Friday, 13 February 2009

Why do some people get help for mental health problems and some don’t

It has always intrigued me why some people get help for mental health problems and some don’t. What seems clear is that it is only partly related to need or severity of problems. A recent paper (Receiving treatment for common mental disorders
Verhaak, P. F., et al Gen Hosp Psychiatry 2009; 31: 46-55) sheds some light on this issue by looking at 743 people from a sample of GP attendees (attending for any reason) with anxiety or depression in the Netherlands. Only just over half of them had received any treatment in the last six months from their GP and about one in seven had received treatment from mental health services. You were more likely to get treatment from your GP if you were younger (just odds ratio 0.96); thought they communicated well (odds ratio 1.64); and recognised you had a mental health problem (odds ratio 7.43)(not surprisingly). Treatment in secondary care was associated with confidence in professional help (odds ratio 1.73) and number of diagnoses (odds ratio 1.47) with no relationship to the severity of anxiety or depressive symptoms.

This emphasises that accessing GP help is dependent on people being mental health literate and recognising that what they are experiencing could be due to a mental disorder. This study only looked at characteristics of the patients and not that of the services they were trying to access. As treatment involves at least two parties this seems to me an important omission which no doubt will be addressed in future studies. 

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2 comments:

Anonymous said...

I think your point asking why only some people receive help for mental health problems is relevant. We should be looking at the behaviour of Mental Health, and Primary Care Providers.
It's a bit like the argument that people who are abused are to blame if they continue the relationship...when few people speak about the abuser being at fault or appears to study them, but that numerous studies are conducted about the pathology of victims of abuse.

As a M H consumer, I have experienced being turned away when in crisis. I know other people who have experienced the same. In fact, in NZ, it appears to be getting harder to get access to Mh services, even for people with psychosis. And Primary Care simply refer - to MH, or as with my Gp who simply sighs and says she doesn't know what to do, because there are no solutions.
The reasons for being denied help?
Going to hospital when suicidal, not calling from home -

CATT being the only medical authority with a mandate for dealing with MH crises - this leaves people at the mercy of the members of team on duty, and their attitudes and beliefs about the caller, plus their own beliefs about mental illness and crisis.

Stigma, in a nutshell, is alive and well in Mh services.

Also, a strange sort of "new Agey' concept has entered into this 'cry for help' scenario. "Self responsibility" seems to be quoted to people feeling at risk of self harm, and even people in psychosis, and a lack of any clinical responsibilty to offer care or compassion seems to be the outcome of this attitude.

Oddly, it appears that the much touted Recovery Model has added a burden to the Mentally Ill. We are now told that we must learn to thrive and flourish despite symptoms, even if they are unbearable.
I have heard a nurse tell a delusional man he would not be treated, that he must go away and learn to deal with his paranoia! Who exactly is mad in this case?

Simon Hatcher MD said...

I agree about the recovery model sometimes being used as am excuse not to treat people or provide them with limited services.