Conceptualizing Mental Health Care Utilization Using The Health Belief Model
Article Text
The process of nickels in psychotherapy, regardless of the clinician ' s skinny, loop of treatment, or outcome measure, begins with this: The client must show a first encounter. However, several national surveys in the ended decade pick on a standard of approximately one - third of individuals diagnosed with a mental disorder receipt any able treatment ( Alegrํa, Bijl, Lin, Walters, & Kessler, 2000; Andrews, Issakidis, & Carter, 2001; Wang et al., 2005 ). A review of the literature surrounding mental health utilization reveals evidence that a entangled array of psychological, social, and demographic factors influence a distressed individual ' s good times to a mental health clinic. Ergo, developing effective strategies for decreasing barriers to care is a critical task for clinicians and administrators. The
aim of this article was to review current research focused on seemly utilization of mental health services and to use the Health Belief Model ( HBM; Becker, 1974 ) as a parsimonious model for conceptualizing the current enlightenment base, as well as predicting and suggesting future research and implementation strategies in the field.
First, it is important to inscription whether increasing mental health service use is an apt public health end. A World Health Organization ( WHO ) survey comparing individuals with severe, moderate, or mild disorder symptoms indicated that approximately half of those surveyed went untreated in the past year ( WHO World Mental Health Survey Consortium, 2004 ), with even less treatment among those with more severe symptoms. Many costs are associated with untreated mental disorders, including overuse of primary care services for a variety of reasons ( Katon, 2003; White et al., 2008 ), kiss goodbye productivity for businesses and misplaced fee for employees ( Adler et al., 2006 ), as well as the negative impact of mental disorders on medical disorders, selfsame as diabetes and hypertension ( Katon & Ciechanowski, 2002 ). These com
bined expenses have been calculated to rival some of the most common and cherished present disorders, cognate as heart disease, hypertension, and diabetes ( Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008 ).
The consequences of providing supplementary services to superscription unmet need may vary by the cost - effectiveness of treatment, availability of providers, and the interaction of mental health symptoms with other illnesses. Medical cost offset and cost - effectiveness research inscription these questions ( for further review, see Blount et al., 2007; Hunsley, 2003 ). Medical cost countervail refers to the estimation of cost savings produced by reduced use of services for primary care as a sequence of providing psychological services. Reduced medical expenses could materialize for several reasons: likewise adherence to lifestyle recommendation changes like as diet, exercise, smoking, or taking medications; exceeding psychological and heartfelt health; and reduction in futile medical visits which serve a minor purpose ( e. g
., making appointments to fill social needs; Hunsley, 2003 ). In comparison with the indirect costs to society, the individual, and the health care system, costs for providing mental health treatment are entirely low ( Blount et al., 2007 ).
However, debate continues regarding how to expedite mental health care utilization. Identification of mental health need through primary care screening for depression is one research area that highlights the complexity of this contention. Palmer and Coyne ( 2003 ) point out several important issues in developing a strategy for addressing this zero: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are complementary in primary care patients who have detected depression and those who have not ( e. g., Coyne, Klinkman, Gallo, & Schwenk, 1997; Williams et al., 1999 ). This is supported by research indicating a goodly gap between the number of individuals who are identified through screening and referred to care, and those who actually receive care ( Flynn, O ' Mahen, Massey, & Marcus, 2006 ). Second, it is critical to evaluate attempts to increase utilization, fairly than to assume they will be outstanding, cost - effective, and targeting the true individuals. Since, a abstract framework that addresses both psychological and practical factors associated with treatment utilization will be a beneficial addition to this literature.
Little systematic research has been conducted on the specific topic of psychological factors related to seeking mental health services. However, extensive work has been conducted within two broad, related areas of research: help - seeking behavior and health psychology. Many models have been proposed to justify help - seeking and health - protecting behaviors, none of which has been accepted as wholly superior to the rest. The HBM ( Becker, 1974; Janz & Becker, 1984; Rosenstock, 1966 ) is one of several commonly used social - cerebral theories of health behavior. This model will be reviewed, followed by a brief discussion of several other models. A discussion of the strengths of the HBM and its shot to mental health treatment utilization research will follow.
Health Belief Model
The HBM ( Rosenstock, 1966, 1974 ), based in a socio - cerebral perspective, was originally developed in the 1950s by social psychologists to break down the oversight of some individuals to use preventative health behaviors for early detection of diseases, patient response to symptoms, and medical compliance ( Janz & Becker, 1984; Kirscht, 1972; Rosenstock, 1974 ). The theory hypothesizes that people are likely to engage in a liable health - related behavior to the extent that they ( a ) perceive that they could contract the sickness or be susceptible to the issue ( perceived susceptibility ); ( b ) affirm that the trouble has serious consequences or will interfere with their daily functioning ( perceived raging ); ( c ) posit that the mugging or preventative going will be effective in reducing symptoms ( perceived benefits ); and ( d ) perceive few barriers to taking racket ( perceived barriers ). All four variables are thought to be influenced by demographic variables identical as pursuit, age, and socioeconomic class. A fifth original consideration, cues to force, is frequently free in studies of the HBM, but nevertheless provides an important social factor related to mental health care utilization. Cues to motion are incidents serviceable as a register of the passion or threat of an infection. These may receive personal experiences of symptoms, parallel as gaze the changing shape of a wharf that triggers an individual to consider his or her risk of skin cancer, or extraneous cues, conforming as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker ( 1988 ) another components of social rational theory ( Ba ndura, 1977a, 1977b ) to the HBM. They proposed that one ' s expectation about the ability to influence outcomes ( self - effectiveness ) is an important component in understanding health behavior outcomes. Thus, steadfast one is capable of quitting smoking ( capability expectation ) is as crucial in important whether the person will actually vacate as knowing the individual ' s perceived susceptibility, frenzy, benefits, and barriers.
Other health care utilization theories
Other models for health care utilization have been proposed and used as a guide for research. In general, these theories pull from a number of learning theories ( e. g., Bandura, 1977a, 1977b; Lewin, 1936; Watson, 1925 ). Two equaling models, the Theory of Planned Behavior ( TPB; Ajzen, 1991 ) and the Self - Regulation Model ( SRM; Leventhal, Nerenz, & Steele, 1984 ), share many commonalities with the HBM. Ajzen ' s TPB proposes that intentions to engage in a behavior predict an individual ' s likelihood of actually engaging in the prone behavior. Ajzen hypothesizes that intentions are influenced by attitudes toward the usefulness of engaging in a behavior, perceived expectations of important others allied as family or friends, and perceived ability to engage in the behavior if germane ( Ajzen, 1991 ). This theory has been beneficial to a variety of health behaviors and has receiv
ed support for its utility in predicting health behaviors ( Ajzen, 1991; Armitage & Conner, 2001; Godin & Kok, 1996 ). However, its relevance in predicting mental health care utilization has celebrated relatively little attention ( for two exceptions, see Angermeyer, Matschinger, & Riedel - Heller, 1999; Skogstad, Deane, & Spicer, 2006 ). Similarly, the SRM ( Leventhal et al., 1984 ) focuses on an individual ' s personal representation of his or her disease as a predictor of mental health treatment use. The SRM proposes that individuals ' representation of their sickness is comprised of how the individual labels the symptoms he or babe is experiencing, the perceived consequences and causes of the symptoms for the individual, the expected time in which the individual would expect to be thankful of symptoms, and the perceived control or cure of the infection ( Lau & Hartman, 1983 ).
The HBM, TPB, and SRM are well - estab
lished socio - thinking models with in agreement strengths and weaknesses. The models assume a analytical result - making process in signal behavior, which has been criticized for not addressing the emotional components of some health behaviors, approximative as using condoms or seeking psychotherapy ( Sheeran & Abraham, 1994 ). There is substantial overlap in the constructs of these three models. For example, an individual ' s perception of the normative beliefs of others can be seen more repeatedly as a benefit of treatment ( e. g., if I research treatment my friends will support my ruling ) or as a barrier ( e. g., my family will regard I am nutty if they know I am seeking trained help ). The SRM lacks a full description of the benefit and barrier aspects of arrangement making identified in the HBM. However, the infection perceptions about timeline, personality, and consequences do sustain a more complete apprehension of aspects of perceived passion, and in this way the SRM can inform the HBM with these factors.
Andersen ' s Sociobehavioral Model ( Andersen, 1995 ) and Pescosolido ' s Network Episode Model ( Pescosolido, 1992; Pescosolido, Brooks Gardner, & Lubell, 1998 ) point up the role of the health care and social network system in influencing patterns of health care use, while Cramer ' s ( 1999 ) Help Seeking Model highlights the role of self - concealment and social support in decisions to search counseling. In particular, the Network Episode Model hypothesizes that sunshiny, independent choice is only one of seve
ral ways that clients enter treatment, along with coercion and passive, indirect pathways to care. According to Cramer ' s model, individuals who habitually conceal personally awkward information encourage to have lower social support, higher personal distress, and more negative attitudes toward seeking psychological help. Hence, according to this model, self - concealment creates high distress, which pushes an individual toward seeking treatment, but also creates negative attitudes toward treatment, pushing an individual away from treatment. The HBM includes system - level benefits and barriers to utilization, but these three models more fully insist on the social - emotional subject of choice making.
Critiques and limitations of the HBM
The HBM has common some criticism regarding its utility for predicting health behaviors. Ogden ( 2003 ), in a review of articles from 1997 to 2001 using social cognition models, questions whether the theory is disconfirmable. Deb form that two - thirds of the studies reviewed plant one or more variables within the model to b
e derisory, and explained variance accounted for by the model ranged from 1 % to 65 % when predicting actual behavior. Yet, Ogden writes, quite than adverse the model, the majority of authors offer alternative explanations for their shaky findings and claim that the theory is supported. While authors ' conclusions about their findings may be overstated in many cases, some explanations of derisory findings are valid limitations of the model. For example, some ( e. g., Cobby, Skinner, & Hampson, 1999 ) point out that construct operationalization could be higher quality for the particular health behavior being studied. However, minor results should not be explained away without considering alternative models as well. Certainly, the HBM has established strong support in predicting some health behaviors ( Aiken, West, Woodward, & Reno, 1994; Gillibrand & Stevenson, 2006 ), but questions remain as to its ability to predict all preventative health situations. The usefulnes
s of the HBM in predicting mental health utilization has not adequately been tested to our erudition.
The HBM may be limited further by its ability to predict more long - term health - related behaviors. For example, from an early review of preventive health behavior models including the HBM by Kirscht ( 1983 ), we can expect that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. Therefore, these outcomes—attending one therapy appointment versus completing a full course of psychotherapy treatment—should be strikingly distinguished from each other.
Strengths of the HBM
Researchers have not explicitly investigated mental health utilization patterns using the HBM framework; however, much of the
existing literature can be conceptualized as dimensions of wildness, benefits, and barriers, indicating that the model may be a useful framework for guiding research in this area. For example, cultural researchers often examine barriers to treatment and perceived raging of symptoms and benefits of treatment in various ethnic populations ( e. g., Constantine, Myers, Kindaichi, & Moore, 2004; Zhang, Snowden, & Sue, 1998 ). In general, the focus of these studies has been to examine cultural differences in beliefs about symptom causes ( Chadda, Agarwal, Singh, & Raheja, 2001 ), changing perceptions of mental health stigma among various ethnic groups ( Schnittker, Freese, & Powell, 2000 ), and cultural mistrust or perceived cultural insensitivity of mental health providers as a barrier to effective treatment ( Poston, Craine, & Atkinson, 1991 ). These studies district the prop for using the HBM as a framework for understanding mental health care utilization for all populations.
Parsimonious and Clear
The model ' s use of benefits and barriers incompatible each other provides a hyped up representation of the judgment - making process. In this " common sense " presentation, the impact of each positive aspect is considered in the content of the
negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one shiny framework.
Useful and Applicable
One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of consistent models. By identifying attitudes that may inhibit just help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or out beliefs about mental health and its treatment. Thus, socio - reasoning theory provides a useful focus for research that in conclusion may payoff in programmatic changes to benefit clients. Once developed, perception - chicken feed interventions can be evaluated through changes in empitic treatment utilization.
Within the HBM framework, three general approaches can be used to increase due utilization: increasing perceptions of individual susceptibility to disorder and fierceness of symptoms, decreasing the psychological or concrete barriers to treatment, or increasing the perceived benefits of treatment. The following discussion will highlight how each perception can be deeper or decreased, and the implic
ations for agnate growth of the perceptions. Examples of thrust strategies that can serve as individual or system - level " cues to bit " will be reviewed within each discipline of the model. In addition, where applicable, the discussions will highlight how sociodemographic factors parallel as age, sex, and ethnicity impact the perceived threat from the disorder and the expectations for the benefits of therapy. The model we discuss assumes that the individual seeking therapy is autonomous in this result making. That is, it is not soon applicable to those who are required to delve into therapy by the judicial system, a spouse, or their house of employment, nor does it address children ' s mental health care utilization. We will label some of these issues briefly later in our discussion.
Figure 1 is a visual representation of the model we propose for conceptualizing mental health care utilization using the HBM as a framework. The studies reviewed in each section below were designed primarily without use of the HBM framework. However, the model is a useful practical tool to adjust and draw in research from a variety of disciplines—marketing, public health, psychology, medicine, etc.
Sociodemographic variables in the HBM
Several demographic variables consistently predict utilization of mental health services. Despite matching levels of distress, some groups are less likely to reconnoitre practiced treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services append men, adults aged 65 and older, and ethnic ignorance groups in the United States ( Wang et al., 2005 ). Within the HBM framework, these demographic variables are hypothesized to influence clients ' perceptions of frenzy, benefits, and barriers to seeking skillful mental health services. Studies exploring the relationship between demographic variables and HBM constructs will be highlighted throughout this article.
Systems approaches to addressing perceived susceptibility and severity
According to the HBM, individuals vary in how tender they swear by they are to contracting a disorder ( susceptibility ). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to hold acceptance of the diagnosis ( Becker & Maiman, 1980 ). In addition, increasing an individual ' s perception of the uproar of his or her symptoms increases the likelihood that he or mouse will inquire into treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived fuss ( i. e., Do I have the disorder and how bad is it? ), and so they will be discussed together. In health - related decisions, the majority of consumers are dependent upon the expertise and referral of the medical known, repeatedly the trusted general practitioner ( Lipscomb, Root, & Shelley, 2004; Thompson, Hunt, & Issakidis, 2004 ). Unlike decisions about the need for a new vehicle or a firmer mattress, foremost whether or not emotions of distress should be interpreted as normal emotional discrepancy or as indicators of depression is a opinion often forsaken to an expert in the area of mental health or a primary care physician. This places a great boundness on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the onslaught of a client ' s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Power and Symptom Awareness
The American Psychological Association ( APA ) provides ethical guidelines for clinicians about how to inform the public appropriately about mental health services. According to the 2002 Ethics Code ( American Psychological Association, 2002 ), psychologists are prohibited from soliciting testimonials from current therapy clients for the purpose of advertising, as individuals in corresponding situation may be influenced by the therapist–client relationship they experience. Additionally, psychologists are prohibited from soliciting business from those who are not seeking care, whether a current or lurking client. This may hold a psychologist suggesting treatment services to a person who has just experienced a car phase or handing out business cards to individuals at a funeral home. However, tragedy or community outreach services are not prohibited, as these are services to the community. Psychologists are prohibited from making false statements knowingly about their training, credentials, services, and fees, and are also prohibited from making knowingly illusory or intensified statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in unsafe situations.
Identification of Symptoms
What, then, does an ethical symptom awareness attack viewing not unlike? It would involve distinctly distinguishing between clinical and nonclinical levels of distress, with an indication of what types of assailment strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be confident to use a stepped care approach beginning with bibliotherapy, psychoeducation, and increases in social support. Also important is the provision of accurate, research - based information regarding symptoms of psychological disorders and treatment options. This may call for challenging our assumptions that psychotherapy is helpful for all psychological unhappiness. Lush studies of distress counseling and postdisaster predicament counseling, for example, persuade there may be an iatrogenic effect of therapy for some individuals ( Bonanno & Lilienfeld, 2008 ). On the other hand, some research indicates that individuals with subclinical levels of trouble who receive treatment number one may avoid evolvement more severe pathology ( e. g., prodromal psychosis; Killackey & Yung, 2007 ). In programming for all components of health beliefs, not just brutality, the credibility of psychotherapy is dependent upon ethical, belonging public health statements and service marketing.
Many examples of mental health education campaigns have been discussed in the literature, often focusing simultaneously on increasing excitation of mental disorder, destigmatizing individuals with mental disease, and increasing tangibility of mental health resources. The Rout Depression Campaign of the UK was designed with these goals in mind, and results of nationally original polls before, during, and after the campaign indicated positive changes in public bias salutary depression and recognition of personal experiences of symptoms ( Paykel, Tylee, & Wright, 1997 ). Similarly, more leafy national campaigns in Australia have provided some expose that education increases public correctness in identifying mental disorder ( Jorm & Kelly, 2007 ). National screening day initiatives for depression, substance abuse, and other psychological disorders also beginning to increase excitability of illness brutality for individuals who may not realize symptoms as signs of malady warranting treatment.
Approximately 71 % ( Lipscomb et al., 2004; Thompson et al., 2004 ) of individuals report looking to their primary care physician for mental health information, treatment, and referrals. However, many physicians deprivation the just scholarship to recognize mental health problems ( Hodges, Inch, & Change, 2001 ). After examining five decades ( 1950–2000 ) of articles classifying the adequacy of physician training in detecting, diagnosing, and treating mental health, Hodges et al. ( 2001 ) offer several suggestions for contributive primary care physicians ' training to effectively name patients with mental health issues. Beyond leak the diagnostic criteria for the major disorders and providing apropos medications when needed, however, physicians also need to be aware that they can act as a " earful to stunt " in the patient seeking psychotherapy. Homologous cues would merry the patient that his or her symptoms of solicitude or depression had reached severe levels and that the trusted family physician believes additional treatment is needed.
Influence of Demographic Variables on Perceived Severity
An individual ' s personal sticker of the symptoms and ailment are thought to minister to perceived brute force. In a study of four vast - procession surveys of psychiatric help seeking, Kessler, Brown, and Broman ( 1981 ) erect that women more often labeled affection of oppression as emotional problems than men did, a circumstance thought to help explicate the approximating compromise that men delve into mental health services less often than women even when experiencing uniform emotional problems. Similarly, Nykvist, Kjellberg, and Bildt ( 2002 ) fashion that among men and women reporting glance and stomach pains, women were more likely to angle pains to psychological discomposure, while men were more likely to testify to no significant engender and little enterprise regarding the somatic symptoms.
Relatively little research has been conducted regarding how individuals of varying backgrounds turn up the fury of their mental infection symptoms. However, some validate suggests that individuals of different ethnic backgrounds appraise the duress of their illness symptoms differently, approximating that individuals from inexperience cultures are more influenced by their own culture ' s norms about mental disorder symptoms than Immaculate Americans ( Dinges & Vermilion, 1995; Okazaki & Kallivayalil, 2002 ). Cues to ball game from providers may be more effective if they are framed in a way that is like with individuals ' attributions about symptoms. In other cases, education about symptoms, provided in a culturally allergic routine, may be required. This is an area where more research is needed to finish practice.
Older adults are more likely to question treatment when they unearth a strong need for treatment ( Coulton & Disgust, 1982 ). However, some aspects of aging may influence whether or not older adults realize incredible symptoms as psychological in being or seemly to intrinsic ailments. For example, among older adults, particularly those experiencing chronic pain or malady, somatic symptoms of mental infection may be interpreted as symptoms of de facto disease or part of a natural aging process, reasonably than as symptoms of depression or anxiety ( Smallbrugge, Pot, Jongenelis, Beekman, & Eefsting, 2005 ). In this way, some depression symptoms may be overlooked by older individuals and the physicians who see them ( Gatz & Smyer, 1992 ).
Systems approaches to addressing perceived benefits
Even if clients do view their symptoms as warranting attention, they are unlikely to explore treatment if they do not deem they will benefit from expert services. For, increasing perceived benefits of treatment is a second approach to increasing relevant utilization.
Public Perceptions of Psychotherapy
In response to aggressive health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to blab consumers about psychological care, research, services, and the assessment of psychological interventions ( Farberman, 1997 ). Results of preprogram focus group assessments indicated that participants were frustrated with changes in health care service delivery in the United States and many participants did not know whether their health insurance policy included mental health benefits. Participants indicated that they did not know when it was applicable to burrow proficient help, and often cited privation of confidence in mental health outcomes, lack of coverage, and disgrace associated with help seeking as main reasons for not seeking treatment. Participants reported that the best way to educate the public about the price of psychological services was to show life stories of how they helped real people with real - life issues. Profound by the focus groups and telephone interviews, APA launched a flyer campaign in two states using television, radio, and set down advertisements depicting individuals who have benefited from psychotherapy, as well as an 800 telephone number, a consumer brochure, and a consumer information website. During the first six months of the campaign, over 4, 000 callers contacted the campaign service bureau for a referral to the state psychological syndicate to appeal campaign literature, with over 3, 000 people visiting the Internet locale rag ( Farberman, 1997 ). In sum, addressing perceived benefits of treatment means answering the matter, " What good would it do? " When individuals are made aware of how treatment could improve their daily functioning, they may be more motivated to overcome the perceived barriers to treatment. Especially for individuals who have not previously sought mental health treatment, describing memorable expectations for treatment may be an essential first step in orienting individuals to make informed treatment decisions.
Public Preference for Providers of Care
Many different types of professionals serve as mental health service providers, and individuals ' beliefs about the relative benefit of seeking help from various apartment and crackerjack sources likely impact decisions to try help. Roles have shifted in treatment over time, with the introduction of managed care and the heavier role of the PsyD, master ' s - level psychologist or superintendent, and MSW as treatment providers. Counseling has been considered a primary role of clergy for many decades; however, specificity of counseling training has changed over time, with some clergy receipt specific training as counselors within seminary education. Primary care physicians have been relied upon for treatment through pharmacotherapy with the development of preferable medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct habitual therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important unrealized gateway for psychotherapy ( Mickus, Colenda, & Hogan, 2000 ).
Level of distress may also influence where individuals search help: Consumer Reports ' popular survey of over 4, 000 participants plant that individuals encourage to see a primary care physician for less severe emotional distress and examine a mental health licensed for more severe distress ( Consumer Reports, 1995 ), while Jorm, Griffiths, and Christensen ( 2004 ) inaugurate that individuals with depressive symptoms were most likely to use self - help strategies in mild to moderate levels of frenzy and to survey competent help at high levels of abandon.
Some support has been endow for the importance of a match between individuals ' perceptions of the engender of symptoms and the type of treatment they probe. In a German national survey, perceptions of the produce of depression and schizophrenia significantly predicted preferences for acknowledged or stead help. Those who official a biological engender of disorder reported they would be more likely to advise an poorly friend to reconnoitre help from a psychiatrist, family physician, or psychotherapist, and less likely to advise seeking help from a confidant. Perceptions of social - psychological causes of ailment, compatible as family conflict, isolation, or alcohol abuse, were related to recommendation a confidant, self - help group, or psychotherapist moderately than a psychiatrist or physician ( Angermeyer et al., 1999 ).
Demographic Variables and Perceived Benefits
Perceptions of mental health treatment as beneficial are likely shaped by cultural influences as well as an individual ' s personal experience. In a subset of randomly selected individuals from a nationally representative survey, Schnittker et al. ( 2000 ) compared Black and Unsullied respondents ' beliefs about the etiology of mental illnesses and their attitudes toward using licensed mental health services. Black respondents were more likely than Bloodless respondents to endorse views of mental indisposition as World spirit ' s will or due to bad singularity, and less likely to attribute mental malady to genetic variation or hard up family upbringing. These beliefs predicted less positive views of mental health services, and the authors found that more than 40 % of the racial discongruity in attitudes toward treatment was attributable to differences in beliefs about the engender of mental disease.
Older adults ' hesitation to search psychological services has been connected with more negative attitudes toward psychological services ( Speer, Williams, West, & Dupree, 1991 ). Attitudes toward psychotherapy loom to improve by aging intimate, however. Currin, Hayslip, Schneider, and Kooken ( 1998 ) assessed dimensions of mental health attitudes among two different cohorts of older adults and fashion that younger cohorts of older adults hold more positive attitudes toward mental health services. Therefore, attitudes among older adults may be less attributable to age than to changing cultural acceptance of mental indisposition over time. Older adults who have engaged in sharp psychological treatment nurse to see mental health treatment as more beneficial than their counterparts who have never sought treatment ( Speer et al., 1991 ).
Across mixed religious orientations, beliefs in a spiritual create of mental infection have been associated with preference for treatment from a religious director reasonably than a mental health there ( Chadda et al., 2001; Cinnirella & Loewenthal, 1999 ). For individuals who interpret psychological distress symptoms as spiritually based, a religious baton may be viewed as a more beneficial provider than a ordinary mental health know stuff. Some clients exalt to see clergy for mental health concerns. Some psychologists have formed relationships between religious organizations and mental health providers to foster collaboration and access to many care options for community members ( McMinn, Chaddock, & Edwards, 1998 ). Benes, Walsh, McMinn, Dominguez, and Aikins ( 2000 ) relate a model of clergy–psychology collaboration. Using Catholic Social Services as a pillar through which collaboration took dwelling, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention ( public language about mental health topics, author training workshops ) through dirty deed ( 1 - 800 access numbers, support groups, and counseling services ). The authors note that bidirectional referrals—not aptly clergy referring to clinicians—and a sharing of techniques and expertise are keys to the success of consistent programs. Providing care to individuals through the source that they consider most credible or accessible is an visionary strategy for increasing perceived treatment benefits and decreasing barriers
Marketing Psychological Services
While the idea of marketing psychological services may seem unappealing to some psychologists, marketing strategies designed to stir fit utilization may serve as both a strategy for the field of psychology as well as an outreach service to improve public health. In order to benefit from psychotherapy, individuals must view it as a legitimate way to inscription their problems. Strategies may append marketing psychological services at a national level, uniform as the APA ' s 1996 public education campaign ( Farberman, 1997 ); at a group level, parallel as a community mental health system providing logic for spare funding; or at an individual level, coextensive as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and mess - solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory
Rochlen and Hoyer ( 2005 ) distinguish social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three poop define social marketing: negative demand, sensitive issues, and invisible preliminary benefits ( Andreason, 2004 ). Negative demand describes the challenge of selling a product ( psychotherapy, in this case ) that the individual does not want to buy. In the case of individuals who see therapy as unhelpful or a frightening experience, addressing negative demand would bear considering the viewpoint of a reluctant tryst and maybe utilizing the Stages of Chicken feed model ( Prochaska & DiClemente, 1984 ), in which the design of the marketing campaign would be to turn an individual from the precontemplation stage to the contemplation stage of copper. Social marketing theory also takes into account the degree of sensitivity in the task being sunny; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, close as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to inquire into psychological help are often not seen immediately, as they are when receipt a pain medication. Wherefore, marketing strategies for mental health must make consumers aware of psychotherapy ' s benefits and the long - term prospect of essential quality of life.
