Dissertation Proposal Chapter 1 Modification

Grand Canyon University

Phoenix Arizona

March 20, 2020

Contents

Chapter 1: Introduction to the Study………………………………………………………. 1

Introduction…………………………………………………………………………………1

Background of the Study……………………………………………………………………2

Problem Statement………………………………………………………………………….3

Purpose of the Study………………………………………………………………………...4

Research Questions and/or Hypothesis…………………………………………………….5

Advancing scientific Knowledge and Significance of the Study……………………………5

Rationale for Methodology………………………………………………………………….6

Definition of Terms…………………………………………………………………………9

Assumptions, Limitations and Delimitations………………………………………………10

Summary and Organization of the Remainder of the Study……………………………….11

Mental health is a major issue around the World. The United Nations (UN, 2015), has identified the issue as one of its Sustainable Development Goals. These are a collection of goals designed globally that aim to achieve a sustainable future for all. The UN expressed its uncertainty regarding the extent to which major social determinants of mental disorders are being addressed worldwide (WHO, 2017). Developing a conceptual framework will address the social determinants and align it with its sustainable development goals. This way it can systematically review the pieces of evidence about the social determinants and identify potential mechanisms and targets for interventions (Lund, et.al., 2018).

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice, millions of people suffer from mental illness in this country. The high numbers necessitate raising public awareness and start campaigning for a much better health care system (Hamilton.et.al, 2016). According to the National Alliance on Mental Health (2019), in 2018, 47.6 million people in the U.S. experienced mental illness which means 1 in every 5 adults. 11.4 million Adults between ages 25 and 35 had an episode of serious mental illness in the same year. In 2016, 7.7 million youths aged 6-17 experienced some sort of mental health disorder, while 9.2 million people were reported to have experienced substance use disorder (National Alliance on Mental Illness, 2019).

According to Kohn, et al. (2018), there is an emphasis on the gap in mental health treatment in America when examined through the prevalence of mental health disorders, the use of mental health services, and the global burden of disease. Statistical data from community-based surveys of mental disorders in the various countries in America including Argentina, Brazil, Canada, Chile, and the United States, etc. were utilized. While 42.6% of children and adolescents in the US suffered mental illness, the treatment gap in this group was 64%. The need to address the issue of mental health has not been given enough attention resulting in the wide gap in treatment. Mental disorders in children can be corrected if detected early enough. Unfortunately, most of the caregivers do not have the skills to detect these disorders causing them to advance (Kohn et al., 2018).

According to Bowdoin et al. (2018), a patient-centered medical home (PCMH) is a model meant for improving health outcomes while at the same time meant to contain the cost of care. This study examines the links between care provided inconsistent with the PCMH and healthcare services utilization as well as expenditures for non-aging citizens who are suffering from mental illness in the United States. 6908 non-aging adults suffering from mental illness participated in the 2007-2012 Medical Expenditure Panel Survey. Utilization of healthcare services was compared with expenditures on care consistent with the PCMH, other participants include a non-PCMH, usual source of care (USC), and participants without a USC. The outcome showed differences in utilization and expenditures between participants who were provided with care consistent with the PCMH and those who had a non-PCMH. USC showed no statistical importance for any healthcare services category. This research study will examine the factors according to mental health providers that influence an individuals' decision to utilize mental health services in South Texas. This research will help us understand why individuals choose to or not to utilize mental health services in the state.

Mental health is one of the leading health issues affecting Americans (Centers for Disease Control and Prevention, 2018). While numerous treatment options have been developed for the treatment of people with mental disorders, statistics show that the number of people suffering from these conditions continues to increase. Multiple studies suggest that people go through various stages before seeking appropriate treatment. However, there are barriers that prevent people to access mental health treatment at the right time. These barriers are broadly divided into system-level structural factors and individual attitudinal factors. Existing research shows that people fail to seek mental health treatment as a result of attitudinal barriers.

While the fear of stigmatization has been considered to be one of the causes of poor utilization, of mental health treatment, available research has shown that it is not one of the reported barriers to seeking treatment for psychological issues. According to Mental Health America (2020), psychologically distressed Americans were more likely to report that they are unable to access medical attention as a result of financial barriers as compared to respondents in New Zealand. Data collected from Netherlands, United States and Canada shows that the income level of respondents does not affect the ability of people suffering from psychological conditions from accessing mental health services (Mental Health America, 2020).

A mental disorder must be diagnosed at its early stages to avoid the advance effects of it progressing into adolescence (Kohn et al., 2018). According to Grayson (2018), there has been a notable difference in how patients utilize mental health services with patients that experience a high level of burden more likely to utilize mental health services. Similarly, the caregivers that experience serious signs of depression or anxiety in their child or adolescent will tend to use the services more than the caregivers who experience mild or no sign of depression or anxiety. The mental health status of the caregiver is of no significance and does not influence need and utilization (Gulliver et al., 2019).

Misra et al. (2017) in their article describe the concept relating to the use of complementary and alternative medicine (CAM) for mental health treatment among children in the Southern State Region. According to the authors, CAM use among US children stands at 12%. The Southern State Region has placed a lot of effort into improving the health care treatment of children. The services offered are directly proportional to the allocation provided. Research showed that some institutions have released a lot of funds to run this sector and that the Sothern State Region receives the second-largest allocation for mental health (Mista et al., 2017). Despite all these efforts, there still exists a gap between the treatments of mental health disorders in the US.

Mays et al., (2018), suggests that ethnicity and nativity differences impact utilization of mental health services for people suffering from mental disorders in the United States. The rate of mental health disorder among black men is higher compared to the African American men. Studies show that most black men in the United States fail to seek medical services for treatment. According to Mays et al., (2018), Obamacare provides opportunities to reduce the nativity and ethnicity variation in the utilization of mental health. Mays et al., (2018), suggest that Significant investment in primary care and expansion of healthcare insurance is likely to increase the utilization of mental health for Caribbean black men.

According to Davis et al., (2017), the United States is facing an epidemic of morbidity and mortality as a result of opioid prescription. According to the study, the use of opioids has quintupled over the past fifteen years yet disability and pain among Americans has not improved. Accordingly, the Centers for Disease Control and Prevention, (2018), emphasizes that more than 235, 000 people have lost their lives from 2000 to 2018 as a result of overdose from opioid prescriptions. Davis et al., (2017), points out that the identification of particular populations that rely heavily on these medications can help in the development of effective preventive measures.

According to Gulliver et al., (2019), mental health needs for university students in the United States have not been met. About 17% of students who attend a university or college suffer from mental disorders. Only one third of students suffering from mental conditions receive treatment despite having insurances that cover services and access to campus health providers. Mental illnesses are likely to persist for students who do not receive early treatment. This leads to grater social impairment, higher rates of substance abuse and ultimately lower graduation rates. Gulliver et al., (2019), argues that there is need to meet these needs that have not been met for a long time now.

The factors affecting the utilization of mental health among students in higher institutions of learning are evolving rapidly (Gulliver et al., 2019). Emerging research shows there are lower rates of treatment among heterosexual students, younger students, racial minority groups, and men. However, campus size, number of providers in an institution, mental health beliefs by students and student characteristics shows a small portion of difference in services among institutions of higher learning. The study suggests that improved awareness on the importance of seeking mental health treatment among students suffering from mental disorders could help improve mental health services utilization.

It is not known what influences an individual's decision to or not to utilize mental health services in the United States. It is not known how mental health providers describe the factors influencing individuals' decision to utilize mental health services. There are increasing mental health cases among the children in the country. In, addition, there is limited research on the factors that influence individual decisions to seek treatment for mental illnesses. This research seeks to identify the key issues that prevent the people of this country from utilizing the mental health services and facilities.

According to Gulliver et al., (2019), there is a pressing need to determine the factors that influence the utilization of healthcare services among students in institutions of higher learning. The study points out that the studies that were carried out on the topic have not yielded substantial results (Gulliver et al., 2019). Existing literature has associated poor utilization of mental health services to lack of awareness, social status, ethnicity and nativity. This research will help to establish how these factors affect the utilization of mental health services.

Chang & Biegel, (2018), stated that more studies need to be conducted to establish how policies can be used to address the financial barriers to the utilization of mental health services in the United States. The study found out that most Latino Americans understand the need for mental health services but are unable to access treatment due to lack of financial resources. Nam et al., 2018, recommends for additional research to determine attitudes and perceptions on seeking treatment among people suffering from psychological conditions as mental health services are still widely underutilized in the United States.

In addition, Gordon (2018) reported that most people in the US particularly those from minority groups prefer seeking support from their families and friends rather than seeking mental health services. The study suggested that more research need to be conducted to establish the factors that may have influenced them to avoid professional help. In another meta-analysis study, the researcher recommended more studies to be conducted in the field to gain a deeper understanding as to why individual fail to utilize mental health services despite the concerted efforts by the government and other non-governmental agencies to create awareness and increase access to mental healthcare (Schnyder et al., 2017).

The purpose of this qualitative descriptive study was to examine how mental health providers describe the factors influencing individuals' decision to utilize mental health services in South Texas. The study aimed to come with the factors that either influence or deter the people in the State from accessing much-needed mental healthcare. Furthermore, the study employed a qualitative study that targeted mental health providers within the State who were service providers that care for the mentally challenged and compare factors impacting utilization and non-utilization of mental services available in the State.

The study made a recommendation on how to improve the mental health accessibility in the State. It identified multiple factors that are associated with both the utilization and under-utilization of specialty mental health services among the people living in the State such as delays in observing and recognizing the symptoms and how to seek help, the absence of appropriate mental health providers, and lack of health insurance. The study will also play a significant role in bridging the gap that has existed in literature concerning the utilization of mental health in the US. This was achieved by suggesting new approaches in which the rate of metal health utilization can be increased.

This study aimed to provide theoretical framework that could be used for future studies focusing on the topic of mental health utilization in the United States. The evidence presented in the study bridges the psychological gap that has for a long time been unexploited by researchers. The study also examines factors that influence the utilization of mental health service among students in higher learning institutions and this will help college and universities to develop better strategies for helping students to seek mental health services. This will help student avid defiant behaviors such as missing classes and engaging in drug abuse.

Research questions and the hypothesis for this study comes from the problem statement. The increasing rates of people suffering from mental health conditions in the United States shows that the interventions measures being implemented now are ineffective, understanding the factors that cause these cases to increase could help develop effective strategies for dealing with mental disorders in the United States. Similarly, the study sought to fill this gap in existing literature by reviewing the factors that influence the utilization of mental health among people living in South Texas.

The following research questions will help to guide this qualitative study:

RQ1: How do mental health providers describe the influence of self-efficacy on individuals' decisions to utilize mental health services?

H1: Self-efficacy influences individuals' decision to utilize mental health services.

RQ2: How do mental health providers describe the influence of behavioral capacity on individuals' decision to utilize mental health services?

H2: Behavioral capacity influences individuals' decision to utilize mental health services.

RQ3: How do mental health providers describe the influence of expectations on individuals' decisions to utilize mental health services?

H3: Expectations influence individuals' decisions to utilize mental health services.

The conceptual framework shown in figure one presents the major factors that influence health seeking behaviors among individual’s with mental illnesses. The framework is inspired by existing research and ideas of other researchers as well as the theoretical framework of this study. Two major themes where identified, environmental and personal factors and relationships between service providers and service users. Each of these themes has subthemes that represent the factors influencing individual’s decisions to utilize mental health. Evidence suggests that environmental factors influencing utilization of mental health include gender, stigma, cultural identity and level of income (Chang, & Biegel, 2018).

Multiple studies have indicated that factors influencing the relationship between mental health providers and service users include discrimination, power and authority, communication and service awareness (Lancaster, 2017). According to Kohn et al., (2018), poor communication and the perception that mental health professionals have power and authority over their patients has led the poor utilization of mental health services in the United States.

The results of this research will add considerably to the results of other studies as it provides means by which prevention and intervention efforts will help to raise mental health awareness and the importance of utilizing mental health services among Americans as well as offer culturally sensitive services. The result would direct efforts and focus on reducing the stigma that is associated with mental health problems in the minds of most people (Morin and Cherry, 2019). Besides, the results will help, and be of value to practitioners in determining the necessary strategies to be used to allow more individuals to receive the necessary health care services that they require. It will also help in eliminating the individualized beliefs that tie people from getting the public services they ought to and thus help them be more responsive to the services which are available to them.

This study will also provide new knowledge to the existing literature on the approaches to the treatment of people suffering from psychological conditions, Practitioners can use the findings of this study to increase improve their practice in dealing with patients with mental illnesses. This study would also be of great importance to researchers in the field of counseling and psychology. Scholars in this field are interested on understanding the factors that influence the utilization of mental health services by those suffering from psychological conditions. Historically, socioeconomic factors have been considered as the primary reason why people avoid seeking mental health services. This has made it difficult for researchers to explore other factors that could have significant impacts on how people perceive mental health services.

Lack of enough knowledge on how various factors influence the utilization of mental health services has led practitioners to use ineffective treatment approaches that endangers the lives of people suffering from the condition. By evaluating the factors that influence utilization of mental health services, this study will help providers to avoid making errors in the healthcare setting that could have adverse effects on their patients. With increased knowledge on the factors leading to poor utilization of mental health the providers will be in a position to use the appropriate techniques in dealing with patient suffering from mental health conditions.

Similarly, the result will enhance knowledge of social learning theory through observation and modeling as they both play significant and primary roles in this process, which moves far and beyond Albert Bandura's behavioral theory, which suggests that all behaviors can or are learned through conditioning, and cognitive theories. Bandura's social learning theory also proposed that learning also exist or develop simply by observing the actions of others (Morin and Cherry, 2019). Therefore, a learning condition like this may be used in explaining different behaviors, including those factors influencing individuals' decision to either utilize or not utilize mental health.

This study will also enhance knowledge of the Health Behavioral Model (HBM). According to Nobiling & Maykrantz (2017) HBM is very effective in exploring perceptions about mental health. However, most previous studies that aimed to determine factors influencing mental health utilization did not make use of this theory. Unlike those researches, the present study will expand knowledge on how the HBM can be used effectively to evaluate health seeking behaviors in a certain region or population. The researcher believes that future studies will utilize the theory in evaluating the factors influencing decisions to utilize mental health among people with mental disorders.

The Theory of Planned behavior on the other hand has also been used in this study to predict health intentions. Unlike the HBM, this theory has been utilized by a wide range of studies to wide range of health intentions and behaviors including substance use health service utilization, drinking and smoking among other (Graham & Rosén, (2019). The theory assumes that people behaviors are influenced by social climate. The findings of this study will help expand the knowledge of the theory and how people can change their behaviors towards utilizing mental health services.

The most appropriate methodology that was used in answering the research questions and which also helped to address the problem statement is a qualitative methodology (Colorafi and Evans, 2016). The qualitative approach is very effective when a phenomenon that is being queried is properly and effectively defined, and this study has distinctly defined the phenomena of factors influencing the behavior and choices of people in a natural environment to utilize or not utilize Mental Health. The methodology is preferred as it is flexible when researching health science topics to support various medical theories.

In addition, this methodology provides a broad picture on why people in South Texas avoid seeking mental health services. Since this study aims to expand knowledge in the field of mental health utilization, qualitative approach is the best approach as it creates openness to explore new topic areas. It also helps to stimulate personal experiences for people living in South Texas concerning the utilization n of mental health. It also helps the researcher to avoid prejudgments which could compromise the outcome of the study. Prejudgments are recipes for biases, and these affects studies significantly. This approach explains particular responses from the focus group.

The methodology supports the research in finding and filling the gap in the study. It was adopted because it would help to provide real-life pieces of evidence from the interview with participants. The literature has determined the causes of the low utilization of mental health in the South to include limitations to accessing health care. It also identified other barriers to specialty mental health care utilization (Augsberger et al., 2015). Interviews and Questionnaires were used to gather correct information. Data was obtained to determine the health-seeking behavior and mental health patients/services in the State.

Quantitative methodology would not have been the best method to be used in this study. According to Queirós, Faria, & Almeida, (2017), qualitative methodology is best used in studies focus on comparing variables. In this study, the researcher is focusing on the behaviors of individuals and their perceptions towards the utilization of mental health. As a result, this methodology would be ineffective. Additionally, the results obtained from a qualitative methodology do not provide a detailed narrative of the phenomenon being studied but focuses on numerical descriptions which may not help to determine the health-seeking behaviors in the focus group (Queirós, Faria, & Almeida, 2017).

Furthermore, numerous studies on factors’ influencing individual’s decisions to utilize mental health services have been conducted using quantitative methodology. As a result, using quantitative approach for this study would yield results that have already been presented by other researchers. The results would be presented in a statistical manner and this would make it difficult for the researcher to explore themes and relationships that influence help seeking behaviors among individuals with mental illnesses in South Texas. It was therefore important to use a different approach in analyzing these factors to gain new knowledge in the field.

Nature of the Research Design for the Study

The design for this piece of research work was a qualitative descriptive study that involved collecting information from service providers in the State, which aimed at identifying the specific issues that are deterring the utilization of mental healthcare facilities in this South. Qualitative descriptive is the most appropriate design selected because it helps to describe how mental health providers and mental health professionals the factors influencing individuals' decision to utilize mental health services. (Kim et al., 2017) This method is also justified as it applies the description of the factors in play and how they affect the outcome. According to Kim et al. (2017), qualitative-descriptive research is descriptive and helps in describing a natural phenomenon.

This method is suitable in research as it helps to describe factors limiting the utilization of mental healthcare in the county. Literature also supports the fact that issues of underutilized mental health resources and non-institutionalized adults are a behavioral risk factor in the South (Hamilton et al., 2016). This approach was also the most appropriate for this study as it gives a holistic understanding of health-seeking behaviors among people in South Texas. In this approach, respondents are in a comfortable environment and therefore the behaviors observed are not biased. This design also ensures the researchers own interpretations of the results they get are transparent.

After analysis of the population group, 12 Mental Health Providers were determined to suffice as a sample group. The respondents were chosen among the mental health providers with a membership of the Mental Health Association in South Texas, which included focus groups of service providers' that formed the sample population. The study area for the research incorporated caregivers, psychiatrists, and therapists' offices, and counseling facilities within the State. A structured system of interviews with a minimum of 120 questionnaires and 40 mental health providers was used as the primary source of data.

The data was collected in three weeks with each respondent given 30 minutes for the interview and filing the questionnaire. Data was collected for the study using interviews and questionnaires. Notes were taken; interviews were tape-recorded and documented properly. Mental health providers with membership in Mental Health Associations were the main participants in the study based on 5 years' experience and the willingness to be interviewed. Providers were selected to complete questionnaire forms that included basic demographic questionnaire, which was used based on their experience’s life (Keenan et al., 2017).

A consent form was sent and obtained with signatures. The selected participants submitted the consent forms and complete the interview using Zoom. Data was collected using a Google Form. Mental health providers/participants' names were removed from the data. Descriptive statistics was used in summarizing the acquired data. Coding was can be used to address questions posed and the transcribed interviews and coded data was also stored on a backup USB thumb drive. The data obtained remains stored on the researcher's computer with the password encrypted.

Other types of qualitative designs would not have led to the desired outcome of this study. One of the qualitative designs that were selected but disqualified from this study is grounded theory. This involves developing a theory that helps to explain the phenomenon being studies. However, it is not tenable to develop a theory to help explain the health-seeking behavior of people living in South Texas. This approach also introduces bias that could be avoided by using descriptive design. In addition, grounded theory results are presented with complexities, making it difficult for practitioners to use them in real life (Keenan et al., 2017).

Ethnographic studies were also considered but rejected as they only focus on cultural characteristics of the focus group. According to Bearman, (2019), ethnography aims to establish the factors which influence health-seeking behaviors for people living in South Texas. As a result, it is untenable to only focus on one factor. In order to facilitate a full and honest discourse, this approach requires that researchers build trust with the respondents. This being time-consuming, may introduce biases in the study if the research does not take considerable time building relationships with the participants. The findings of the study depend on the interpretation of the researcher and this could introduce biases in the study.

Phenomenology research design was also considered for this study but rejected on the basis that is has lower levels of reliability and validity as compared to qualitative descriptive research design. Researcher induced bias is one of the big issues that makes it inappropriate to use this design in this study. In addition, it is very difficult to present the findings of this study. This compromises one of the most important significance of this study which is to increase knowledge in the field of utilization of mental illness in the United States. It is impossible to achieve that if data is not presented appropriately (Stratford, E., & Bradshaw, 2016).

The researcher also considered cases studies but rejected it on various grounds. First, the findings obtained from such a study cannot be generalized to represent a wider population (George, 2019). Secondly, the researcher can form bias when conducting studies using case studies. As a result, this affects the reliability and validity of the study. In addition, the process of data collection is very intensive and long. Since this study will be conducted within a short period of time case studies are inappropriate. Errors of memory and judgment can also arise from cases studies affecting the efficacy of the study (George, 2019).

The following terms were used in this study

Behavioral Capacity: An individual’s ability to execute a certain behavior based on their knowledge and skills (Chapman et al., 2018).

Behavioral Health: the link between health and behavior and well-being of the mind, spirit and the body. Psychotherapy has been used widely to address behavioral issues (Mays et al., 2018).

Coping Strategy refers to a thought process or a series of actions used to meet an unpleasant or stressful situation or in modifying an individual’s reaction to such situations (Susanti, Lovell & Mairs, 2019). It involves a direct and conscious approach to challenges in contrast to mechanisms of defense (Paul et al., 2018).

Culture: An umbrella term that encompasses social norms or behavior found in human communities as well as customs, laws, arts, believes knowledge, habits and capabilities of people in these groups. It is acquired through the learning process of socialization and enculturation (Anderson, 2018).

Discrimination: the prejudicial or unfair treatment of a certain group of people in the society, especially on the basis of sex, race or age. It involves refusing to give a certain group of people their right based on gender or racial affiliation (Purwaningsih, Armini & Susanti, 2017).

Ethnic Minority: a group within a community that has different cultural, national or racial from the native population. In the United States, Hispanics, Latinos and Africa-Americans are considered minority groups. (Chang & Biegel, 2018)

Help-Seeking Propensity: a person’s perceived ability and intention to seek professional help for a psychological disorder (Sontag-Padilla et al., 2016).

Health Professional: An individual who provides healthcare advice and treatment based on his/her experience and formal training. The field includes those who work as psychologist, psychiatrist, pharmacists, therapist, and counselors among others (Bastani, Javanbakht & Ravangard, 2019).

Healthcare Provider: A doctor of osteopathy or medicine nurse practitioner, optometrist, clinical psychologist, chiropractor, dentist, podiatrist or social workers who have gone through formal training and are authorized to practice by the State (Anderson, 2018).

Mental Health: absence of mental illness or the level of psychological well-being. People with mental health are able to carry out their daily activities without any difficulties (Chang & Biegel, 2018).

Mental Illness: a mental disorder that affects an individual’s behavior, mood and thinking (Sontag-Padilla et al., 2016). Examples of mental illnesses include addictive behaviors, eating disorders, schizophrenia, anxiety disorders and depression (Sontag-Padilla et al., 2016).

Mental Health First Aid: help provided to an individual experiencing a mental health crisis or developing mental disorder (Morgan, Ross & Reavley, 2018).

Mental health services: diagnosis, assessment, counseling or treatment to assist a patient in alleviating disorder, conditions, symptoms or mental illness (Sontag-Padilla et al., 2016). Mental health services are normally provided by physicians, psychologists, therapists, counselors and licensed social workers among other healthcare practitioners (Chang & Biegel, 2018).

Mental Health Utilization: Refers to description or quantification of the use of mental health services by an individual for the purpose of obtaining information about an individual’s mental status, promoting wellbeing or preventing and treating a mental disorder or (Azman, Jamir Singh & Sulaiman, 2017).

Need for Care: circumstances in which medical help is necessary for an individual or a group (Nam et al., 2018).

Psychological Disorder: a condition characterizes by remarkable disturbance in an individual’s behavior, emotion or cognitive regulation that reflects a dysfunction in development. This is a psychological or biological process associated with the functioning of the brain (Nam et al., 2018). Psychological disorders are associated with considerable distress in occupational and social activities (Chang & Biegel, 2018).

Psychotherapy: a psychological approach to help people with emotional difficulties and mental illnesses to overcome problems and change behavior (Sontag-Padilla et al., 2016). It helps to control or eliminate troubling symptoms to increase health and well-being of an individual (Sontag-Padilla et al., 2016).

Self-Efficacy: An individual’s believe in his/her capacity to adopt and execute behaviors that are necessary to achieve certain objectives. It shows the confidence in the ability of an individual to exert control over his/her social environment, motivation and behaviors (Cavalhieri, Chwalisz & Greer, 2019).

Service Utilization: extent to which individuals use mental health services provided by healthcare institutions (Chang & Biegel, 2018).

Stigma: an unfair or negative believe that a group of people or the society may have about someone or something (Gulliver et al., 2019).

Treatment Gap: The number of people with a disorder, illness or disease but are unable to access healthcare services It can be used to measure the outcome of healthcare (Woloshyn & Savage, 2018).

This study examines the factors that influence individuals’ decisions to seek mental health. Numerous studies have shown that the number of cases of people experiencing adverse effects of mental illnesses have increased significantly over the past few years in the United States. However, there has been a gap in literature about the factors that determine whether an individual will seek mental health services or not. This study aims to fill that gap this gap and develop new knowledge on the field of mental health utilization. The study is carried out in South Texas United States to collect perceptions of health providers on the factors influencing people’s decisions to seek mental health services.

The study explores the existing gap in literature concerning utilization of mental health. A qualitative methodology is used for the study. The qualitative approach is very effective when a phenomenon that is being queried is properly and effectively defined, and this study has distinctly defined the phenomena of factors influencing the behavior and choices of people in a natural environment to utilize or not utilize Mental Health. The methodology is preferred as it is flexible when researching health science topics to support various medical theories (Colorafi and Evans, 2017)

The present study also used a descriptive research design to help in answering the research questions. Kim et al., (2017) reported that descriptive research design is the most appropriate design selected because it helps to describe how mental health providers and mental health professionals the factors influencing individuals' decision to utilize mental health services. This method is suitable in research as it helps to describe factors limiting the utilization of mental healthcare in the country. Literature also supports the fact that issues of underutilized mental health resources and non-institutionalized adults are a behavioral risk factor in the South (Hamilton et al, 2016).

This study discuses three closely related theories namely Social Cognitive Theory, the Health Believe Model (HBM) and the Theory of Planned Behavior (TPB). HBM was developed to help understand the failure of individual to adopt preventive strategies for diseases. The theory suggests that “a person's belief in a personal threat of an illness or disease together with a person's belief in the effectiveness of the recommended health behavior or action will predict the likelihood the person will adopt the behavior” Purwaningsih Armini & Susanti, 2017). On the other hand, TPB has been used widely to understand and predict behaviors.

The sample for this study was selected from 12 mental health providers in South Texas. The respondents were chosen among the mental health providers with a membership of the Mental Health Association in South Texas, which included focus groups of service providers' that formed the sample population. The study area for the research included caregivers, psychiatrists, and therapists' offices, and counseling facilities within the State. A structured system of interviews with a minimum of 120 questionnaires and 40 mental health providers were used as the primary source of data. The data was collected in three weeks with each respondent given 30 minutes for the interview and filing the questionnaire.

There are various assumptions, limitations and delimitation associated with this study. Assumptions are things that are accepted by the researcher as true without any proof (Theofanidis & Fountouki, 2018). Limitations, yet, are factors that may affect the study but are beyond the control of the researcher (Theofanidis & Fountouki, 2018). Delimitation are research boundaries set by the researcher (Howie, 2017). Hence, the researcher avoids crossing the boundaries that is set while conducting the study.

The following assumptions were made in this study:

1. Respondents will answer the interview questions in honesty. The respondents were told that their personal information would be made confidential increasing the likelihood that the information they provided would not be used for any other purposes rather than for the study. According to Matthew, Barron, & Hodson, (2019), confidentiality in research is a right to the subjects and an obligation for the researcher. In addition, Lancaster, (2017), suggests that confidentiality in research studies helps to increase trust between the researcher and the respondents allowing them to provide honest responses.

2. The respondents have a sincere interest in taking part in the study and do not have other hidden agendas such as receiving money for providing certain information (Theofanidis & Fountouki, 2018).

3. The inclusion criteria used for the sample of this study are appropriate and as a result assures all the participants have similar and same experiences on the phenomenon being studied. According to Patino & Ferreira, (2018), the most appropriate inclusion criteria should allow minimal attrition, efficient accrual for the participants and good rate of follow-up participation.

Limitations associated with this study include.

1. Collecting data from participants is time-consuming and therefore thus study was conducted for several weeks. Since there were interactions between the researcher and the participants, discussions would deviate from the main issues increasing the time of the study.

2. The results of this study cannot be verified as the participants have more control of the data collected. The researcher only relied on the data presented by the respondents to verify the results.

3. This approach was labor intensive as it required the researcher to interview individual respondents and also issue questionnaires.

4. The research problem could not be tested or verified as the study used a descriptive study design. While comparisons were made, it was impossible to presents data statistically.

5. There is a possibility of researchers, subjectivity and errors. Aggarwal & Ranganathan, (2019), stresses that descriptive studies may contain errors as the researcher may ignore data that conforms to the hypothesis of the study.

The study had the following delimitation:

1. Since the main aim of this study was to determine providers’ perspectives on the utilization of mental health in South Texas, the research only collected qualitative data to help inform behaviors.

2. The participants included in this study were healthcare providers in South Texas. As a result, this study did not involve healthcare providers from other parts of the United States.

3. The study only focused on mental healthcare organizations in South Texas that are members of the mental healthcare organization. As a result, healthcare organizations that do not provide mental healthcare and are not members of the mental health organization are not been included in the study.

There are numerous factors that may influence health-seeking behaviors for people suffering from mental illnesses. However, most studies link cultural and historical factors as the only factors that can influence the decision of individuals to seek mental health. This research could help unearth other factors that influence the utilization of mental health. According to Kohn, et al., (2018), there is an emphasis on the gap in mental health treatment in America when examined through the prevalence of mental health disorders, the use of mental health services, and the global burden of disease. This provides an opportunity for more studies to be conducted in the field to expand the existing knowledge.

The aim of this qualitative descriptive study was to examine how mental health providers describe the factors influencing individuals' decision to utilize mental health services in South Texas. The study aimed to come with the factors that either influence or deter the people in the State from accessing much-needed mental healthcare. While the study also employed a qualitative study that targeted mental health providers within the State who were service providers that care for the mentally challenged and compare factors impacting utilization and non-utilization of mental services available in the State.

Recommendations on how to improve the mental health accessibility in the State were made. The study identified multiple factors that are associated with both the utilization and under-utilization of specialty mental health services among the people living in the State such as delays in observing and recognizing the symptoms and how to seek help, the absence of appropriate mental health providers, and lack of health insurance. The study will also play a significant role in bridging the gap that has existed in literature concerning the utilization of mental health in the US. This was achieved by suggesting new approaches in which the rate of metal health utilization can be increased.

It is not known what influences an individual's decision to or not to utilize mental health services in the United States. This study provides new knowledge to the existing literature on the approaches to the treatment of people suffering from psychological conditions, Practitioners can use the findings of this study to increase improve their practice in dealing with patients with mental illnesses. This study would also be of great importance to researchers in the field of counseling and psychology. Scholars in this field are interested on understanding the factors that influence the utilization of mental health services by those suffering from psychological conditions.

A qualitative methodology was used to conduct this study. This methodology provides a broad picture on why people in South Texas avoid seeking mental health services. Since this study aims to expand knowledge in the field of mental health utilization, qualitative approach is the best approach as it creates openness to explore new topic areas. Descriptive research design was the most appropriate research design used in this study. It helps to describe how mental health providers and mental health professionals the factors influencing individuals' decision to utilize mental health services (Kim et al., 2017). According to Kim et al. (2017), qualitative-descriptive research is descriptive and helps in describing a natural phenomenon. This method is also suitable in research as it helps to describe factors limiting the utilization of mental healthcare in the county.

These study had various assumptions including the respondents providing honest information, the respondents would have a sincere interest in taking part in the study and do not have other hidden agendas and the inclusion criteria used for the sample of this study are appropriate and as a result assures all the participants have similar and same experiences on the phenomenon being studied. Limitations for this study include the research methodology is time-consuming, approach was labor intensive, and the results cannot be verified as the participants have more control of the data than the researcher. The delimitation of the study included only qualitative data that was collected, healthcare providers from other parts of the United States were not included and healthcare organizations that do not provide mental healthcare and are not members of the mental health organization are not included in the study.

Chapter two of this dissertation focuses on literature review. This involves reviewing all the existing literature on the utilization of mental health in the United States. This section is very important in the dissertation as it describes how the present study is related to prior research in the same field (Hart, 2018). It also creates a sense of rapport with readers or audience so that they can use it to enhance their knowledge on the health-seeking behaviors of individual in South Texas. This section also helps to avoid repetition in studies and help the researcher to focus on a particular phenomenon that has not been fully evaluated before.

Chapter three presents the methods used to collect data in this study. A qualitative descriptive study was used to collect information from service providers in the State, which aimed at identifying the specific issues that are deterring the utilization of mental healthcare facilities in this South. Qualitative descriptive was the most appropriate design selected because it helps to describe how mental health providers and mental health professionals the factors influencing individuals' decision to utilize mental health services. Queirós, Faria & Almeida, (2017), suggests that descriptive research method is the most suitable design in this research as it helps to describe a certain phenomenon.

Chapter four provides the findings of this study. The section summarizes the findings of the collected data and the mechanics of analysis. The first paragraph of chapter four will briefly restate the problem statement outlined in chapter one. It will proceed to point out the salient results and present them in form of summarized data. Description of the analysis will be presented in an attempt to answer the hypothesis of the study. The statement of the findings will be made without any implications, evaluation, assessment, interpretation or speculation.

Chapter five will present interpretation and discussing as they relate to the present study and the existing literature. A conclusion organized by the research questions will be outlined in this section. The significance of this study on the health-seeking behaviors among residents of South Texas will also be outlined in this chapter. At the end of the chapter recommendations will be made on the direction which further studies related to the utilization of mental health in the United States should take. Finally, the paper will make a succinct conclusion on the study.

References

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André Queirós, Daniel Faria, & Fernando Almeida. (2017). Strengths and Limitations of Qualitative and Quantitative Research Methods. doi:10.5281/zenodo.887088

Bearman, M. (2019). Key concepts in Qualitative Research Design. In Healthcare Simulation Research (pp. 73-78). Springer, Cham.

Chang, C., & Biegel, D. E. (2018). Factors Affecting Mental Health Service Utilization Among Latino Americans with Mental Health Issues. Journal of Mental Health, 27(6), 552-559. doi:10.1080/09638237.2017.1385742

Davis, M. A., Lin, L. A., Liu, H., & Sites, B. D. (2017). Prescription Opioid use Among Adults with Mental Health Disorders in the United States. Journal of the American Board of Family Medicine: JABFM, 30(4), 407-417. doi:10.3122/jabfm.2017.04.170112

Gulliver, A., Farrer, L., Farrer, L., Bennett, K., Bennett, K., Griffiths, K. M., & Griffiths, K. M. (2019). University Staff Mental Health Literacy, Stigma and their Experience of Students with Mental Health Problems. Journal of further and Higher Education, 43(3), 434-442. doi:10.1080/0309877X.2017.1367370