The purpose of this qualitative descriptive study is to examine how mental

Factors Influencing Utilization of Mental Health Services in South Texas Kehinde Alli Dr. John Johnson January 31, 2022

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1

Purpose Statement

The purpose of this qualitative descriptive study is to examine how mental health providers describe influencing factors among south Texas residents to utilize or reject mental health services.

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The purpose of this study is to seek insight into how intrapersonal issues result in limited capability to receive care for different types of mental health conditions. This study shall perform study of this issue and the external driving forces that cause this. The study shall also provide insight in the systemic perspective to determine how mental health institutions and the local government in Texas have an impact on health improvement measures.

Literature Review: Background to the Problem/Define the Need/Gap

To research and understand the factors affecting decisions not to utilize Mental Health Services

Mental disease stigmatization

Worrying about privacy of their health problem

High expenses of mental health treatment

Causes of the issue

Having no medical care insurance

Being afraid that another individual might know.

Concerns of the mental health facilities failing to meet hygiene standards.

Lower income earnings makes it had to get mental health services

Solving the issue

Stigma reduction

Educating people on mental health

Creation of Awareness

Augsberger, Yeung, Dougher, & Hahm (2015).

Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016).

Lake & Turner, (2017); Luitel, et al. (2017); Magaard et al. (2017); Mastapha, (2018); Velasco et al. (2020).

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This literature review conducts the analysis of mental illness and lack of capability of affected persons to receive care and treatment suitable to their conditions. Lake & Turner, (2017) identified that the current environment requires effective study in order to deal with the prevalent mental health issues and to offer care that is required for persons suffering from the conditions. The urgency in improving access to mental health services is critical since it has the capability of affecting the strategies already implemented in society.

Augsberger et al. (2015) in support of this research argued that mental health services had been underutilized by Asian women living in this county, as a result of both cultural needs and mismatch of the services offered in the health facilities in this Southern State. The author analyzed the hidden barriers to accessing care and utilization of mental health for Asian American Women in Southern Texas

Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016). Reviewed and analyzed how the likelihood of lower hospitalization was associated with the race of African Americans while increasing age was a key predisposing factor in increased likelihood of hospitalization in South Texas.

According to Velasco et al., (2020) there are issues that limit access to healthcare such as family beliefs, stigma, self-will for improvement, literacy, and availability of access to mental health services. This often results in result in lack of access to mental health services (Volkow, 2020). The mentally ill persons get exposed to limited capability to access mental health based on their internal barriers and external barriers that limit adaptation.

Knaak et al., (2017) identified that some persons suffering from mental health often reject treatment measures due to stigma in the healthcare industry (Luitel et al., 2017; Magaard et al., 2017; Mastapha, 2018). This is a negative aspect that is highly detrimental since the affected persons find it hard to function in all their environments. It is thus imperative to study personal barriers and external barriers in order to formulate an effective plan of managing the issues.

3

Problem Statement

It is not known how mental health providers in South Texas describe the factors that influence utilization of mental health services

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While the literature indicates that mental health issues are prevalent, it is not known in the south Texas community how the residents suffer from different types of mental illnesses. All the barriers for mental health improvement discussed in the literature review section are clear indicators as to why the problem is prevalent and requires attention. The process of identification of the problem for research revealed that there are a variety of mental health issues each with unique impact on people.

The problem identification is accurate and provides guidance to determine the appropriate method of dealing with mental health related conditions. The process of selecting mental health issues from the public becomes difficult since issues arise when systemic, interpersonal, and intrapersonal barriers exist as people seek to improve their wellbeing (Qin & Hsieh, 2020; Santini et al., 2020). To this end, it is not known how mental health providers in South Texas describe the factors that influence utilization of mental health services.

Literature Review: Theoretical Foundations

The theoretical model for the research gap is the Cognitive theory of Psychopathology by Aaron T. Beck. The theory states that individual perception is influenced by positive and negative mental health status (DeYoung & Krueger, 2018).

This model fits directly into the dissertation because it is helpful at describing how individual’s perceptions of situations including spontaneous thoughts on events influence people’s emotional, behavioral, and psychological reactions in relations to mental health services. Furthermore, this theory connects to the study of mental health utilization through the concepts of perception.

According to Steele et al. (2017) the LBGT community’s beliefs about utilizing mental health services conforms to an identity that is not agreed upon. In their view, an individual’s perception grows into the belief that supports non-utilization of mental health services.

DeYoung, C. G., & Krueger, R. F. (2018). A cybernetic theory of psychopathology. Psychological Inquiry, 29(3), 117-138. doi:10.1080/1047840x.2018.1513680

Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Green, D. C., Williams, C. C., & Ross, L. E. (2017). LGBT identity, untreated depression, and unmet need for mental health services by sexual minority women and trans-identified people. Journal of Women’s Health (Larchmont, N.Y. 2002), 26(2), 116-127. doi:10.1089/jwh.2015.5677

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The theoretical foundation of this research will be based on the cognitive theory of psychopathology that was suggested by Aaron T Beck. It states that individual perception is influenced by positive and negative mental health status (DeYoung & Krueger, 2018). This model fits directly into the dissertation because it is helpful at describing how individual’s perceptions of situations including spontaneous thoughts on events influence people’s emotional, behavioral, and psychological reactions in relations to mental health services. The theory emphasizes that the distorted beliefs influence people’s understanding of themselves, their surroundings, and their interaction with others. As such, distorted beliefs influence the way individuals process information.

The problems of underutilization of mental health services and non-institutionalization of adults has been emphasized as behavioral risk factors. According to Kohn et al. (2018) there is a gap in utilization of mental health services in the United States among the individuals that require treatment and those that actually receive the treatment. Therefore, there is the need to establish and understand what the social determinants of mental disorders are, and align them with the sustainable development goals, and to establish the potential mechanisms and targets for interventions (Kohn et al., 2018).

5

Research Questions, Phenomenon, Variables and Hypotheses

Research Questions

RQ1: How do mental health providers describe the factors influencing utilization of mental health services?

RQ 2: How do mental health providers describe strategies of encouraging patients to utilize mental health services?

RQ 3: How do caregivers describe the factors influencing patient’s utilization of mental health services?

RQ4: How do caregivers describe strategies of encouraging patients to utilize mental health services?

De Luca, Blosnich, Hentschel, King, & Amen (2016). Mental Health Care Utilization: How Race, Ethnicity and Veteran Status are Associated with Seeking Help. Retrieved from https://link.springer.com/article/10.1007/s10597-015-9964-3

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The process of forming the research questions shall use current data involved in mental health improvement initiatives which is imperative since many people have been experiencing anxiety and depression due to the Covid-19 pandemic (Newby et al., 2020; Mullet et al., 2020; Moreno et al., 2020). The technique of creating research questions would also generate effective outcomes since the issue of mental health in Texas has been prevalent and exists for millions of the residents. Inability to access care due to external constraints and influence from the environment shall also get addressed.

De Luca et al. (2016) states that veterans disproportionately experience higher rates of mental illness than civilians, conflicting results surround the impact of race/ethnicity on treatment utilization. The authors utilized the CDC’s Texas Behavioral Risk Factor Surveillance System data; while no differences were found in health care utilization between non-Hispanic white veterans and non-veterans, there were distinct patterns among racial/ethnic minority veterans and non-veterans. Black and Latino non-veterans reported significantly lower health care utilization compared to non-Hispanic white non-veterans.

6

Methodology

Qualitative study.

The methodology will be utilized to assist in offering actual evidences from the interview with participants. Previous studies show that the main cause of low use of services of mental health is the limitations of getting access to medical care (Augsberger, Yeung, Dougher, & Hahm, 2015).

Data collection operations will be performed using interviews and questionnaires to collect accurate information.

Information will be acquired to map the behavior of people who seek health care relating to mental health.

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The research methodology chosen for this study is qualitative methodology since it has the best approach of dealing with data that involves respondents. The research method is not focused on numerical analysis since it is possible to acquire data based on personal accounts as respondents provide non-numerical responses. Qualitative research methodology is focused on non-numerical responses which provide information related to a topic getting studied by researchers (Aspers & Corte, 2019). The methodology can get performed by using respondents, data, visual objects, or documents that all have connection to a phenomenon getting studied (Poucher et al., 2019). The methodology also provides directions for any topic since it is possible to determine a research approach that has capability of generating future study of a similar phenomenon.

7

Design

Descriptive Study

It is the suitable design since it provides data that is given by mental health providers who interact with patients in this field. It makes the information presented reliable and valid.

Literature review agrees with the argument that there is under usage of mental health resources. The State has a risk of having mentally ill people who have no access to care they require (Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, 2016).

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Qualitative descriptive design is the most approach since it provides insight into a phenomenon and how it affects the normal functioning of affected persons. The design offers proper analyses of healthcare departments since it displays their characteristics mainly instead of focusing on required data (Bradshaw et al., 2017). The method allows analysis of a phenomenon based on the respondents and their daily activities that are connected to the expected positive outcomes.

8

Population, Target Population, and Sample

Population:

United States Mental Health Providers.

Target Population:

mental health providers who are members of the Mental Health Association in South Texas.

Sample:

Sample participants will come from Southern Texas, United States.

15 mental health providers will be selected as the sample group.

Interviews: Minimum of 15 Mental Health providers

The participants will be sampled from the three closest mental health centres/hospitals in the region

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The population that this paper shall address is persons living in Texas who had been affected by mental health related issues. Selection of persons living in Texas is effective since there is a lot of data from credible sources which relates to prevalence of mental health issues in the area and the need to improve mental health of al residents. The target population for this study shall be adults living in Texas who had recently developed mental health issues due to the pandemic, those whose mental health issues had worsened due to the pandemic, and those who could not access care due to external constraints. All the respondents shall be persons who had been living in south Texas even before the pandemic and had based their livelihood and daily operations to the social structure displayed in South Texas.

The persons selected for the research would involve people from the target population who would be willing to take part in the research. The process of selection of persons from the target population would involve 15 persons who would have volunteered to take part in the study. All the volunteers would be set up at a single location or their residences since the research shall get conducted online. The volunteers will select 15-35 mental healthcare providers spread across the state of Texas. The next study sample would involve 100 people living in Texas.

9

Instruments and Data Sources: Qualitative Study

Interviews will be used to gather information. The information will be collected by taking notes, making recordings and documenting the responses from the interviews. 15 participants will participate in the study

The main participants would be mental health providers who are members of mental health association who would be available for the interviews.

Information gathered will be summarized using Descriptive Statistics.

Questions posed will be addressed through coding.

A narrative summary will be developed.

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The process of generating this data shall involve assessment of interview participants and creating a connection between them and the topic getting studied. The data for this methodology section shall mainly come from persons taking part in the research. The interview questions and focus group questions would get aligned to the research questions involved in the study.

Due to prevailing environmental conditions, the data collection instruments shall be Zoom meetings, Google Forms, and Emails. The 3 channels are selected since they all are freely accessible using internet connection and have capability of generating valid data from respondents. The use of social media would also be effective in the research process since it would be possible to find persons interest in taking part in the study. There are more that on billion active social media users on “Facebook, Messenger, and Instagram” (Tankovska, 2021). This provides a large platform and source of data for persons living in Texas since the majority use social media and have internet connections.

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Instruments and Data Sources: Qualitative Study (cont.)

Collection of data that would be used will comprise of:

Acquiring a list of mental health providers who are members of Mental Health Organizations including:

Mental Health America (MHA)

National Alliance on Mental Health (NAMI)

National Institute of Environmental Health Sciences (NIEHS)

National Institute of Mental Health (NIMH)

Survey monkey will be used to collect data

Questions will be developed in part from:

National Institute of Environmental Health Sciences Mental Health Questionnaire

Agency for Healthcare Research and Quality (AHRQ) Mental Health Quality Measures Questionnaire

Twelve Mental Health Providers would be selected to complete the NIEHS and the AHRQ Questionnaires

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Research Data Source #1. Zoom meetings shall get used to enable connection between volunteers for the research and mental health providers. The use of zoom meetings would be effective since no permission is required from the developers to use the platform. The only requirement is for users to create new accounts and to have stable internet connection that would not interfere with transmission. The data source would provide information on mental health providers, and it would be possible to identify how they connect to the proposed research questions.

Research Data Source #2. Google Forms shall get used to register persons interested in taking part in the study. The use of google forms is effective since no permission is required to use them for any research project. The forms can get developed by simple accessing google forms option on the google drive of a registered user. This technique would be suitable since the forms would contain these fields: name, email, age, gender, checkbox to select whether suffering from mental health issues or not, and phone contact details.

Additional Data Source. Emails shall get used to communicate with respondents in an official manner and to generate valid data from mental healthcare providers. The use of emails would create an official communication technique that shall get used to connect with mental health providers and members of the public. The communication process before the study begins will all get recorded on the emails and it shall be possible to find valid data that generates required output for the study

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Data Analysis Procedures

The data collected through both literary research and qualitative interviews will focus on thematic and factual relevance of the issue.

The data related to Factors Influencing Utilization of Mental Health Services in South Texas will be inferred and thematically categorized for analysis after the identification of relevant information groups in both the documents and the interviews.

The statistical significance for the secondary data and the additional data elements that are collected through interviews will be assessed using the IARF tool, which provides statistical significance estimates for all sample sizes of samples and the number of observations (Vaismoradi & Snelgrove, 2019).

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The data analysis methodology and procedures will be the focus of this section through an in-depth exploration. The main goal of the qualitative data analysis is identifying actionable and factual data about the limitations and challenges that contribute to Factors Influencing Utilization of Mental Health Services in South Texas . The data collected through both literary research and qualitative interviews needs to be focused on thematic and factual relevance of the issue. This thematic process is also the point of reference in the case of the analysis of the specific issues related to Factors Influencing Utilization of Mental Health Services in South Texas. The data collected will be used to construct an independent and objective, well-defined dataset that will lead to the final report.

The data related to Factors Influencing Utilization of Mental Health Services in South Texas will be inferred and thematically categorized for analysis after the identification of relevant information groups in both the documents and the interviews. These information groups will be grouped for analysis and extraction of factual data that will be divided into an initial set that consists of relevant data elements and a supplementary set that consists of additional data elements from secondary data collected through interviews. The thematic analysis of the core research data allows researchers to gain insights on Factors Influencing Utilization of Mental Health Services in South Texas. The supplementary set of secondary data and the additional data elements from secondary data collected through interviews will be used to develop a conceptual framework that can guide a final report on Factors Influencing Utilization of Mental Health Services in South Texas. One of the purpose of this is to define the most promising areas for further research. The statistical significance for the secondary data and the additional data elements that are collected through interviews will be assessed using the IARF tool, which provides statistical significance estimates for all sample sizes of samples and the number of observations (Vaismoradi & Snelgrove, 2019).

References

American Psychological Association (2020) Cognition is central to drug addiction. Retrieved from https://www.apa.org/monitor/jun01/cogcentral

Aspers, P., & Corte, U. (2019). What is Qualitative in Qualitative Research. Qualitative sociology, 42(2), 139–160. https://doi.org/10.1007/s11133-019-9413-7

Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC Health Services Research, 15(1), 542. doi:10.1186/s12913-015-1191-7

Basu, S., Rehkopf, D. H., Siddiqi, A., Glymour, M. M., & Kawachi, I. (2016). Health behaviors, mental health, and health care utilization among single mothers after welfare reforms in the 1990s. American Journal of Epidemiology, 183(6), 531-538. doi:10.1093/aje/kwv249

Boardwalk Recovery (2019). Cognitive Behavioral Therapy for Substance Abuse. Retrieved from https://boardwalkrecoverycenter.com/cognitive-behavioral-therapy-for-substance-abuse/

Blosnich, J. R., Marsiglio, M. C., Gao, S., Gordon, A. J., Shipherd, J. C., Kauth, M., . . . Fine, M. J. (2016). Mental health of transgender veterans in U.S. states with and without discrimination and hate crime legal protection. American Journal of Public Health (1971), 106(3), 534-540. doi:10.2105/AJPH.2015.302981

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References (cont’d.).

Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a Qualitative Description Approach in Health Care Research. Global Qualitative Nursing Research, 4, 233339361774228. https://doi.org/10.1177/2333393617742282

De Luca, S. M., Blosnich, J. R., Hentschel, E. A. W., King, E., & Amen, S. (2015). Mental health care utilization: How race, ethnicity and veteran status are associated with seeking help. Community Mental Health Journal, 52(2), 174-179. doi:10.1007/s10597-015-9964-3

Hamilton, J. E., Desai, P. V., Hoot, N. R., Gearing, R. E., Jeong, S., Meyer, T. D., . . . Gerson, L. W. (2016). Factors associated with the likelihood of hospitalization following emergency department visits for behavioral health conditions. Academic Emergency Medicine, 23(11), 1257-1266. doi:10.1111/acem.13044

Hom, M. A., Stanley, I. H., & Joiner, T. E. (2015). Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clinical Psychology Review, 40, 28-39. doi:10.1016/j.cpr.2015.05.006

Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum, 30(2), 111–116. https://doi.org/10.1177/0840470416679413

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 Panamericana De Salud Publica = Pan American Journal of Public Health, 42, e165. doi:10.26633/RPSP.2018.165

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References (cont’d.).

Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. The Permanente journal, 21, 17–024. https://doi.org/10.7812/TPP/17-024.

LARSON, Z. (2018). America’s Long-Suffering Mental Health System. Retrieved from http://origins.osu.edu/article/americas-long-suffering-mental-health-system

Luitel, N.P., Jordans, M.J.D., Kohrt, B.A., Rathod, S.D., & Komproe, I.H. (2017) Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal. PLoS ONE 12(8): e0183223. https://doi.org/10.1371/journal.pone.0183223.

Magaard, J.L., Seeralan T, Schulz, H., & Brütt A.L. (2017) Factors associated with help-seeking behaviour among individuals with major depression: A systematic review. PLoS ONE 12(5): e0176730. https://doi.org/10.1371/journal.pone.0176730.

Mastapha, A. R. Z. (2018). “Perceived Stigma and Barriers To Mental Health Care Among Former Military Service Members” (2018). Theses and Dissertations–Educational, School, and Counseling Psychology. 74. https://doi.org/10.13023/etd.2018.261.

Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., & Jones, N. et al. (2020). How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry, 7(9), 813-824. https://doi.org/10.1016/s2215-0366(20)30307-2.

Muller, A., Hafstad, E., Himmels, J., Smedslund, G., Flottorp, S., & Stensland, S. et al. (2020). The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Research, 293, 113441. https://doi.org/10.1016/j.psychres.2020.113441

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References (cont’d.).

Newby, J.M., O’Moore, K., Tang, S., Christensen, H., & Faasse, K. (2020) Acute mental health responses during the COVID-19 pandemic in Australia. PLoS ONE 15(7): e0236562. https://doi.org/10.1371/journal.pone.0236562.

Poucher, Z., Tamminen, K., Caron, J., & Sweet, S. (2019). Thinking through and designing qualitative research studies: a focused mapping review of 30 years of qualitative research in sport psychology. International Review Of Sport And Exercise Psychology, 13(1), 163-186. https://doi.org/10.1080/1750984x.2019.1656276

Qin, X., & Hsieh, C. (2020). Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence from China. INQUIRY: The Journal of Health Care Organization, Provision, And Financing, 57. https://doi.org/10.1177/0046958020950566.

Steele, L. S., Daley, A., Curling, D., Gibson, M. F., Green, D. C., Williams, C. C., & Ross, L. E. (2017). LGBT identity, untreated depression, and unmet need for mental health services by sexual minority women and trans-identified people. Journal of Women’s Health (Larchmont, N.Y. 2002), 26(2), 116-127. doi:10.1089/jwh.2015.5677

Vaismoradi, M., & Snelgrove, S. (2019, September). Theme in qualitative content analysis and thematic analysis. In Forum Qualitative Sozialforschung/Forum: Qualitative Social Research (Vol. 20, No. 3).

Velten, J., Lavallee, K. L., Scholten, S., Meyer, A. H., Zhang, X., Schneider, S., & Margraf, J. (2014). Lifestyle choices and mental health: A representative population survey. BMC Psychology, 2(1), 58. doi:10.1186/s40359-014-0055-y

Volkow, N. (2020). Addressing the Stigma that Surrounds Addiction. https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction

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———————

Factors Influencing Utilization of Mental Health Services in South Texas Kehinde Alli Dr. John Johnson 31st of January, 2022

CONFIDENTIAL

GCU – For Internal Use Only

1

Purpose Statement

The purpose of this qualitative descriptive study is to examine how mental health providers describe influencing factors among south Texas residents to utilize or reject mental health services.

CONFIDENTIAL

GCU – For Internal Use Only

The purpose of this study is to seek insight into how intrapersonal issues result in limited capability to receive care for different types of mental health conditions. This study shall perform study of this issue and the external driving forces that cause this. The study shall also provide insight in the systemic perspective to determine how mental health institutions and the local government in

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