedure of data recording and transcribing was the same as that used for the FGDs. In order to evaluate the characteristics of the questionnaire and to delete items with low reliability and factor loadings, the researcher performed exploratory factor analysis using principal components extraction with Varimax rotation. The reliability of the questionnaire was investigated by means of internal consistency methods using Cronbach’s alpha. The self-report paper-and-pen questionnaire was administered to participants in small groups of not exceeding 20 participants at each of the COSUP sites.

examples of barriers to treatment

This study recorded the experiences of COSUP clients already in treatment and of peer outreach workers working with people using substances but not yet receiving treatment. By virtue of their being in treatment, the participants had already overcome some treatment barriers. Young adults not receiving treatment may experience additional barriers or prioritise their experiences differently. This study has indicated a need for cultural competence in mental health treatment, including the treatment of SUD. Substance use treatment facilities can supplement medical and psychosocial treatment services with spiritual/religious consultation services.

Political Barriers

Lastly, the NEM describes a highly elaborate model with many details, themes and correlations that could not all be confirmed in our study. Nonetheless, in the light of improving comparisons across studies, the NEM may provide a valuable model to categorise findings of studies on help-seeking. Acquaintances with knowledge of mental health care sometimes informed participants about treatment options.

  • According to the Centers for Disease Control and Prevention , upwards of 59% of Americans will be diagnosed with a mental illness at some point in their lifetime.
  • Despite the negative lifestyle changes, the financial and emotional costs, the damage that addiction often bears, these people did not realize that their lives were at stake.
  • Individuals with severe SUDs commonly have co-occurring mental health conditions that also require intervention.
  • The need for amendment of the health system’s infrastructure is both evident and supported by the WHO Mental Health Atlas, 2017 Edition .
  • Even among those with health insurance, many are forced to use out-of-network benefits to cover mental health care, which leads to higher out-of-pocket costs compared to other types of care.

The enhancement to the community’s knowledge would ultimately improve the wellbeing of those affected by mental illnesses within African countries. All study recommendations were intended to help individuals receive better mental illness treatment and decrease the current barriers to treatment while impacting individual health and wellbeing. The most common recommendations included bolstering the availability of mental illness treatment facilities and resources and amending policy. This would have a dual impact on addressing both infrastructural and physical barriers. Policy development or amendment would provide government officials with an opportunity to take a closer look at current budget allocation and redistribute funds to meet community needs within their respective countries. Policies should also be developed to standardize training of health professionals who work specifically with individuals with mental illnesses.

Reasons and correlates for dropping out of treatment

Even in a country with a well-developed mental health care system and in absence of financial barriers, there are many barriers to treatment-seeking in adult patients with depressive and anxiety disorders. National campaigns to increase awareness and decrease stigma in the general population, and to empower the social environment might reduce the treatment gap. In order to address this barrier, there must be an expansion of the healthcare workforce 11 ways to curb your drinking to meet the needs of the population. Community educational programs should provide information to recruit individuals into healthcare and offer mentorship to those who are interested in formal medical certifications and training. Registries listing available healthcare providers who are trained to treat mental illness should also be available to community members via resource websites and bulletins at community centers and religious institutions.

Typically, commitment of a mental ill individual is avoided unless a determination has been made declaring them to be dangerous. Unfortunately, loved ones of an individual struggling with mental illness who have refused treatment have very limited options available to them. When mental health issues and illnesses go untreated, they affect a person’s ability to live a fulfilling life and carry on with school, work, or family responsibilities. Our studies scored high in methodological quality, which was assessed using our risk of bias tool that was adapted from the Critical Appraisal Skills Programme.

We wrote our systematic review in accordance with Cochrane methodology and PRISMA guidelines (Higgins and Green 2011; Moher et al 2009). We conducted a literature search through PubMed, MEDLINE via PubMed, PSYCHInfo, the Educational Resources Information Center , and Cochrane Library from inception of the study to June 2020. We also limited our search strategy to “NOT HIV” because our initial search yielded several articles involving HIV. We also searched for relevant articles in and manually reviewed references of included studies in our systematic review . Stigma emerged as one of the most significant barriers to treatment-seeking among young adults living with SUDs.

Fragmented services

Our findings emphasize that it might be helpful to educate the general population by means of national public health care campaigns about mental health problems and stigma and to propagate disclosure of symptoms. Research has shown national campaigns to be effective in improving depression awareness and health literacy . Based on our finding that the social environment plays a substantial facilitating role such campaigns may specifically empower the social environment as well.

Let’s take a closer look at how these obstacles impact access to much-needed mental health treatment and resources. Our findings indicate that treatment-seeking reflects a complex interplay of multiple factors. We found mental health illiteracy, negative attitudes toward professional help -including stigma- and logistic problems to be prominent barriers to care.

Subgroup analyses were conducted and revealed similar barriers in both rural and urban settings. However, physical barriers, such as access to treatment, and attitudinal barriers, such as community stigma, were more prevalent within rural settings . Participants were asked about the barriers to treatment they experienced while seeking help. They could give their views and explanations as well as additional information related to barriers identified through the quantitative data. The study population consisted of 512 young adults receiving treatment from COSUP. A representative sample size, calculated using the survey sample size calculator method with a confidence level of 95% and a margin of error of 5% , was 220.

The majority (71%) were highly educated and had a treatment history in mental health care (79%). Among the subgroup with twelve-month mental disorders who perceived a need for mental health alcohol and atrial fibrillation care but did not access any, according to level of severity . To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.

Nurses, pharmacists, and all health care providers who have touch points with patients may make important contributions. Just as we have framed the issue to clearly encourage physicians to change their behaviors, a similar approach could be taken in the broader health care system to make the system more responsible for and effective at addressing adherence issues. Limitations include reviewer’s previous exposure to study material, which may have resulted in implicit bias when interpreting results. Our study design strength was limited due to the qualitative data presented in our studies and lack of quantitative data among all included studies. The 4 included mixed-methods cross-sectional studies provided quantitative data; however, we were unable to conduct a formal quantitative analysis and assess for publication bias due to heterogeneity in the presentation of the quantitative data. In addition, the data collection form which was standard among reviewers was not universally accepted and may have introduced bias.

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