Perceived barriers and facilitators of mental health service utilization in adult trauma survivors: A systematic review

Background: It is well established that veterans suffering from mental health difficulties under use mental health services. Objective: This study aimed to understand more about the barriers that prevent veterans from seeking professional help and the enablers that assist veterans in seeking professional help. It also aimed to explore potential mechanisms to improve veterans’ help-seeking and pathways to care. Method: The study employed a qualitative design whereby 17 veterans who had recently attended specialist veteran mental health services took part in semi-structured interviews. The resultant data were analysed using grounded theory. Results: Participants described two distinct stages to their help-seeking: initial help-seeking and pathways through treatment. Specific barriers and enablers to help-seeking were identified at each stage. Initial barriers included recognizing that there is a problem, self-stigma and anticipated public stigma. Initial enablers included being in crisis, social support, motivation and the media. Treatment pathway barriers included practical factors and negative beliefs about health services and professionals. Treatment pathway enablers included having a diagnosis, being seen in a veteran-specific service and establishing a good therapeutic relationship. Participants provided some suggestions for interventions to improve veterans’ help-seeking in future; these focussed on enhancing both veterans and health professionals’ knowledge regarding mental health difficulties. Conclusions: This study identified a number of barriers and enablers that may impact a veteran’s journey in seeking help from professional services for mental health difficulties. Enablers such as reaching a crisis point, social support, the media, having a diagnosis of PTSD and veteran-specific mental health services appeared to be important in opposing stigma-related beliefs and in supporting veterans to engage in help-seeking behaviours.

Section: Discussionsupporting

confidence: 58%

Pathways into mental health care for UK veterans: a qualitative study

Mellotte

Murphy

Rafferty

et al. 2017

“…We found, in a systematic review on perceived barriers and facilitators to mental health service use, that PTSD-symptoms, according to re-experiencing, prevent trauma survivors from engaging in professional treatment (Kantor, Knefel, & Lueger-Schuster, 2017); intrusion predicted mental health service use in the present study. A possible explanation may be that severe psychopathology leads to higher psychological strain and therefore a wish for change (Bicanic, Snetselaar, de Jongh, & van de Putte, 2014; Gavrilovic et al, 2005; Kantor et al, 2017).…”

Section: Discussionsupporting

confidence: 48%

“…A possible explanation may be that severe psychopathology leads to higher psychological strain and therefore a wish for change (Bicanic, Snetselaar, de Jongh, & van de Putte, 2014; Gavrilovic et al, 2005; Kantor et al, 2017). In contrast, depression deterred participants from help-seeking which could be attributed to the nature of depression including fatigue, loss of activities, and hopelessness (Sherwood, Salkovskis, & Rimes, 2007).…”

Section: Discussionmentioning

confidence: 99%

Investigating institutional abuse survivors’ help-seeking attitudes with the Inventory of Attitudes towards Seeking Mental Health Services

Kantor

Knefel

2017

Self Cite

Background: Although effective treatments exist, many trauma survivors delay or avoid professional help. Attitudes towards help-seeking are associated with intentions to and actual treatment use, but were neglected in research on trauma survivors so far. Objective: This study aimed to investigate the reliability, construct validity, and predictive power of the Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) and to investigate attitudes of adult institutional abuse survivors. Method: A total of 220 adult survivors of institutional abuse were interviewed using IASMHS, the PTSD Checklist for DSM-5 (PCL-5), the Childhood Trauma Questionnaire Short-Form (CTQ-SF), the Life Events Checklist (LEC-5), and the depression-subscale of the Brief Symptom Inventory (BSI-18). They were further asked about their current mental health service use. We assessed the fit of different models of IASMHS with confirmatory factor analyses and predicted current mental health service use with a binominal logistic regression model. Results: The three-factor structure of IASMHS provided the best fit. One of the three scales (help-seeking propensity), the PTSD-intrusion scale, and the depression scale significantly contributed to the prediction of current mental health service use. Single items of the psychological openness scale loaded weakly on the according factor. Our sample showed a similar IASMHS profile compared to other samples with mental health problems. Conclusion: Overall, IASMHS appears to be a useful instrument to assess attitudes towards seeking mental health services in trauma survivors. It can be used to investigate help-seeking attitudes and its correlates to better understand and facilitate survivors’ treatment use.

“…concerns about re-experiencing. In contrast, little is known about facilitators which enable affected individuals to seek help (Kantor, Knefel, & Lueger-Schuster, 2017). Recent developments have highlighted the potential of smartphone applications to provide better access to psychoeducation, self-help strategies, and identifying oneself as a person who needs professional support (Olff, 2015).…”

Section: Internet Information On Childhood Abuse and Neglect (Ican)mentioning

confidence: 99%

The global collaboration on traumatic stress

Schnyder

Schäfer

Aakvaag

et al. 2017

Self Cite

Trauma is a global issue. The great majority of the global burden of disease arising from mental health conditions occurs in low- and middle-income countries (LMICs), among populations in political, economic, and/or cultural transition and those struck by forced migration. These mental health problems frequently arise as a result of traumatic events that adversely affect adults, children, and families, including war, mass violence, natural disasters, and accidents. In response to this, the International Society for Traumatic Stress Studies (ISTSS) launched the Global Initiative to have a stronger global impact on trauma-related issues. As part of this initiative, the Global Collaboration was established by representatives of eight professional organizations active in the field of traumatic stress. The group decided to focus on childhood abuse and neglect as its first collaboration. They collected guidelines worldwide, providing the basis for a synthesized core guide for prevention and treatment that can be customized for specific cultural contexts. The resulting ‘Internet information on Childhood Abuse and Neglect’ (iCAN) is a comprehensive guide for adults who have been affected by childhood abuse and neglect, as well as for the survivors’ significant others. It is currently provided in eight languages, and is freely available at the homepage of ISTSS and other websites. A second achievement of the Global Collaboration is the validation of the Computerized Childhood Attachment and Relational Trauma Screen (CARTS), a self-report measure designed to measure occurrences of childhood maltreatment, and its translation into multiple languages, including Croatian, Dutch, French, Georgian, German, Italian, Japanese, Norwegian, Russian, and Spanish. A study is currently planned to collect normative responses to the questionnaire, and to conduct cross-cultural comparisons. The Global Collaboration’s success may be seen as an encouraging step towards a truly global structure in the field of traumatic stress.