Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals

Abstract

Background An unmet mental health need exists when someone has a mental health problem but doesn’t receive formal care, or when the care received is insufficient or inadequate. Epidemiological research has identified both structural and attitudinal barriers to care which lead to unmet mental health needs, but reviewed literature has shown gaps in qualitative research on unmet mental health needs. This study aimed to explore unmet mental health needs in the general population from the perspective of professionals working with vulnerable groups. Methods Four focus group discussions and two interviews with 34 participants were conducted from October 2019 to January 2020. Participants’ professional backgrounds encompassed social work, mental health care and primary care in one rural and one urban primary care zone in Antwerp, Belgium. A topic guide was used to prompt discussions about which groups have high unmet mental health needs and why. Transcripts were coded using thematic analysis. Results Five themes emerged, which are subdivided in several subthemes: (1) socio-demographic determinants and disorder characteristics associated with unmet mental health needs; (2) demand-side barriers; (3) supply-side barriers; (4) consequences of unmet mental health needs; and (5) suggested improvements for meeting unmet mental health needs. Conclusions Findings of epidemiological research were largely corroborated. Some additional groups with high unmet needs were identified. Professionals argued that they are often confronted with cases which are too complex for regular psychiatric care and highlighted the problem of care avoidance. Important system-level factors include waiting times of subsidized services and cost of non-subsidized services. Feelings of burden and powerlessness are common among professionals who are often confronted with unmet needs. Professionals discussed future directions for an equitable mental health care provision, which should be accessible and targeted at those in the greatest need. Further research is needed to include the patients’ perspective of unmet mental health needs.

Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data

“…System-level factors related to underfunding and a lack of trained professionals impede equitable access (Bartram, 2017; Coalition of Ontario Psychiatrists, 2018; Fleury & Grenier, 2012; Mental Health Commission of Canada, 2012, 2017). Individuals who, because of low income and/or lack of supplementary health insurance, cannot afford consultation in the private sector (Gulliver, Griffiths, & Christensen, 2010; Harvey & Gumport, 2015; Mojtabai, 2005; Perreault et al, 2013; Walker, Cummings, Hockenberry, & Druss, 2015) face long wait times for access to psychotherapy in the public sector (van Nieuwenhuyse & Dumas, 2012), leading to unmet need for care and increased first appointment nonattendance (Davis, Smith, Talbot, Eldridge, & Betts, 2020; Rens, Dom, Remmen, Michielsen, & Van Den Broeck, 2020; Sweeney et al, 2019). Economic evaluation of psychotherapy and CBT is needed to support decision making around the allocation of resources to overcome barriers to care for patients with anxiety disorders, which are among the most common (Kessler et al, 2005) and economically impactful (Chisholm et al, 2016) mental disorders globally.…”

Experiences with Family Planning amongst Persons with Mental Health Problems: A Nationwide Patient Survey

“…This might explain the reported unmet need for discussing family planning in our study. Previous research has shown that mental health professionals considered taboo and stigma barriers to providing care for their patients [ 26 ]. For patients with a mental health disorder, complex care needs, care avoidance, and lack of trust in mental health professionals hindered patients from seeking help.…”

The evolution of the subjective well-being of the general population during the COVID-19 pandemic period: the case of Belgium

“…Occupational status contained the following categories: professionally active (worker, employee, self-employed, official), unemployed, unable to work, retired (or early retirement), student, housewife/man, career break, or other situation. Four age groups were distinguished: early adulthood (ages 18-34), early middle age (ages [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], late middle age (ages 50-64), and late adulthood (ages 65 and older).…”

“…Access to adequate mental health care services is one of those weaknesses. A study by Rens et al 48 highlighted the issue of unmet mental health needs in the general population in Belgium. Moreover, nearly half of the patients in Belgium had to wait one month or more for a first contact in 2017 49 .…”