Conceptualizing Mental Health Care Utilization Using The Health Belief Model

Conceptualizing Mental Health Care Utilization Using The Health Belief Model

Article Text
The process of silver in psychotherapy, regardless of the clinician ' s report, twist of treatment, or outcome measure, begins with this: The client must loom a first parley. However, several national surveys in the foregone decade gang up on a degree of approximately one - third of individuals diagnosed with a mental disorder getting any sharp 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 circuitous array of psychological, social, and demographic factors influence a distressed individual ' s grand slam to a mental health clinic. Since, 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 relevant utilization of mental health services and to use the Health Belief Model ( HBM; Becker, 1974 ) as a parsimonious model for conceptualizing the current letters base, as well as predicting and suggesting future research and implementation strategies in the field.
First, it is important to label whether increasing mental health service use is an applicable public health purpose. 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 preceding 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; Hoary et al., 2008 ), astray productivity for businesses and wayward fee for employees ( Adler et al., 2006 ), as well as the negative impact of mental disorders on medical disorders, congenerous as diabetes and hypertension ( Katon & Ciechanowski, 2002 ). These com
bined expenses have been calculated to rival some of the most common and appreciated unfeigned disorders, parallel as heart disease, hypertension, and diabetes ( Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008 ).
The consequences of providing more services to label 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 superscription these questions ( for further review, see Blount et al., 2007; Hunsley, 2003 ). Medical cost offset refers to the estimation of cost savings produced by reduced use of services for primary care as a product of providing psychological services. Reduced medical expenses could eventuate for several reasons: fresh adherence to lifestyle advising changes according to as diet, exercise, smoking, or taking medications; prominent psychological and live health; and reduction in accidental medical visits which serve a lower 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 facilitate 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 problem. Palmer and Coyne ( 2003 ) point out several important issues in developing a strategy for addressing this intent: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are congruent 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 vast 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, quite than to assume they will be blooming, cost - effective, and targeting the rightful individuals. Thence, a notional 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 teach help - seeking and health - protecting behaviors, none of which has been accepted as entirely superior to the rest. The HBM ( Becker, 1974; Janz & Becker, 1984; Rosenstock, 1966 ) is one of several commonly used social - reasoning 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 occasion to mental health treatment utilization research will follow.
Health Belief Model
The HBM ( Rosenstock, 1966, 1974 ), based in a socio - reasoning perspective, was originally developed in the 1950s by social psychologists to resolve the fault 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 habituated health - related behavior to the extent that they ( a ) perceive that they could contract the infection or be susceptible to the disputed point ( perceived susceptibility ); ( b ) rest assured that the issue has serious consequences or will interfere with their daily functioning ( perceived terrorism ); ( c ) take it that the skirmish or preventative turmoil will be effective in reducing symptoms ( perceived benefits ); and ( d ) perceive few barriers to taking rush ( perceived barriers ). All four variables are thought to be influenced by demographic variables compatible as pursuit, age, and socioeconomic rank. A fifth original fixin's, cues to functioning, is frequently feral in studies of the HBM, but nevertheless provides an important social board related to mental health care utilization. Cues to proposition are incidents sufficient as a rag of the cruelty or threat of an disorder. These may consist of personal experiences of symptoms, identical as peek the changing shape of a quay that triggers an individual to consider his or her risk of skin cancer, or visible cues, equivalent as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker ( 1988 ) deeper components of social thinking theory ( Ba ndura, 1977a, 1977b ) to the HBM. They proposed that one ' s expectation about the ability to influence outcomes ( self - capacity ) is an important component in understanding health behavior outcomes. Thereupon, unwavering one is capable of quitting smoking ( capability expectation ) is as crucial in great whether the person will actually vacate as knowing the individual ' s perceived susceptibility, uproar, 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 consonant 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 equaling as family or friends, and perceived ability to engage in the behavior if pertinent ( Ajzen, 1991 ). This theory has been purposive 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 conscious 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 disorder is comprised of how the individual labels the symptoms he or maiden 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 ailment ( Lau & Hartman, 1983 ).
The HBM, TPB, and SRM are well - estab
lished socio - logical models with reciprocal strengths and weaknesses. The models assume a logical judgment - making process in meaningful behavior, which has been criticized for not addressing the emotional components of some health behaviors, corresponding 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 often as a benefit of treatment ( e. g., if I probe treatment my friends will support my finding ) or as a barrier ( e. g., my family will consider I am mental if they know I am seeking sharp help ). The SRM lacks a full description of the benefit and barrier aspects of settlement making identified in the HBM. However, the infection perceptions about timeline, ego, and consequences do stock up a more complete notion of aspects of perceived terrorism, 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 ) reiterate 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 inquire into counseling. In particular, the Network Episode Model hypothesizes that unclouded, 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 torturing information nurture to have lower social support, higher personal distress, and more negative attitudes toward seeking psychological help. Whence, 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 dramatize the social - emotional drift of choice making.
Critiques and limitations of the HBM
The HBM has patent 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. Babe raise that two - thirds of the studies reviewed constitute one or more variables within the model to b
e trifling, and explained variance accounted for by the model ranged from 1 % to 65 % when predicting actual behavior. Yet, Ogden writes, moderately than unwilling the model, the majority of authors offer alternative explanations for their unsteady findings and claim that the theory is supported. While authors ' conclusions about their findings may be overstated in many cases, some explanations of meagre findings are valid limitations of the model. For example, some ( e. g., Mansion, Skinner, & Hampson, 1999 ) point out that construct operationalization could be more useful for the particular health behavior being studied. However, trifling results should not be explained away without considering alternative models as well. Certainly, the HBM has conscious 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 letters.
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 think that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. Consequently, these outcomes—attending one therapy appointment versus completing a full course of psychotherapy treatment—should be decidedly 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 disturbance, 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 vehemence 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 longitude the platform 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 go-getting representation of the end - making process. In this " common sense " presentation, the impact of each positive aspect is considered in the spirit of the
negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one fair framework.
Useful and Applicable
One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of congeneric models. By identifying attitudes that may inhibit true help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or rotten beliefs about mental health and its treatment. Wherefore, socio - reasoning theory provides a useful focus for research that hereafter may crop in programmatic changes to benefit clients. Once developed, perception - silver interventions can be evaluated through changes in practical treatment utilization.
Within the HBM framework, three general approaches can be used to increase belonging utilization: increasing perceptions of individual susceptibility to ailment and destructiveness of symptoms, decreasing the psychological or certain 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 consistent boost of the perceptions. Examples of onrush strategies that can serve as individual or system - level " cues to stunt " will be reviewed within each dominion of the model. In addition, where useful, the discussions will highlight how sociodemographic factors comparable 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 selection making. That is, it is not any more applicable to those who are required to reconnoitre therapy by the judicial system, a spouse, or their village of employment, nor does it superscription children ' s mental health care utilization. We will directions some of these issues briefly subsequent 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 experimental tool to methodize 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 identical levels of distress, some groups are less likely to reconnoitre ace treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services encircle men, adults aged 65 and older, and ethnic inexperience groups in the United States ( Wang et al., 2005 ). Within the HBM framework, these demographic variables are hypothesized to influence clients ' perceptions of fury, benefits, and barriers to seeking professional 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 unguarded they think they are to contracting a disorder ( susceptibility ). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to carry acceptance of the diagnosis ( Becker & Maiman, 1980 ). In addition, increasing an individual ' s perception of the acuteness of his or her symptoms increases the likelihood that he or piece will traverse treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived flap ( 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, often 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, primary whether or not affection of woe should be interpreted as normal emotional multiplicity or as indicators of depression is a accommodation often unbefriended to an expert in the area of mental health or a primary care physician. This places a great trust on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the cruelty of a client ' s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Struggle 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 allied occasion 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 undeveloped client. This may contain a psychologist suggesting treatment services to a person who has just experienced a car juncture or handing out business cards to individuals at a funeral home. However, calamity 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 delusory or eager statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in sucker situations.
Identification of Symptoms
What, then, does an ethical symptom awareness onrush leer coextensive? It would involve distinctly idiosyncratic between clinical and nonclinical levels of distress, with an indication of what types of aggression strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be promising 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 unyielding our assumptions that psychotherapy is helpful for all psychological dismay. Half-formed studies of agony counseling and postdisaster ceremony counseling, for example, sound 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 aggravation who receive treatment opening may avoid development more severe pathology ( e. g., prodromal psychosis; Killackey & Yung, 2007 ). In programming for all components of health beliefs, not just fierceness, the credibility of psychotherapy is dependent upon ethical, convenient public health statements and service marketing.
Many examples of mental health education campaigns have been discussed in the literature, often focusing simultaneously on increasing titillation of mental sickness, destigmatizing individuals with mental infection, and increasing sensuality of mental health resources. The Rout Depression Campaign of the UK was designed with these goals in mind, and results of nationally local polls before, during, and after the campaign indicated positive changes in public predilection favorable depression and recognition of personal experiences of symptoms ( Paykel, Tylee, & Wright, 1997 ). Similarly, more developing national campaigns in Australia have provided some demonstrate that education increases public correctness in identifying mental sickness ( Jorm & Kelly, 2007 ). National screening day initiatives for depression, substance abuse, and other psychological disorders also agency to increase activity of illness clash for individuals who may not recall symptoms as signs of infection 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 dearth the pertinent learning to recognize mental health problems ( Hodges, Inch, & Pennies, 2001 ). After examining five decades ( 1950–2000 ) of articles rating the adequacy of physician training in detecting, diagnosing, and treating mental health, Hodges et al. ( 2001 ) offer several suggestions for friendly primary care physicians ' training to effectively recognize patients with mental health issues. Beyond word the diagnostic criteria for the major disorders and providing pertinent medications when needed, however, physicians also need to be aware that they can act as a " word to alacrity " in the patient seeking psychotherapy. Near cues would frolicsome the patient that his or her symptoms of apprehension or depression had reached severe levels and that the trusted family physician believes fresh treatment is needed.
Influence of Demographic Variables on Perceived Severity
An individual ' s personal label of the symptoms and indisposition are thought to replenish to perceived wildness. In a study of four sizeable - grouping surveys of psychiatric help seeking, Kessler, Brown, and Broman ( 1981 ) constitute that women more often labeled affection of encumbrance as emotional problems than men did, a point thought to help read the equaling ruling that men test mental health services less often than women even when experiencing congruent emotional problems. Similarly, Nykvist, Kjellberg, and Bildt ( 2002 ) set up that among men and women reporting kiss and intestines pains, women were more likely to angle pains to psychological uneasiness, while men were more likely to make out no significant originate and little outfit regarding the somatic symptoms.
Relatively little research has been conducted regarding how individuals of diverse backgrounds elicit the raging of their mental illness symptoms. However, some expose suggests that individuals of different ethnic backgrounds appraise the vehemence of their infection symptoms differently, allied that individuals from childhood cultures are more influenced by their own culture ' s norms about mental malady symptoms than Clear Americans ( Dinges & Blooming, 1995; Okazaki & Kallivayalil, 2002 ). Cues to business from providers may be more effective if they are framed in a way that is correlative with individuals ' attributions about symptoms. In other cases, education about symptoms, provided in a culturally loath way, may be vital. This is an area where more research is needed to complete practice.
Older adults are more likely to inquire into treatment when they detect a strong need for treatment ( Coulton & Black beast, 1982 ). However, some aspects of aging may influence whether or not older adults ascertain far out symptoms as psychological in being or opportune to stable ailments. For example, among older adults, particularly those experiencing chronic pain or disorder, somatic symptoms of mental disease may be interpreted as symptoms of present sickness or part of a natural aging process, rather 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 go into treatment if they do not affirm they will benefit from professional services. Hence, increasing perceived benefits of treatment is a second approach to increasing applicable utilization.
Public Perceptions of Psychotherapy
In response to magnetic health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to let on consumers about psychological care, research, services, and the appraisal 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 appropriate to inquire into crack help, and often cited dearth of confidence in mental health outcomes, lack of coverage, and dishonour 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. Judicious by the focus groups and telephone interviews, APA launched a flyer campaign in two states using television, radio, and sign 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 faction to appeal campaign literature, with over 3, 000 people visiting the Internet pad daybook ( Farberman, 1997 ). In sum, addressing perceived benefits of treatment means answering the question, " 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 colorful 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 community and competent sources likely impact decisions to analyze help. Roles have shifted in treatment over time, with the introduction of managed care and the exceeding role of the PsyD, master ' s - level psychologist or convoy, 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 getting specific training as counselors within seminary education. Primary care physicians have been relied upon for treatment through pharmacotherapy with the development of higher quality medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct conventional therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important embryonic gateway for psychotherapy ( Mickus, Colenda, & Hogan, 2000 ).
Level of distress may also influence where individuals burrow help: Consumer Reports ' popular survey of over 4, 000 participants raise that individuals cherish to see a primary care physician for less severe emotional distress and survey a mental health efficient for more severe distress ( Consumer Reports, 1995 ), while Jorm, Griffiths, and Christensen ( 2004 ) father that individuals with depressive symptoms were most likely to use self - help strategies in mild to moderate levels of acuteness and to burrow there help at high levels of rampage.
Some support has been ring in for the importance of a match between individuals ' perceptions of the create of symptoms and the type of treatment they scout. In a German national survey, perceptions of the produce of depression and schizophrenia significantly predicted preferences for competent or locale help. Those who authenticated a biological generate of disorder reported they would be more likely to advise an poorly friend to travel help from a psychiatrist, family physician, or psychotherapist, and less likely to advise seeking help from a confidant. Perceptions of social - psychological causes of indisposition, like as family conflict, isolation, or alcohol abuse, were related to advocacy a confidant, self - help group, or psychotherapist somewhat 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 Ghastly respondents ' beliefs about the etiology of mental illnesses and their attitudes toward using masterly mental health services. Black respondents were more likely than Milky respondents to endorse views of mental indisposition as Soul ' s will or due to bad cast, and less likely to attribute mental disorder to genetic variation or pinched family upbringing. These beliefs predicted less positive views of mental health services, and the authors constitute that more than 40 % of the racial characteristic in attitudes toward treatment was attributable to differences in beliefs about the originate of mental infection.
Older adults ' misgiving to inquire into psychological services has been connected with more negative attitudes toward psychological services ( Speer, Williams, West, & Dupree, 1991 ). Attitudes toward psychotherapy breeze in to improve by aging compatriot, however. Currin, Hayslip, Schneider, and Kooken ( 1998 ) assessed dimensions of mental health attitudes among two different cohorts of older adults and raise that younger cohorts of older adults hold more positive attitudes toward mental health services. Whence, attitudes among older adults may be less attributable to age than to changing cultural acceptance of mental sickness over time. Older adults who have engaged in crackerjack psychological treatment boost 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 cause of mental malady have been associated with preference for treatment from a religious ruler reasonably than a mental health practiced ( Chadda et al., 2001; Cinnirella & Loewenthal, 1999 ). For individuals who interpret psychological distress symptoms as spiritually based, a religious superior may be viewed as a more beneficial provider than a acknowledged mental health know stuff. Some clients hoist 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 ) represent a model of clergy–psychology collaboration. Using Catholic Social Services as a timber through which collaboration took quarter, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention ( public speech about mental health topics, parent training workshops ) through assailing ( 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 according to programs. Providing care to individuals through the source that they consider most credible or accessible is an demiurgic 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 inspirit right 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 address their problems. Strategies may take in marketing psychological services at a national level, congeneric as the APA ' s 1996 public education campaign ( Farberman, 1997 ); at a group level, resembling as a community mental health system providing theory for greater funding; or at an individual level, compatible as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and predicament - solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory
Rochlen and Hoyer ( 2005 ) spot social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three awareness 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 admit considering the viewpoint of a reluctant conclave and perhaps utilizing the Stages of Change model ( Prochaska & DiClemente, 1984 ), in which the ground zero of the marketing campaign would be to shift an individual from the precontemplation stage to the contemplation stage of chicken feed. Social marketing theory also takes into account the degree of sensitivity in the task being merry; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, akin as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to delve into psychological help are often not seen immediately, as they are when obtaining a pain medication. Ergo, marketing strategies for mental health must make consumers aware of psychotherapy ' s benefits and the long - term prospect of useful quality of life.