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Problem Identification Paper

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Herzing University

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Introduction

Professional nurses are central to identifying and addressing clinical practice problems that undermine equitable access to care and patient outcomes. One such issue is the lack of transportation for patients requiring mental health services, a barrier that directly interferes with continuity of care and overall well-being. Transportation represents a critical social determinant of health, and without reliable access, patients are at greater risk for missed appointments, untreated psychiatric symptoms, and preventable hospitalizations. Nurses in both clinical and community settings often recognize these patterns, as they frequently witness patients unable to engage in care due to logistical barriers. The article by Kemp (2025) highlights the broader systemic challenges within school-based mental health models and policies, underscoring how accessibility barriers prevent individuals from obtaining essential behavioral health services. This work illustrates the pressing need for nurses and healthcare systems to implement targeted interventions that address transportation barriers as part of a larger strategy to advance equitable access to mental health care.

Identified Practice Problem

The practice problem identified is the lack of reliable transportation for patients with mental health conditions to attend in-person visits. This issue is significant because it directly affects treatment adherence, therapeutic engagement, and clinical outcomes. Many patients with mental illness face socioeconomic stressors such as unemployment, financial instability, and limited social support, which compound the effects of inadequate transportation. Consequently, these individuals may experience disrupted medication management, inconsistent participation in therapy, and delayed crisis intervention. Recognizing and addressing transportation barriers is essential for reducing health disparities and improving long-term outcomes in psychiatric populations.

Evidence Supporting the Practice Problem

Transportation and Mental Health Access in Policy Context Kemp (2025) emphasizes that school-based mental health policies and care models often fail to address broader systemic barriers to access, including transportation. While focused on younger populations, this analysis reflects a widespread reality: transportation challenges intersect with structural inequities, leaving vulnerable groups unable to obtain timely and effective care. Nurses, particularly those in primary and psychiatric care, are positioned to recognize these inequities and advocate for accessible, community-driven solutions.

Rural Transportation and Health Access Henning-Smith, Kozhimannil, and Casey (2018) found that rural residents face disproportionate challenges in accessing healthcare due to limited public transportation infrastructure. The study noted that individuals with mental health needs in rural settings were particularly impacted, with transportation barriers contributing to higher rates of missed appointments and increased reliance on emergency services. These findings reinforce that transportation is not merely an inconvenience but a structural determinant shaping mental health outcomes.

Transportation as a Barrier Across Healthcare Settings Syed, Gerber, and Sharp (2017) conducted a systematic review of transportation barriers and concluded that lack of reliable transit is one of the most common obstacles to healthcare access, particularly behavioral health. Their review demonstrated that patients without transportation are more likely to miss or delay care, which results in fragmented treatment and worse disease management outcomes. The authors stressed that transportation is a modifiable barrier, one that health systems must address through innovative models of care delivery.

Social Determinants of Health and Missed Mental Health Appointments Douthit, Kiviniemi, and Kaplan (2020) specifically examined the role of social determinants of health in missed mental health appointments. Their findings revealed that patients without reliable transportation were twice as likely to miss appointments compared with those with dependable access. Importantly, the authors highlighted potential solutions—including telehealth, ridesharing partnerships, and community-based shuttle services—that could mitigate the negative impact of transportation barriers. This evidence demonstrates that nurses can play an active role in designing and implementing interventions that address transportation as part of a comprehensive, patient-centered approach.

Conclusion

Transportation barriers represent a significant clinical practice problem that directly impacts continuity of care and outcomes for mental health patients. As Kemp (2025) shows, accessibility issues such as transportation remain a pressing challenge in healthcare policy and practice, often leaving vulnerable groups without consistent behavioral health services. Supporting literature confirms that limited transportation contributes to missed appointments, delayed treatment, and poorer long-term outcomes across diverse populations. Nurses are uniquely positioned to identify transportation barriers and advocate for patient-centered, system-level interventions. Addressing these challenges is essential to advancing equity, ensuring continuity of care, and improving mental health outcomes across communities.

References

Douthit, N., Kiviniemi, M., & Kaplan, L. (2020). Social determinants of health and missed appointments in community mental health settings. Journal of Affective Disorders, 273, 147–153. https://doi.org/10.1016/j.jad.2020.04.010

Henning-Smith, C., Kozhimannil, K. B., & Casey, M. (2018). Rural transportation barriers and their impact on health care access. Journal of Primary Care & Community Health, 9, 1–6. https://doi.org/10.1177/2150131918769966

Kemp, C. (2025). An analysis of school-based mental health models and policies. AJN, American Journal of Nursing, 125(1), 46–52. https://doi.org/10.1097/01.NAJ.0001094688.17194.47

Syed, S. T., Gerber, B. S., & Sharp, L. K. (2017). Traveling towards disease: Transportation barriers to health care access. Journal of Community Health, 38(5), 976–993. https://doi.org/10.1007/s10900-013-9681-1