DISSERTATION PROJECT

Introduction

Hester (2017) noted that there is a huge gap between patients experiencing mental health illnesses and individuals who access treatment in the United States. As a result, there is the need to identify the factors that influence individuals to seek or not to utilize or not to utilize mental health services. Kohn et al., (2018) expressed the need for more studies to establish why people suffering from mental illnesses avoid getting treatments. Platt, Wolf & Scheitle, (2018) suggested that more studies need to be conducted to determine why individuals decide to utilize or reject mental health services. This study aims to evaluate the factors influencing an individuals' decision to utilize or reject mental health services in South Texas.

Background of the Problem

Sampogna et al., (2017), found that mental health is one of the major public health concerns in the United States. However, there is a considerable gap in research as to why people utilize or reject the treatment of mental health. According to Stanley, Hom & Joiner, (2018) there are numerous factors that influence people to utilize mental health services. Additionally, Irteja et al., (2020), indicated the need for more studies to be conducted to establish the factors that influence people to seek mental health services.

This problem has a long history In the United States dating back to when mental health services were established in the country (Calear et al., 2017). A lot has been done over the years to encourage individuals to utilize mental health services. Most notable, mental health America was established in 1909n to help address major mental health issues at the time including schizophrenia, bipolar disorder, and Dementia (Chang & Biegel, 2018). Historically, mental health was described as mental hygiene, a term used since 1843. At the time research indicated that mental hygiene would work best through religion, culture, and education (Chang & Biegel, 2018).

Theoretical Foundations/Conceptual Framework and Review of the Literature/Themes

Theoretical literature

Social cognitive theory is used to address the gap identified in this research. According to Kohn et al., (2018), social cognitive theory can be applied to encourage people experiencing mental health problems to utilize mental health services. This theory describes how individuals believes and the environment influence people’s behaviors. The theory holds that people’s believes affect how people behave. The theory suggests that people need to have the skills to be able to perform some behaviors. Regarding utilization or rejection of mental health services, behavioral capability can help people to change their intentions and behaviors.

Literature Themes

Various themes were identified in the literature review including

Mental Health Infrastructure Comment by Dr. Seymour: Good job James. This section is now done. You can repeat the process for the next section and submit one more section for me to check on. Then you’ll be ready to do the rest on your own. Excellent work, Dr. Seymour

This involves mental health workers including psychiatrists, counselors, psychiatric nurses, and psychologists (Anderson, 2018). Over the past few years, the US health sector has experienced various challengers due to the lack of enough health professionals. This increases the challenges of encouraging people to utilize mental health. In addition, individuals residing in remote areas are unable to access mental health care because they are scarce. The following articles conducted studies on the infrastructure. For example, there is an overall lack of infrastructure (Andreucci, Russo & Olszewska-Guizzo , 2019) and this leads to less than half of those in need having access (Cummings et al., 2017). When researchers look for specific issues with infrastructure the issues of hiring, space (National Academies of Sciences, Engineering, and Medicine, 2018), and lack of youth services are noted (Cummings et al., 2016).

Andreucci, Russo & Olszewska-Guizzo (2019) noted that mental health is a significant health problem in the US. They collected data from 14 studies using systematic review methods. They analyzed their data using meta-analysis. Overall, they found that poor infrastructure made it difficult to address the problem. The study suggested that creating an urban environment can help address the issue. Indeed, this lack of infrastructure means that more than half of the people suffering from mental health issues in the United States are unable to access mental health services (Cummings et al, 2017). Cummings et al.’s (2017) study was conducted using national data on mental health treatment resources availability from 2013 to 2015. Data was obtained from the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator. They found that 42.5% (3382 of 7959) of communities in the highest income quartile had specialty mental health treatment resource vs 23.1% (1841 of 7959) of communities in the lowest income quartile. This lack of infrastructure has significant consequences.

National Academies of Sciences, Engineering, and Medicine, (2018) (NASEM) collected data from 9,986 facilities using meta-analysis methods. They analyzed their data using content analysis. They found that mental health professionals hire a wide range of mental health professionals including care navigators, peer specialist, therapists, social workers and psychiatric nurses. However, lengthy hiring process and problems to do with retention have significantly contributed to shortage of mental health professionals. In addition, NASEM (2018) reported that some locations do not have enough physical space needed to fill some vacancies and consequently accommodate all their clients. In addition, infrastructure problems include a lack of mental health specialists for youth. Cummings et al., (2016) collected data from the 2008 National Survey of Mental Health Treatment Facilities. They analyzed their data using content analysis. They found that there is poor specialist treatment infrastructure for youth with mental health illness in the US (Cummings et al., 2016). Thus, there are several aspects that result in a lack of providers.

In addition to lack of providers, there are also problems with where the facilities are located. Kilbourne et al., (2018) that reported that people from poor communities are unable to access mental healthcare services due to distance and their social economic status. This study included 123 participants and used a qualitative interview format to collect reasons for lack of services. Themes included travel time, social economic status, and lack of enough mental health professionals. In summary, there are many problems with the infrastructure including number of providers, hiring and retention of providers, and location of providers.

Synthesis. There are several studies that have convergent findings regarding the current factors influencing the utilization of mental health including Hester (2017) systematic review, and the Kohn et al., (2018) large national survey. Areas of convergence (similar findings) are that the main factors affective individual’s decisions to utilize mental health include distance, socioeconomic status and space for healthcare facilities. That is these studies found similar things including: poor utilization of mental health in poor communities and lack of finances to access mental health services. They found some divergent findings such as increased utilization of mental health among women as compared to men.

They were strong because of their large numbers and geographic reach. This study had many strengths including it created openness and provided detailed information about people attitudes, feelings and behaviors. Limitations were reported including small sample size (REFS) and AUTHOR (year) reported researcher bias. They were limited by the inability to gain context on the survey numbers they were collecting. There are several empirical studies reviewed regarding the integration of mental health in schools including Andreucci, Russo & Olszewska-Guizzo (2019), Anderson, (2018), and Kohn et al.( 2018). Some were limited by small sample sizes Calear et al., (2017). Comment by Dr. Seymour: Put the references of WHICH studies were strong. Not all of them were. Comment by Dr. Seymour: Again, references needed. Comment by Dr. Seymour:

Additional articles not in the above section speak to these issues. For example Wang, & Xie, (2019) found that most regions have developed infrastructure for the provision of mental health services similar to the Hester (2017) study reviewed here. Another study by Chang & Biegel, (2018), found that women are more likely to utilize mental health services as compared to men. Another study by (Anderson, 2018) was divergent/ different in that it focused on ethnicity instead on gender and found that people from minority groups are less likely to access mental health services as compared to people from major communities. Comment by Dr. Seymour: You can leave this section here, but it should not be included in future synthesis. It is actually advised for a different university that is not as stringent as GCU. Sorry.

Synthesis.

There are several studies that have convergent findings regarding the current mental health situation in schools including AUTHOR, YEAR crime study, and the AUTHOR YEAR large national survey. Areas of convergence (similar findings) are: xxxxxx That is these studies found similar things including: xxxx. They found some divergent findings (different things) such as xxxxxxx.

They were strong because of their large numbers and geographic reach. This study had many strengths including xxxxx. Strengths should be noted everywhere they can apply to an article. Limitations were reported xxxxx. They were limited by the inability to gain context on the survey numbers they were collecting. There are several empirical studies reviewed regarding the integration of mental health in schools including AUTHOR YEAR about xxxx, AUTHoR YEAR about xxxxx, AUTHOR YEAR about xxxx. Some were limited by small sample sizes including author year and author year.

Additional articles not in the above section speak to these issues. For example REF found XXX similar to the REF study reviewed here. Another study by xxx found that xxxxx. Another study by xxx was divergent/different in that it focused instead on xxxxxx and found xxxxx.

Literature. There were three studies investigating the prevalence of spotted fish. The first collected 259 in person interviews about people’s memories of fish they’ve seen throughout their lifetime. Thematic analysis found two themes that people didn’t remember well and two that almost all fish had been spotted. The second study collected 3029 direct observations of fish in an aquarium and found that a statistically significant amount at the p< .001 level were spotted. The final study surveyed people on the internet and asked them to count how many fish were in their tank and what portion were spotted. An ANOVA found a statistically significant difference between men and women, indicating that men had more spotted fish at the p >.05 level. Overall, the findings provide convergent evidence that most fish are spotted, but the final study provided some divergent evidence indicating that women may have fewer spotted fish than men. Overall, the evidence seems clear that most fish are spotted. Comment by Dr. Seymour: Silly example so that you know how to write up the articles as a whole.

Synthesis. There are several studies that cover a wide array of the influence of police education and accountability on use of force and related outcome measures. These include Stickle’s (2016) police education and training study, Wetherington’s (2018) police pre-employment standards study, Shjarback’s (2015) police early warning system study, Huff et al.’s, (2018) and Donner’s (2018) research on police officer misconduct. There is some convergence in the findings of Stickle (2016) and Huff et al., (2018). That is these studies found increased education and training are associated with decreased use of force and reported misconduct. Divergent findings included Wetherington’s (2018) research showing increased education had no association with police disciplinary problems. There is also some disagreement between Huff et al.’s, (2018) findings that early warning systems were one of many elements reducing police misconduct while Shjarback (2015) finding no effect of the system’s on rates of complaints. A unique finding in this series is Donner’s (2018) significant and positive correlations between previous misconduct and future misconduct.

Most of the studies on this topic were not strong indicators of the effect of police education and accountability on use of force or related outcome measures. For instance, Stickle (2016) correlated archival survey data with use of force complaints which are not an accurate measure of the rate of incidents or their justification. Another example is found in Huff et al., (2018) who’s results are overly broad in identifying a long list of elements which appeared to be associated with reduced complaints. However, both Stickle (2016) and Huff et al., (2018) used large sample sizes which increased their power. The strongest of the studies reviewed is Shjarback (2015) who used a pre/posttest design to determine the effect of early warning systems on rates of force. Many of the authors intimated a need for stronger measures and methodologies in research accountability or hiring standards (Huff et al., 2018; Shjarback, 2015).

Follow these steps:

1. Finding research that goes under those subheadings.

2. Writing up each article as an annotated bibliography FIRST – later you will pull them together and synthesize them.

Each Annotation includes: type of study, number of participants, what data was collected, how it was analyzed, several sentences about the findings with specific numbers and themes reported, limitations.

3. Group articles together into paragraphs if they go together with transition sentences --- add topic sentences and summary sentences for every paragraph.

4. SYNTHESIS paragraphs at end of subsection that lists, compares, contrasts, similarities noted, all of the articles in that section. See example.

INTRODUCTIONS- now that you know about the whole subsection go back and write a short introduction to each subsection. This is required by the rubric.

You need 50 articles (2014 or later), 25% can be older.

You need 30+ pages.

Example: The articles include in this section are on several subtopics including xxxxxx (REFSSS), xxxx (REFS), and xxxx (REFS). Some articles about jumping beans focused on how high they jump (refs, ref, refs), while other articles focused on the colors of the jumping beans (refs, refs, refs). In the first subsection(IF YOU HAVE SUBSECTIONS IN A BIG SECTION< YOU MIGHT NOT) called xxxxx, there are three articles about xxxxxx and xxxx (Ref, Ref, Ref). In the second subsection called xxxx, there are six articles about xxxx, xxxx and xxxx (Ref, Ref, Ref). Comment by Dr. Seymour: Read the synthesis of this section Write a 3-4 sentence introduction to the research in this section. Use the general idea in this introductory sentence I wrote. Include ALL subheadings in the section. Be sure to reference EVERY article from the section at least once.

Reasons for Lack of Access to Mental Health

According to (Kohn et al., 2018) there are numerous factors that have been identifies as the reasons why people are unable to access mental health services. Lack of insurance is one of the reasons why people cannot access these services. Poor socioeconomic status particularly for families in rural areas makes it difficult for them to access mental health services. Distance has also been found to be another reason as to why people are unable to utilize these services (Kohn et al., 2018).

In the United States, 42% of the population believe that cost and poor insurance coverage are the top barriers that prevents them from accessing mental health care (Kohn et al., 2018). While only 25% reported that they make decisions between using mental health treatment or paying for daily necessities (Calear et al., 2017). Getting face-to-face services remains a top priority for many Americans who are seeking mental health treatment than getting access to medication. Approximately 38% of Americans, or 96 million, on several occasions have waited longer than a week for mental health treatment services. Distance is another barrier in that about 46% of the population have experienced or knew someone who has had to travel for over one-hour roundtrip to seek treatment (Calear et al., 2017).

Although many Americans have tried seeking mental health treatment, in addition to the 29% of the population who want to; however, failed to seek the treatment for either themselves or loved ones due to lack of knowing where to go for the services. Statistics also indicate that 21% of adults in the US have tried to see a professional but were unable to do so because of reasons outside of their control (Calear et al., 2017).

Populations that Use Mental Health Services

According to (Kohn et al., 2018),Numerous studies indicate that women are at a higher risk of developing mental health issues due to drug abuse and sexual abuse, As a result, a high number of women seek mental health services as compared to their male counterparts.

Populations that Reject Mental Health services

Calear et al., (2017) noted that people from minority groups have been found to be the people who fail to utilize mental health services. Asian women have particularly been linked to lower utilization of mental health in the country.

People who do have Access to Mental Health

According to Calear et al., (2017), Medicaid, Medicare, Obamacare started covering mental health care after the implementation of the Affordable Care Act. The shortage of healthcare professionals means they are not willing to participate in treating insured patients because the payments are too low.

Populations that Use Mental Health Services

Chang & Biegel, (2018), in their research found out that women who had been exposed to sexual abuse and drug abuse formed the high numbers of people who utilize mental health services among the Hispanic and non-white people in the county.

Reasons for Use of Mental Health Services

Calear et al., (2017) reported that behavioral health treatment, such as psychotherapy and counseling. Mental and behavioral health inpatient and outpatient treatment services (Hester, 2017). Substance use disorder (commonly known as substance abuse) treatment (Wang, & Xie, 2019).

Reasons for Rejection of Mental Health Services

According to Wang, & Xie, (2019), 31% of Americans are worried about being judged for seeking mental health services, and 21% of the population, have lied to people about seeking mental health services. The stigma is accurate among young Americans, who of course worried of being judged by others when they confess of seeking mental health services (Wang, & Xie, 2019).

Advancing Scientific Knowledge and Significance of the Study

This study will help in addressing the existing gap in literature concerning utilization of mental health services in US. The study will significantly provide insights as to why individuals reject or utilize mental health services. The study will also narrow down to certain factors that hinder people from utilizing mental help despite those services being accessible. In addition, the study will provide important background information for defining the problem and addressing issues associate with lack of utilizing mental health services (Anderson, 2018).

The results will help mental health providers with significant knowledge to help them determine effective strategies in encouraging individuals to seek mental health services. The information obtained will be used by healthcare professionals for mental healthcare promotion. The findings of this study will also be important for social workers helping mental health patients cope with their situations in the community setting. In addition, the study will provide insights on how social cognitive theory may be used to help in promoting mental health. This is especially important considering the increased cases of individual with mental illnesses failing to utilize these services (Chang & Biegel, 2018).

Rationale for Methodology

This study utilized qualitative methodology to solve the problem identified. This methodology was selected because it allows researchers to evaluate feelings and believes of the study subjects. It also helps the subjects of the study to provide responses based on their personal experiences. In addition, this approach reduces the researcher’s biasness increasing the reliability of the findings obtained. It is appropriate for answering the research questions that ask about the reasons that contribute to mental health patients to accept or reject treatment because it provides primary verbal data that is collected in detail (André et al., 2017).

Nature of the Research Design for the Study

A descriptive research design was used for this study. This design is the most appropriate design for the present study since it not known how mental health providers describe the factors influencing individual decisions to utilize or reject mental health services in South Texas. This is because the method is appropriate for the research to collect data from the mental health providers in depth. It is appropriate for the research questions because it gives the participant an opportunity express the points in length by choosing their own words. As a researcher more understanding is achieved through open-ended questions.

Ethical Considerations

Before the commencement of the study, the researcher will contact his organization to explain the proposed study. Once the organizational and IRB approvals are given, the organization will provide a list of qualified candidates and an email invitation will be sent to the mental health professionals regarding participation in the study. Participants will be recruited by asking the staff secretaries to forward an email from me to the staff.

References

Calear, A. L., Banfield, M., Batterham, P. J., Morse, A. R., Forbes, O., Carron-Arthur, B., & Fisk, M. (2017). Silence is deadly: A cluster-randomized controlled trial of a mental health help-seeking intervention for young men. BMC Public Health, 17(1), 834. doi:10.1186/s12889-017-4845-z

Hester, R. D. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Systems, 11(1), 47. doi:10.1186/s13033-017-0154-2

Kohn, R., Ali, A. A., Puac-Polanco, V., Figueroa, C., López-Soto, V., Morgan, K., . . . Vicente, B. (2018). Mental health in the Americas: An overview of the treatment gap. Revista Pan Americana De Salud Publica = Pan American Journal of Public Health, 42, e165. doi:10.26633/RPSP.2018.165