Are your chances of recovering from mental illness greater if you seek care independently or if you’re ordered into care? This was the subject of a new study recently published in the Journal of Society and Mental Health titled, Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment.
Researchers looked at the database of the United States National Survey on Drug Use and Health which surveyed people on their pathway to treatment, and how effective they rated their treatment. Researchers also noted the participants’ race, age, sex, as well as their socioeconomic and health factors.
“Getting mental health services is important,” says study author, Dr. Sirry M. Alang, professor of sociology and anthropology at Lehigh University. “Much of the research on access to mental health care is premised on the assumption that using services reduces unmet need. But how one enters into care and their perceptions of care are also relevant.”
Dr. Alang wanted to know how people come into contact with mental health services, their perceptions about the effectiveness of the services they receive, and whether there is a connection between the two. The theory Dr. Alang and colleagues had was that if most people independently decide to seek mental health care, then it means there are less barriers to care.
“We were hoping to find that most people with mental health problems will make independent decisions to seek care, and that in general, if they received care, then they obviously believe that that care is effective,” Dr. Alang told us. “We also hoped to find that people with more socio-economic resources such as higher education, income, and who have health insurance will be more likely to seek care on their own.”
As far as race was concerned, the study found that the probability of being ordered into mental health care was 86 per cent greater for Blacks than Whites and more than two times greater for Latinos than Whites.
Concerning socioeconomic and health factors, those with a college education, employment, and good, self-rated health were associated with a significantly lower probability of being ordered into care than seeking care independently.
Gender-wise, the study found that women are more likely to independently enter care than men.
People with severe mental illnesses had a 29 per cent greater probability of being ordered into care and a 38 per cent greater probability of being asked by someone else to receive care compared to their counterparts whose mental illnesses were not severe.
“This means that people who are likely and able to seek care on their own are more likely to get into care sooner,” Dr. Alang told us. “Perhaps, seeking care independently might mean better access to quality care.”
As a result, Dr. Alang says people are more likely to come back when necessary, and to maintain their treatment plan and expectations. However, people who are unlikely and unable to get care on their own might be coerced into care.
“The fact that they were forced against their will to get care might make them less likely to rate that care as effective, or to decide to come back on their own if they have symptoms,” says Dr. Alang. “In addition, the perception of the care people receive indicates some measure of the quality of mental health services. We think these are all important because seeking care early and receiving good quality care will lower rates of disabilities caused by severe mental disorders.”
Two things surprised Dr. Alang and colleagues most about the study. First, that being Black or Latino was a greater predictor of coercion into care than the severity of a person's mental illness. Second, that even if people have severe symptoms, ordering them to receive care/coercion into care is not going to make them think that the care they receive will help.
“It might defeat the purpose of getting them into care if it takes away their autonomy,” Dr. Alang told us, “and if they believe that the treatment is unhelpful. We want mental health services to be effective. We want people to believe these services are effective so that they can seek mental health care sooner rather than later so that they can prevent disability and reduce costs. Given that positive outcomes of care are more likely to occur when individuals get into care on their own or even through encouragement from peers/family (asked by others to seek care) than when coerced, improving access to services, affordability of care, and access to resources that will facilitate self-entry into mental health care is important.”
Dr. Alang says that addressing how racial discrimination limits access to and use of mental health services among Blacks and Latinos will make it easier for them to enter into care on their terms and will improve engagement and treatment outcomes.
“Coercion into care threatens autonomy,” Dr. Alang told us. “We know that patient autonomy is a core principle of medical ethics. That Black and Latino persons are more likely to be coerced than Whites means that there are racial differences in our ability to exercise autonomy. This undermines patient-centered care, strengthens existing barriers to mental health services, and undercuts our ability to reduce inequities in access to and quality of mental health care.”