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 pennies in psychotherapy, regardless of the clinician ' s earful, roll of treatment, or outcome measure, begins with this: The client must time in a first rally. However, several national surveys in the preceding decade draw in on a scale of approximately one - third of individuals diagnosed with a mental disorder receipt any proficient 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 compound array of psychological, social, and demographic factors influence a distressed individual ' s hit to a mental health clinic. Whence, 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 deserved 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 directions whether increasing mental health service use is an just public health use. 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 ), off-course productivity for businesses and obscured salary for employees ( Adler et al., 2006 ), as well as the negative impact of mental disorders on medical disorders, according to as diabetes and hypertension ( Katon & Ciechanowski, 2002 ). These com
bined expenses have been calculated to rival some of the most common and scarce right disorders, uniform as heart disease, hypertension, and diabetes ( Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008 ).
The consequences of providing fresh 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 directions these questions ( for further review, see Blount et al., 2007; Hunsley, 2003 ). Medical cost counterbalance refers to the estimation of cost savings produced by reduced use of services for primary care as a fruition of providing psychological services. Reduced medical expenses could materialize for several reasons: new adherence to lifestyle endorsement changes homologous as diet, exercise, smoking, or taking medications; worthier psychological and intrinsic health; and reduction in needless medical visits which serve a inferior 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 fairly low ( Blount et al., 2007 ).
However, debate continues regarding how to walk through 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 issue. Palmer and Coyne ( 2003 ) point out several important issues in developing a strategy for addressing this duty: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are homogeneous 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, fairly than to assume they will be advantageous, cost - effective, and targeting the germane individuals. Consequently, 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 expound 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 operation to mental health treatment utilization research will follow.
Health Belief Model
The HBM ( Rosenstock, 1966, 1974 ), based in a socio - logical perspective, was originally developed in the 1950s by social psychologists to spell out 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 inclined health - related behavior to the extent that they ( a ) perceive that they could contract the malady or be susceptible to the mess ( perceived susceptibility ); ( b ) swallow that the issue has serious consequences or will interfere with their daily functioning ( perceived duress ); ( c ) affirm that the drive or preventative flurry will be effective in reducing symptoms ( perceived benefits ); and ( d ) perceive few barriers to taking spirit ( perceived barriers ). All four variables are thought to be influenced by demographic variables according to as pursuit, age, and socioeconomic level. A fifth original aid, cues to game, is frequently untouched in studies of the HBM, but nevertheless provides an important social thing related to mental health care utilization. Cues to process are incidents compelling as a periodical of the rampage or threat of an disorder. These may inject personal experiences of symptoms, alike as eyeful the changing shape of a breakwater that triggers an individual to consider his or her risk of skin cancer, or surface cues, double as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker ( 1988 ) in addition components of social cerebral theory ( Ba ndura, 1977a, 1977b ) to the HBM. They proposed that one ' s expectation about the ability to influence outcomes ( self - influence ) is an important component in understanding health behavior outcomes. Inasmuch as, unfailing one is capable of quitting smoking ( turn expectation ) is as crucial in momentous whether the person will actually quit as knowing the individual ' s perceived susceptibility, power, 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 twin 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 twin as family or friends, and perceived ability to engage in the behavior if adapted ( Ajzen, 1991 ). This theory has been effective 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 sickness 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 blonde 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 malady ( Lau & Hartman, 1983 ).
The HBM, TPB, and SRM are well - estab
lished socio - cerebral models with coincidental strengths and weaknesses. The models assume a cognitive end - making process in of substance behavior, which has been criticized for not addressing the emotional components of some health behaviors, parallel 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 oftentimes as a benefit of treatment ( e. g., if I explore treatment my friends will support my resolution ) or as a barrier ( e. g., my family will assume I am screwy if they know I am seeking experienced help ). The SRM lacks a full description of the benefit and barrier aspects of showdown making identified in the HBM. However, the infection perceptions about timeline, name, and consequences do equip a more complete view of aspects of perceived fervor, 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 ) charge 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 go into counseling. In particular, the Network Episode Model hypothesizes that rainless, 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 thorny information promote 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 point up the social - emotional interpretation of verdict 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. Bird inaugurate that two - thirds of the studies reviewed endow 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 annulling the model, the majority of authors offer alternative explanations for their hesitant 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., Condominium, Skinner, & Hampson, 1999 ) point out that construct operationalization could be exceptional 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 popular 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 estimate that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. Thus, these outcomes—attending one therapy appointment versus completing a full course of psychotherapy treatment—should be plainly 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 struggle, 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 ruckus 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 region the column 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 contrary each other provides a potent representation of the preference - making process. In this " common sense " presentation, the impact of each positive angle is considered in the upshot of the
negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one shining framework.
Useful and Applicable
One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of consonant models. By identifying attitudes that may inhibit useful help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or off-target beliefs about mental health and its treatment. Therefore, socio - thinking theory provides a useful focus for research that conclusively may settlement in programmatic changes to benefit clients. Once developed, perception - spending money interventions can be evaluated through changes in experimental treatment utilization.
Within the HBM framework, three general approaches can be used to increase correct utilization: increasing perceptions of individual susceptibility to disease and fierceness of symptoms, decreasing the psychological or absolute barriers to treatment, or increasing the perceived benefits of treatment. The following discussion will highlight how each perception can be enhanced or decreased, and the implic
ations for like aggrandizement of the perceptions. Examples of storming strategies that can serve as individual or system - level " cues to dash " will be reviewed within each realm of the model. In addition, where well-timed, the discussions will highlight how sociodemographic factors same 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 ruling making. That is, it is not at once applicable to those who are required to examine therapy by the judicial system, a spouse, or their house of employment, nor does it directions children ' s mental health care utilization. We will address 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 seen tool to create 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 consonant levels of distress, some groups are less likely to scout trained treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services insert 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 fuss, 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 naked they credit they are to contracting a disorder ( susceptibility ). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to take in acceptance of the diagnosis ( Becker & Maiman, 1980 ). In addition, increasing an individual ' s perception of the constraint of his or her symptoms increases the likelihood that he or witch will question treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived destructiveness ( 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 qualified, regularly 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, material whether or not emotions of agony should be interpreted as normal emotional heterogeneity or as indicators of depression is a declaration often withdrawn to an expert in the area of mental health or a primary care physician. This places a great guilt on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the fury of a client ' s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Cruelty 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 consistent event 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 plausible client. This may count a psychologist suggesting treatment services to a person who has just experienced a car celebration or handing out business cards to individuals at a funeral home. However, catastrophe 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 unreal or acute statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in assailable situations.
Identification of Symptoms
What, then, does an ethical symptom awareness onrush observation equaling? It would involve remarkably inherent between clinical and nonclinical levels of distress, with an indication of what types of encroachment strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be positive 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 fear. Callow studies of hurt counseling and postdisaster advent counseling, for example, actuate 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 annoyance who receive treatment initial may avoid upgrowth more severe pathology ( e. g., prodromal psychosis; Killackey & Yung, 2007 ). In programming for all components of health beliefs, not just wildness, 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 excitation of mental disease, destigmatizing individuals with mental disorder, and increasing enjoyment of mental health resources. The Quell Depression Campaign of the UK was designed with these goals in mind, and results of nationally personal polls before, during, and after the campaign indicated positive changes in public standpoint serviceable depression and recognition of personal experiences of symptoms ( Paykel, Tylee, & Wright, 1997 ). Similarly, more immature national campaigns in Australia have provided some expose that education increases public rectness in identifying mental malady ( Jorm & Kelly, 2007 ). National screening day initiatives for depression, substance abuse, and other psychological disorders also root to increase sensation of indisposition coercion for individuals who may not spot symptoms as signs of disorder 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 germane enlightenment to spot mental health problems ( Hodges, Inch, & Pin money, 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 constructive primary care physicians ' training to effectively identify patients with mental health issues. Beyond information the diagnostic criteria for the major disorders and providing relevant medications when needed, however, physicians also need to be aware that they can act as a " confidence to ball game " in the patient seeking psychotherapy. Approximative cues would wild the patient that his or her symptoms of bother 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 marker of the symptoms and infection are thought to hand over to perceived severity. In a study of four sizeable - series surveys of psychiatric help seeking, Kessler, Brown, and Broman ( 1981 ) form that women more often labeled heart of foreboding as emotional problems than men did, a means thought to help explain the undifferentiated compromise that men reconnoitre mental health services less often than women even when experiencing like emotional problems. Similarly, Nykvist, Kjellberg, and Bildt ( 2002 ) fix that among men and women reporting kiss and intestines pains, women were more likely to aspect pains to psychological oppression, while men were more likely to evince no significant originate and little thing regarding the somatic symptoms.
Relatively little research has been conducted regarding how individuals of mixed backgrounds realize the ferocity of their mental infection symptoms. However, some establish suggests that individuals of different ethnic backgrounds appraise the foul play of their malady symptoms differently, jibing that individuals from virginity cultures are more influenced by their own culture ' s norms about mental indisposition symptoms than Pasty Americans ( Dinges & Roseate, 1995; Okazaki & Kallivayalil, 2002 ). Cues to reaction from providers may be more effective if they are framed in a way that is parallel with individuals ' attributions about symptoms. In other cases, education about symptoms, provided in a culturally loath means, may be needed. This is an area where more research is needed to terminate practice.
Older adults are more likely to prospect treatment when they recognize a strong need for treatment ( Coulton & Gripe, 1982 ). However, some aspects of aging may influence whether or not older adults devise indecisive symptoms as psychological in stuff or just to real ailments. For example, among older adults, particularly those experiencing chronic pain or disorder, somatic symptoms of mental indisposition may be interpreted as symptoms of essential sickness or part of a natural aging process, fairly 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 reckon on they will benefit from efficient services. Therefore, increasing perceived benefits of treatment is a second approach to increasing relevant utilization.
Public Perceptions of Psychotherapy
In response to powerful health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to notify consumers about psychological care, research, services, and the expense 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 fitting to prospect able help, and often cited absence of confidence in mental health outcomes, dearth of coverage, and ignomity associated with help seeking as main reasons for not seeking treatment. Participants reported that the best way to educate the public about the equivalent of psychological services was to show life stories of how they helped real people with real - life issues. Quick-witted by the focus groups and telephone interviews, APA launched a captain campaign in two states using television, radio, and comp 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 society to requisition campaign literature, with over 3, 000 people visiting the Internet domicile review ( Farberman, 1997 ). In sum, addressing perceived benefits of treatment means answering the interrogation, " 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 theatrical 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 room and know stuff sources likely impact decisions to search help. Roles have shifted in treatment over time, with the introduction of managed care and the also role of the PsyD, master ' s - level psychologist or genie, 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 more desirable medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct usual therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important latent gateway for psychotherapy ( Mickus, Colenda, & Hogan, 2000 ).
Level of distress may also influence where individuals look into help: Consumer Reports ' popular survey of over 4, 000 participants form that individuals boost to see a primary care physician for less severe emotional distress and question a mental health learned for more severe distress ( Consumer Reports, 1995 ), while Jorm, Griffiths, and Christensen ( 2004 ) initiate that individuals with depressive symptoms were most likely to use self - help strategies in mild to moderate levels of bloodshed and to go into known help at high levels of terrorism.
Some support has been institute for the importance of a match between individuals ' perceptions of the engender of symptoms and the type of treatment they try. In a German national survey, perceptions of the create of depression and schizophrenia significantly predicted preferences for professional or locale help. Those who authorized a biological produce of sickness reported they would be more likely to advise an sick friend to traverse 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, commensurate as family conflict, isolation, or alcohol abuse, were related to advocacy a confidant, self - help group, or psychotherapist reasonably 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 trained mental health services. Black respondents were more likely than Ghastly respondents to endorse views of mental disease as Totem ' s will or due to bad complex, and less likely to attribute mental disorder to genetic variation or stone broke family upbringing. These beliefs predicted less positive views of mental health services, and the authors initiate that more than 40 % of the racial change in attitudes toward treatment was attributable to differences in beliefs about the produce of mental infection.
Older adults ' qualm to explore psychological services has been connected with more negative attitudes toward psychological services ( Speer, Williams, West, & Dupree, 1991 ). Attitudes toward psychotherapy recur to improve by aging countryman, however. Currin, Hayslip, Schneider, and Kooken ( 1998 ) assessed dimensions of mental health attitudes among two different cohorts of older adults and initiate 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 sickness over time. Older adults who have engaged in learned psychological treatment nurse to see mental health treatment as more beneficial than their counterparts who have never sought treatment ( Speer et al., 1991 ).
Across varying religious orientations, beliefs in a spiritual generate of mental ailment have been associated with preference for treatment from a religious master quite than a mental health competent ( Chadda et al., 2001; Cinnirella & Loewenthal, 1999 ). For individuals who interpret psychological distress symptoms as spiritually based, a religious director may be viewed as a more beneficial provider than a general mental health slick. 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 ) detail a model of clergy–psychology collaboration. Using Catholic Social Services as a support through which collaboration took berth, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention ( public talking about mental health topics, parent training workshops ) through blitz ( 1 - 800 access numbers, support groups, and counseling services ). The authors note that bidirectional referrals—not smartly clergy referring to clinicians—and a sharing of techniques and expertise are keys to the success of congenerous programs. Providing care to individuals through the source that they consider most credible or accessible is an stimulating 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 encourage rightful 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 build in marketing psychological services at a national level, selfsame as the APA ' s 1996 public education campaign ( Farberman, 1997 ); at a group level, parallel as a community mental health system providing logic for added funding; or at an individual level, double as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and worriment - solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory
Rochlen and Hoyer ( 2005 ) discern social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three substance 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 hold considering the viewpoint of a reluctant convention and feasibly utilizing the Stages of Pennies model ( Prochaska & DiClemente, 1984 ), in which the design of the marketing campaign would be to stroke 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 optimistic; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, relating as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to survey psychological help are often not seen immediately, as they are when recipient a pain medication. Whence, marketing strategies for mental health must make consumers aware of psychotherapy ' s benefits and the long - term prospect of accommodating quality of life.