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Reflective Essay
thesis for my political science degree. As someone who could not fathom writing a paper more^ The most daunting part of my academic career had arrived where I had to write a 30-page than 15 pages, the idea of writing a thesis of original work scared me, luckily Cal Poly Pomona’s services helped any anxieties I had about my research project. My department mentor, Professor Neil Chaturvedi advised me to start reading peer-reviewed sources which closely aligned with my research project to help create my research question. As someone who took the courseoffered by Cal Poly Pomona Library titled “Lib 150”, I found this process relatively easy since I formerly had experiences navigating through the University Library search engine. I started my research with a broad lens by researching mental health service opinions from two sets of populations, those diagnosed with a mental illness and the general public. By doing overall research, it helped me weave in the common denominator of negative opinion about mentalhealth services.
Having researched other classes before, I was all too familiar with the process of a search engine yielding so many results to the point that it could be overwhelming. And while the number of research results seemed promising to expand my research, as I scanned through thelisted peer-reviewed articles, I kept finding myself in a position in which I didn't find any scholarly articles which paralleled my research point of interest. For example, since my research focused on mental health education and the effects of mental health services, I kept encountering research that examined attitudes about mental health perception in places like Cambodia, or Canada, although similar, it was not something I could use since I wanted to contribute toscholarship in the context of mental health attitudes in the United States. Having encountered the infamous ‘writer block,’ I decided to meet with my subject librarian, Donald Page, who was able to garner scholarly material which best fit my research. He helped me generate research terms such “mental health attitudes” “Mental health opinion United States” “public health opinion/attitudes United States” and “Mental health perspective.” What further help me garnerrelevant research was adjusting the dates publishes along with the subject. Because my paper aimed to contribute research in the realm of public administration, the option of narrowing subjects to "political science" and "public administration" helped me obtain better results. After adjusting these settings, I was able to locate multiple sources which included scholarly articles that were accessible online and some materials that I had to be ordered. I was also able to ordertwo books via document delivery in time, and the most fun part of my research was using archived newspaper online to examine public attitudes about mental health which is provided through one of the library databases.
was able to create a literature review which would later motivate my research question. Since^ As I combed over more than forty peer-reviewed sources which concerned my research, I there was a common theme amongst my literature review which suggested that an individual’s lack of mental health education affected their mental health delivery, I was able to create the question of what role does mental health education play in mental health delivery. My research question later helped me create the hypothesis that argued that “an individual’s limited mentalhealth education negatively affects their opinion of mental health services. After creating my data via survey, I was able to assess my data to determine that there is a stark difference between who received and did not receive mental health education and their reported attitudes of mental
health services. With these results, social scientists along with health care official can confirm what is usually assumed about mental health education and the effect of an individual’s attitudes about mental health delivery. Despite my dread to write a thesis paper because I did not consider myself as a social science researcher, the tools provided through the University Library helped this process become easier and enjoyable. My success in contributing to political science scholarship is not to say that my research process itself was a breeze, I was often met with discouraging times such asbelieving that there was no scholarly material published in which I can’t discuss in my literature review. Knowing that there had to be existing research on my topic, I overcame the barrier of not finding well-suited research about my topic by consulting with my subject librarian who would help me have a new set of eyes in my approach to my research project. Upon learning new research strategies, I was able to gather peer-reviewed resource which helped motivate myscholarship contribution in the effects of mental health education on mental health services.
ABSTRACT
One in five Americans have a mental health condition (U.S. Department of Mental Health), yet despite the increase of mental health insurance provided by the Affordable Care Act, the utilization of these services does not parallel the current number of people diagnosed. Although factors such as insurance cost and mental health clinic proximity play an influential role in the accessibility of these services, existing literature suggests that an individual’s multi-layer identity may impede their mental health delivery. Although deinstuilization was geared to foster apositive environment for the mentally ill in a community setting, current public attitudes suggest that they do not reflect the objectives of this movement. In order to assess the implications of public attitudes toward the mentally ill, this paper will utilize public opinions to examine the effects of mental health education and how respondents view issues pertaining to mental illness. By using public opinion, this thesis seeks to examine if limited mental health educationnegatively affects public opinion of these services.
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I. Introduction
Current data indicate that 1 in 5 adults have a mental health condition, and youth mental health continues to decline from 5.9% in 2012 to 18.2% in 2015 (Mental Health America 2017). While there is increased availability of mental health services provided by the Affordable Care Act, there is not a proportional use of service to the number of people who are diagnosed with a mental health condition. Americans tend only revisit the issue of mental health once another mass shooting has occurred. However, as seen with the 2017 Las Vegas shooting or the Sutherland Springs, Texas church shooting, after an allotted amount of time subsides, the public continue with their lives without creating a dialogue past gun control. Although mental health treatment garners bipartisan support, Americans are not as willing to use mental health services as they would with any other social service program. Part of the underutilization of these services is rooted in public attitudes leading up to deinstitutionalization. As medical professionals treated mentally ill patients by housing them in state institutions, Americans became inundated with images and stories of under-resourced and inhumane facilities. With the combination of the development of chlorpromazine and the advocacy to shift from state mental institutions to community-based treatment, deinstitutionalization began to take root. This paper will specifically examine attitudes post deinstitutionalization to examine if current attitudes contribute to an individual’s unfavorable view about mental health services.
Due to the recurrent theme that individuals are not aware of current mental health services that are available (Saechao et al. 2011), or the several types of mental health treatments and how they can effectively treat mental illnesses (Marna et al. 2008). The lack of mental health education leads me to create the research question of: how does mental health education affect attitudes of respondents view on mental health treatments? My thesis will explore if an
increase its economic productivity by investing in treatments which can allow an individual to remain employed.
In order to provide context to the current problems surrounding mental illness and how these shared attitudes affect mental health service opinions, I will provide a literature review which discusses current scholarship about public views on mental health treatment. Upon presenting different scholars discussion of public attitudes of mental health treatments, the hypothesis will be presented which is motivated by the literature review. To examine current attitudes of mental health treatment, this quantitative study will utilize a random sample of Cal Poly Pomona students whose data and its implications will be discussed in the section titled as results.
II. Literature Review
Despite the increase of coverage for mental health services, Americans continue to not use mental health treatments proportionally to the number of people diagnosed. The following literature review includes scholars discourse in attempting to understand why mental health underutilization continues to persist by identifying obstacles across several ethnicities and socio- economic backgrounds. While previous works of literature concluded the limited number of mental health providers drove underutilization of these services, current studies articulate that an individual’s lack of mental health education about treatments tailored to their needs may funnel the decrease of utilizing these services thus creating an unfavorable opinion of these services.
Patient Mistrust in Health Care
To examine why individuals may have a negative opinion of mental health services, it is essential to review the treatment of specific populations in health care. Historically, there has
been a level of mistrust in health care amongst minorities. As the early years of medical practices developed in the United States, minorities were often the first to be subjected to inhumane testing. James Marion, who is dubbed as the father of gynecology was the first to successfully develop the surgical technique in repairing the vesicovaginal fistula at the expense of performing multiple surgeries on three enslaved African American women. While many people have highlighted the successes of Marion’s surgical advancements, this pattern of using minorities to advance medical practices continued throughout history. As seen with the legacy of the Tuskegee study of Syphilis, this 1932 U.S. Public Health Service investigation received a public outcry once it was revealed that the six hundred black men chosen in this study were misled about the intentions of the research and were deliberately denied treatment to observe the effects of Syphilis being untreated. Years after the investigation was concluded, (Emily et al. 2001) articulates that for many African Americans the Tuskegee Trail became the epitome of the mistreatment of black people in medicine. While no patients were purposely injected with syphilis, (Brandon, Lydia, and Thomas 2005) argues that most of the respondents in their study who had limited accurate knowledge of this study remained under the impression that the patients were given Syphilis by research investigators. When questioned if another unethical research like Tuskegee could be carried out in modern times, mostly blacks from this study reported that such a situation was more likely to happen again. To understand why a high percentage of mental health services remain underutilized, (Randolph and Reginald 2017) argues that medical mistrust is a crucial component to understanding why African Americans are hesitant in seeking mental and physical health care. To understand why minorities, have a higher distrust of physicians in comparison to whites, (Katrina et al. 2007) roots minority mistrust to current and historical inequitable treatment, disparities in patient-provider communication and
groups are more likely to utilize public insurance, therefore, explaining why people who use public insurance would report a lower quality of healthcare in compared to those privately insured. (Irena and Gabriella 2017) highlights that people with little education, well-educated blacks, and Native Americans report a higher rate of perceived discrimination in health treatment. After adjusting sociodemographic and health-related factors (Iren and Gabriella 2017) expressed that discrimination against Blacks quadrupled and for Native Americans more than tripled. Since an individual’s race or their form of insurance plays an influential role in their satisfaction of health care, individuals who report a negative experience may refrain from returning to use these services. Although these studies did not specifically examine the discrimination of patients who used mental health services, the findings of discrimination shared in health care as whole can be a starting point in the underutilization of health care programs as specific as mental health services. While the number of people insured has increased with the expansion of the Affordable Care Act, the quality of publicly funded services suggests that some individuals remain discouraged from using these services because some individuals believe that their quality of care would not match those who are privately insured. These two scholarships suggest the combination of an individual's type of insurance (public vs. private) and their race can contribute to their over dissatisfaction of health care which in turns explains negative attitudes of health care.
Immigration Status
Using a sample deriving from California, (Elizabeth et al. 2006) also suggests that an individual’s immigration status may impede their healthcare delivery. In this study, (Elizabeth et al. 2006) argues that being foreign-born is not as significant amongst Blacks, Native Americans, and Whites, however for Asians and Latinos the foreign-born factor increases their rate of
dissatisfaction with their medical visitations. One explanation (Elizabeth et al. 2006) provides is that fewer noncitizen immigrants have Medicaid or job-based insurance, therefore, explaining why there may be a high level of dissatisfaction in this population in comparison to other groups. In conjunction with the factor that an individual’s immigration status may hinder their health care delivery, (Jie and Arturo 2011) examination of immigration status on mental health care utilization demonstrates that there are disparities in mental health care among immigrants and native-born Americans. Using data from the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006 this study revealed that an immigrant's inferior access to health care services was a driving force in funneling disparities in mental health utilization for non-U.S. citizens. Because most immigrants are three times more likely not to be uninsured than U.S. citizens, when using mental health services, the first barrier in accessing these services can be rooted in not being insured for general doctor visits. For immigrants, the first year of living in a different country does take a toll on their mental health, so it is imperative that these services be able should the individual find the need to use these services. Between these two scholarships, (Elizabeth et al. 2006) argues that the lack of general health care insurance for immigrants impedes in their access to general care. But when examining mental health services and the effects immigration status (Jie and Arturo 2011) highlights that individuals negative opinion of mental health services can be contributed to the lack of access to these services.
Sexual Orientation
Existing literature articulates that people who identify as LGBT or who are gender non- conforming are at an elevated risk for mental health disorders. (Diana et al. 2008) confirms previous research that perceived discrimination remains an influential factor in the disparity of
doctors. While most studies suggest that current mental health treatment for these groups are ineffective, (Anna, Ronald, and Lori 2001) explains that LGBT patients would increase their utilization if counseling catered to sensitive LGBT issues such as discussing treatments of transitioning such as hormone therapy or sex reassignment surgery. While direct discrimination influences LGBT patient’s unlikelihood to consistently seek care, (Taylor 2014) addresses the need to highlight the issue of visibility. Most matters pertaining to LGBT patients may be difficult to identify which may lead them to believe that their problems are not as significant, which consequently may discourage them to seek out care. (Taylor 2014) identifies this as a postponement, due to the lack of representation of LGBT patients in research and health care providers, (Taylor 2014) suggest that LGBT patients do not utilize mental health service because of the lack of representation rather than affordability. Although only 4.1% of Americans identify as LGBT, it worth exploring why the same group who has a high need for mental health services equally report a high level of mental health service dissatisfaction. Some limitations surrounding this study include that LGBT mental health utilization is that sampling of this group has an increased likelihood of being nonrandom because researchers cannot guess an individual sexual orientation accurately. Another disadvantage in studying LGBT members is that this population does experience a high rate of homelessness; therefore, researchers are put in a difficult position to seek people who falls under the LGBT umbrella.
Effectiveness of Mental Health Treatment
A theme that prevails in the underutilization of mental health services is the low credibility of the effectiveness of mental health services. One influential factor in the skepticism of using these services is the patient disconnect in understanding how their treatment works and their expected commitment to their program. To understand the underlying question of why
some patient’s withdrawal before completing their mental health treatment, (Marna et al. 2008) suggest that some patients view their treatment as ineffective if they do not see immediate progress. Other patients may not understand how their treatment would help them as in the case in enrolling in counseling therapy. For someone who has never been in a setting where they are expected to talk about their emotions, they may have a tough time understanding the benefits of talking about their problems to improve their mental health. When patients believe that their treatment is ineffective, they may stop attending future sessions because they assume that other meetings would not be helpful. Typically, for a client to be considered as recovered, they must at least attend 11-13 sessions. For some individuals (Marna et al. 2008) argues that 11-13 sessions may get in the way of family or work obligations so completing all required meetings may not be realistic, therefore hindering the effectiveness of their treatment program. When doctors and patients do not set goals, (Marna et al. 2008) asserts that a client would more likely end their treatment prematurely. To lower the perception that mental health treatment is ineffective, (Mark et al. 2002) claims clinicians should spend the time to educate their patients of their mental health condition so that their patients could understand why their mental health treatment is needed to recover. Individuals may often underestimate the severity of their illness, so by recognizing how severe their illness is, patients are more inclined to remain in their programs despite not seeing immediate results.
Stigma Toward Mental Illness
The driving force behind the underutilization of mental health services continues to be the stigma in seeking professional help. Unfortunately, despite our generations efforts to reduce mental illness stigma, the media continues to influence most of our depiction of mental illnesses. Typically, when new stories cover the topic of someone who has a mental illness, these
families, having a mental illness was synonymous with having a character flaw since it was associated with a sign of weakness. Since having a mental illness was an unfavorable characteristic, (Haig, Byron and David 2003) stated that it was common for individuals to experience a sense of guilt if they looked for help beyond the scope of their family. The same stigmatization is also reflected amongst military veterans. In an investigation examining the barriers to mental health care amongst Iraq and Afghanistan veterans, (Paul et al. 2011) provided veterans with a closed-ended questionnaire asking veterans about their experience with seeking mental health treatment. In this study, some of the most frequent responses from veterans included that they would not seek help because “It would be too embarrassing, it would harm my career, I would be seen as weak, my unit leadership might treat me differently, and members of my unit might have less confidence in me”. Because of public and self-stigma, attitudes toward mentally ill patients create fear; therefore, people who are diagnosed with a mental illness are reluctant to seek care to avoid the stigmatization associated with being mentally ill.
Family Influence
In concurrence with public stigma, the role of the patient’s family can indicate the likelihood of a patient to seek care while simultaneously shaping attitudes of these services. As the mentally ill continue to fight against stigma, (Patrick and Frederick 2004) suggest that stigma for an individual can extend to their family members which in turn can hurt a patient use of mental health services. Despite distinguishing public stigma, (Patrick and Frederick 2004) study revealed that in some instances people believed that parents are to blame for their child’s mental illness. It could be inferred that because stigma can extend to an individual's family, family members may discourage a patient to receive mental health treatment to avoid the 'courtesy stigma' that is evoked by association of someone with a mental illness which may jeopardize the
individual’s family members relationships. As discussed in the earlier section about the medical mistrust patients may experience, a family member negative experience with their health care can be transmitted to their family members. The effects of family mistrust in mental health professionals was reviewed in (Michael, Sean, and Vo 2010). In this study participants were questioned about their opinion of mental health professionals. Upon being asked several questions regarding mental health care, the participants in this study disclosed that using these services inflicted a sense of guilt since their family members believed that their mental illness could be resolved amongst family members rather than seek help from 'strangers.' In a qualitative study which included thirty participants, (Alejandro et al. 2007) examined how the role of stigma leads to the adherence to psychiatric medications. One patient disclosed that her experience with disclosing her mental illness amongst her family was more of a challenge than dealing with her mental illness. Regarding taking their antidepressants one patient revealed, “Yes, I went through a lot, I suffered a lot, and secondly, it was like my family did not understand me. It was as if they thought that what I had was nothing, a joke. I would explain to them, and they would say to me, “What you need to do is stop all those medications and throw them out.” For many patients, they were brought up to believe that they should not air their dirty laundry outside. As a result, many people will be pressured into not seeking help to maintain the image that they can cope with life’s hurdles. Alternatively, (Haig, Bryon and David 2003) also suggest that because Latinos report a high satisfaction of receiving moral support from their family member and place a high value in privacy, these two factors contribute to the underutilization of mental health services because patients believe their problems could be solved with their family members. The collection of these scholarships which provide conflicting views on the role family shape the underutilization of mental health services and the attitude that is influenced by external factors.
anxiety. It is also articulated that devout believers are discouraged to seek help because psychotherapist may encourage patients to use irreligious ideas or practices that steer from the church's principles. Additionally, religious people may use coping strategies that are endorsed by the church such as engaging in prayer when facing a challenging time. With the combination of satisfaction from seeking support from spiritual leaders, (Deidre et al. 2008) highlights that people continue to solicit mental health help from the church because it is less expensive than professional mental health care. (Deidre et al. 2008) also expresses the concern many of the participants shared such as feeling more comfortable to seek help in a church setting because they believed that consulting a medical professional would mean that their provider would discourage using coping mechanisms such as prayer as being inferior in comparison to mental health treatments. The limitations to this realm of studies include depression being the most studied clinical disorder concerning religion. While religious involvement has lead scholars to believe that religion plays a crucial role in mental health utilization, more research should be developed on how religion influences the utilization of mental illnesses with mental health care utilization with other mental illnesses such as schizophrenia which needs more medical care attention.
Language Barrier
Although the medical field has become increasingly diverse, language continues to be an obstacle to mental health delivery. Despite having interpreters available, the lack of a patient's shared language with their provider continues to present numerous challenges across several ethnicities. In examining the effects of language as a barrier amongst Latinos, (Haig, Byron and David 2003) argues that the proficiency in English may lead to patients to become overwhelmed when navigating through their health care system. Most of the common barriers that are
overlooked continuously include a patient’s inability to complete paperwork to receive mental health treatment or the low success of being able to communicate efficiently with a monolingual therapist. A common theme that prevailed amongst language and mental health treatment was a patient's increased satisfaction from having a therapist who spoke their native language, in these studies specifically; the native language was Spanish. This satisfaction can be attributed to a patient’s ability to express their emotion in Spanish, therefore, increasing their engagement with their provider. Interpreters who mediate these sessions may also run the risk of misinterpreting dialogue, (Donna, Robertson, and Teng 2007) qualitative study argued that having an interpreter present can sometimes feel like an ‘exercise in futility.’ Foreign-born individuals consistently report language as being a barrier to seeking mental health treatment for the same reason that they feel that their interpreter cannot effectively translate their emotions to their provider. For an individual who is not proficient in English, navigating through their health care provider for resources can become overwhelming and discouraging. In a qualitative study which measured the difficulty for immigrant’s mental health accessibility, (Lyren et al.2005) revealed that a typical statement included the challenge for patients to make medical appointments for themselves. One patient disclosed that they had to rely on their son to make appointments since their proficiency in English was limited. The same patient shared that she previously attempted to book an interpreter but the process of finding one was challenging since most interpreters were not available to fit into her schedule. When this same patient was not able to schedule an interpreter, she had no choice but to cancel her appointment. While there is a lot of scholarship discussing the limitations of verbal language posing as a barrier, another language that is often overlooked when discussing mental health patient communication is sign language. In an interview amongst 54 deaf adults, (Annie, Vicki, and Ruth 1998) concurs with existing literature
