A Qualitative Evaluation of Barriers to Care for Trauma-Related Mental Health Problems Among Low-Income Minorities in Primary Care

Abstract

This study aimed to identify barriers and facilitators of mental health care for patients with trauma histories via qualitative methods with clinicians and administrators from primary care clinics for the underserved. Individual interviews were conducted, followed by a combined focus group with administrators from three jurisdictions; there were three focus groups with clinicians from each clinic system. Common themes were identified, and responses from groups were compared. Administrators and clinicians report extensive trauma histories among patients. Clinician barriers include lack of time, patient resistance, and inadequate referral options; administrators cite reimbursement issues, staff training, and lack of clarity about the term trauma. A key facilitator is doctor-patient relationship. There were differences in perceived barriers and facilitators at the institutional and clinical levels for mental health care for patients with trauma. Importantly, there is agreement about better access to and development of trauma-specific interventions. Findings will aid the development and implementation of trauma-focused interventions embedded in primary care.

Patient Preferences for Discussing Childhood Trauma in Primary Care

“…[12][13][14][15] Medical clinicians are less likely to screen for trauma-related mental health issues because they overestimate the time it takes, and they have poor access to appropriate services and treatment. 12,16 Early detection and intervention could decrease the likelihood of the assorted problems associated with childhood trauma exposure, such as mental health disorders, chronic medical conditions, and adult health risk behaviors. 17 Early detection could also decrease the likelihood of revictimization, 18 and improve overall health, which can positively influence quality of life.…”

The impact of Medicaid expansion on utilization of mental health services in west Louisville, Kentucky.

“…Of note, clinicians and administrators observed stigma-related patient resistance, symptom-related difficulties such as planning or denial, transportation limitations, and financial barriers to patient participation in a mental health care plan (Chung et al, 2012;Mesidor et al, 2011). However, systemic and service delivery issues also serve as obstacles to consumers' ability to utilize mental health services.…”

“…However, systemic and service delivery issues also serve as obstacles to consumers' ability to utilize mental health services. Chung et al (2012) found that provider referral options, reimbursement issues, and education constrained primary care providers' ability to appropriately assist patients with their mental health care needs. After interviewing providers in a mental health care setting, Mesidor et al (2011) reported that mental health budget cuts and provider competency influence an organization's ability to meet comprehensive patient needs.…”

“…In a qualitative study of primary care providers and administrators, Chung et al (2012) cited the provider-patient relationship as key factors influencing mental health treatment. Integration of mental health and primary care services also promotes use of mental health services, especially when co-location of providers results in a personal introduction by the referring provider (Horevitz, Organista, & Arean, 2015).…”

“…Questions were designed to understand the current landscape of mental health services in West Louisville, systemic and service delivery issues (Chung et al, 2012;Mesidor et al, 2011), and local workforce availability (Thomas et al, 2009). Additional questions probed for providers' perceptions of consumers' attitudes toward mental health services, as well as observed facilitators and barriers to consumer engagement in mental health services.…”