HELP – Removing Two Barrriers To Behavioral Health Care To Better San Diego
Current data confirms that approximately 15 percent of the nations’ citizens receive mental health services in some form over a given year. While that may seem like a large percentage of the population, it is believed that the percentage should probably be even higher. The truth is: Professional mental health services can be difficult to access for many individuals, and even with access available, many people are still reluctant to seek psychological help for fear of being stigmatized.
Although lack of funding would seem to be an obvious limitation to access, the issue of accessibility in mental health services pertains more to the circumstances that make it difficult or impossible for certain individuals to actually get to an office.
Typically, such individuals include those who are homebound for reasons ranging from serious illnesses, lack of adequate transportation, and agoraphobia to social anxiety disorders, and certain disabilities. Other complex situations such as having young children, residing in a more rural area, or even circumstances relating to protective services all demonstrate challenges to keeping in-office appointments. A typical visit to a therapist often demands scheduling adjustments and always requires finding a way to get to and from a therapist’s office. While this is a simple routine for some people, there are many others who are burdened by these requirements, making it difficult and at time impossible for them to access these vital services.
Extensive research on home-based therapy documents a number of other unique instances that make a typical therapy appointment impractical for many individuals. In some cultures, an example being certain Indian tribes, the home is a much more acceptable venue for mental health interventions that the medical office (Schacht, Tafoya & Marabla, 1989).
The fear of being categorized as insane or mentally ill can be overwhelming enough to make individuals avoid mental health services altogether. Moreover, this issue of stigma extends far beyond one’s internal concerns.
The anxiety of possibly facing stigmatization quite often revolves around common false assumptions such as the idea that the client’s employer will find out and it will affect their position at work, or the client may fear losing their insurance benefits due to a mental illness diagnosis. Research conducted by Patrick Corrigan from the Department of Psychiatry at the University of Chicago proves that stigma plays a large role in deterring people from pursuing mental health services for reasons “namely to avoid the label of mental illness and the harm it brings”(Corrigan, 2004). Corrigan’s research concludes that “in particular, the threat of social disapproval or diminished self-esteem that accompanies the label may account for underused services”.
The Elderly Population
The elderly population is particularly affected by both of these barriers. Pertaining to accessibility, the aging process often drives individuals to become homebound or at least creates difficulties associated with leaving the house. Diagnoses as common as arthritis or impaired vision can create difficulties in committing to regularly scheduled appointments.
Today’s elderly population grew up in an era when psychological help was not only uncommon, but was actually looked down upon. Needing mental help meant needing a locked room with padded walls, therefore the elderly tend to hold a more skeptical, stigmatized view of psychological services.
Ironically however, the elderly population also happens to be those most affected by depression, and therefore more often in need of mental health services. Untreated depression has severe implications for the elderly. It doubles the risk of developing cardiac disease, reduces the ability to rehabilitate, and increases the chances of dying from illnesses. Furthermore, it is more likely to lead to suicide than in any other age group. In fact, suicide rates for individuals over the age of 85 are almost twice as high as the overall national rate.
The high depression rate can be easily understood. Older adults are more vulnerable because they have experienced multiple devastation losses such as the ending of careers, loss of independence, deaths of family and friend, and loss of senses and certain body functions.
Studies of older persons who have committed suicide indicate that few were receiving mental health treatment or treatment that was deemed adequate. Overall, depression affects nearly 6 million Americans over the age of 65, but only ten percent receive treatment. Information from the Cleveland Clinic Foundation cited both stigma and the belief that there is no help as a reason for why many elderly do not seek treatment for depression. Dr. Zur’s research also points out that too often senior adults have other physical disabilities that distract them from addressing psychiatric needs (Zur, 2006).
It is quite an ironic paradox. The population most in need of mental health services happens to be that which has the least access to such services.
HELP Services has used the above facts and statistics as motivation for creating a business that brings therapy services into a client’s home or care facility in hopes of solving the issues of accessibility and stigma. By bringing licensed psychologists and social workers to the individual residences, clients can readily obtain professional therapy without having to worry about getting to an office. It also allows clients to maintain their privacy, thus helping to relieve some of the stigma anxiety associated with appointments in offices open to the public.
In addition to overcoming the issues of accessibility and stigma, the concept of in-home therapy has brought about a number of additional benefits that a typical visit to an office environment lacks. For instance, the ability to experience a client’s actual lifestyle by visiting them at home can be a tremendous benefit in assessing their problems. The research of Dr. Zur (2006) supports this claim, stating that home-based psychotherapy allows the therapist to “get a first-hand view of the family living situation”. Observing the environment and social dynamics of the individual—the presence or absence of food in the cupboards, medication and unused medical supplies, organization abilities, the neighborhood in which they live, and how they interact with family and friends- helps in accessing the individual’s needs and developing a treatment plan.
Offering clients the ability to conduct counseling sessions in the privacy and comfort of their home will improve the quality of mental healthcare in San Diego by removing the two barriers that interfere with these services the most: Accessibility and Stigma.
Annette Conway, Psy.D.