Discussion – Mental Healthcare

Discussion – Mental Healthcare

1. Program of Study

DHA: Doctor of Healthcare Administration

2. Problem Statement

Mental health is an important aspect of individual and community wellness. It profoundly affects interpersonal interactions and considerably influences individuals’ behavior and adoption of healthier life choices (Samartzis & Talias, 2019). In the pursuit of community prosperity and wellness, healthcare systems are increasingly emphasizing the need to enhance mental healthcare across communities. While this has positively impacted mental healthcare in some jurisdictions, some areas lag in their efforts to enhance mental health care. This calls for a concerted effort to enhance mental healthcare worldwide. Further, poor access to mental health care continues to undermine global efforts towards enhancing mental healthcare. Snowden et al. (2022) note that many people across the globe are unable to meet their healthcare needs. This has been attributable to the poor availability of mental healthcare resources, poor acceptability of the available mental health resources, and poor affordability of mental healthcare.

To begin with, the poor availability of mental healthcare services and resources contributes to the lack of access to mental healthcare. It occurs when the number of mental healthcare facilities is incommensurate to the populations served. This is the case in resource-limited settings where mental healthcare facilities are deficient (Muhorakeye & Biracyaza, 2021). In such settings, the lack of healthcare investments in mental healthcare facilities makes it difficult to establish mental healthcare facilities, denying communities access to mental healthcare. Poor availability of mental healthcare can also be a consequence of remote geographical location and proximity to mental healthcare facilities (Cortina & Hardin, 2023). People living in remote locations and far-flung areas may be unable to access mental healthcare facilities easily. This further underlines the need to invest in bringing mental healthcare services closer to the people.

Poor accessibility of mental healthcare may also be due to the poor affordability of existing mental healthcare services. The high cost of mental healthcare, coupled with the lack of insurance coverage in some communities, remains a driving force for diminished access to high-quality mental healthcare (Muhorakeye & Biracyaza, 2021). This is especially pronounced in impoverished communities, where the lack of insurance coverage is high. In these communities, individuals are unable to access mental healthcare services due to their high cost.

Poor access to mental healthcare can also occur from low acceptability of the available mental healthcare services and resources. This is especially common in cultures with divergent beliefs on aspects of health, such as perception of disease and illness, healthcare seeking, and Westernized medicines. Samartzis and Talias (2019) note that the adoption of mental healthcare resources is particularly low in cultures that do not believe that mental health disorders are actual illnesses that require healthcare interventions. In these cultures, mental health illnesses are belittled and sometimes associated with sorcery, witchcraft, and evil spirits. This considerably lowers the mental healthcare-seeking behaviors of individuals from these communities. Poor perception of mental health illnesses has also been linked with social stigma against these illnesses, further diminishing the mental healthcare-seeking behavior of the affected persons.

Low health literacy levels have also been associated with poor accessibility of mental healthcare services. Lack of knowledge of mental health illnesses has been associated with poor healthcare-seeking behavior and, subsequently, poor mental health accessibility (Muhorakeye & Biracyaza, 2021). Individuals who are not knowledgeable about mental health illnesses and their impact on health are unlikely to seek mental healthcare services.

Poor access to mental healthcare is apparent across communities. However, ethnic minority groups are disproportionately affected by poor access to mental healthcare than the ethnic majority groups (Snowden et al., 2022). The unmet mental healthcare needs of these ethnic minorities remain high even as the prevalence of mental health illnesses increases in these groups (Thomeer et al., 2022). This highlights the need to address mental health illnesses in ethnic minority groups.

Poor access to mental healthcare has profound effects on individuals’ and communities’ wellness. It may result in significant health deterioration in persons with mental health illnesses. Muhorakeye and Biracyaza (2021) note that poor access to high-quality mental healthcare may cause disease exacerbation with consequent functional decline in patients with mental health illnesses. This will result in loss of productivity, reduced work and school days, and hospital visits. An increase in mortality rates may also be apparent when people with mental health illnesses do not seek mental healthcare. This highlights the need to address poor access to mental healthcare.

Poor access to mental healthcare may also have negative economic impacts on individuals and communities. Deficient mental healthcare services and resources may cause treatment gaps in patients with mental health illnesses, forcing the patient and their families to shoulder the burden of addressing the gaps (Cortina & Hardin, 2023). For instance, patients living in far-flung areas spend more trying to access mental healthcare resources. Likewise, communities may have to incur extra costs to access mental healthcare services due to the high cost of managing these illnesses. The overall economic baggage of mental health illnesses further makes the services unattractive to some communities. Marbin et al. (2022) note that the disparities in mental health disorders apparent in ethnic minority groups and impoverished communities are a direct consequence of these communities’ inability to access available mental healthcare resources. This further highlights the need to address the problem.

In summation, the problem is poor access to mental healthcare among ethnic minority groups, resulting in decreased consumption of mental healthcare resources and increased morbidity, mortality, and functional decline (Snowden et al., 2022).

3. Purpose Statement

The purpose of this proposed qualitative study is to explore the factors contributing to poor access to mental healthcare among ethnic minority groups. The study will draw 15 participants from a community in Akron, OH. The community predominantly consists of ethnic minority groups, with African Americans constituting the majority. The research participants will be subjected to a semi-structured interview that will investigate their perception of the potential barriers to mental healthcare and their perceptions of the available mental healthcare resources in the community.​

4. Research Methodology (Proposed Method and Design)

The purpose of my study is to explore the factors contributing to poor access to mental healthcare among ethnic minority groups. The research method that can help achieve the purpose of the study is qualitative. The qualitative research method is often focused on answering the why behind a phenomenon (Bazen et al., 2021). In this respect, it gains an increased understanding of a problem by obtaining people’s opinions and perspectives on the problem.

Qualitative methods answer the questions about experiences and perspectives from the participant’s standpoint. Using this methodology will enable the researcher to obtain pertinent information on the topic under research from the participants (Bazen et al., 2021). This methodology will enable me to interrogate the participants’ perspectives and opinions on mental healthcare utilization and thereby gain insight into factors that may be influencing diminished access to mental healthcare and mental health resources among ethnic minority groups. This informs the suitability of qualitative methods in the proposed study. The qualitative methodology is suitable for the study as it will enable the determination of the lived experience of the population under scrutiny.

Having insights into the lived experiences of a population may enable the discernment of factors that influence their mental health and healthcare-seeking behaviors (Tomaszewski et al., 2020). In this respect, having insights into the lived experiences of ethnic minority groups may inform specific factors that influence their mental health-seeking behavior and adoption of diverse mental healthcare resources. This further informed the use of qualitative methodology in the proposed study. The qualitative method allows the interrogation of research questions that cannot be easily represented in numbers. Factors such as human perceptions and experiences that characterize qualitative research are better explained than represented graphically. This way, the researcher can have a broader insight into population-specific factors and experiences related to the topic under study. In this respect, the representation of factors that influence mental healthcare among ethnic minority groups is better explained than quantified. The qualitative method, therefore, gives a broader insight into factors that influence mental healthcare among ethnic minority groups. This further informed the selection of the qualitative methodology in the proposed study.

The research design that will be utilized in the proposed study is phenomenology. It is uniquely positioned to help healthcare researchers to learn from others’ experiences. The phenomenology design is a form of qualitative research design that focuses on lived experiences and requires an elaborate and in-depth understanding of the perceptions of the audience and their thought processes of a phenomenon under research. The design gives insights into the structure of diverse experiences such as perceptions, emotions, imaginations, embodied actions, and social activity, among others, and how they may interplay in their decision-making process and, consequently, health behaviors. This design is appropriately aligned with the problem statement, the purpose statement, and the research questions of the proposed research.

The phenomenology design is in congruence with the problem statement. The identified problem is poor access to mental healthcare among ethnic minority groups, resulting in diminished consumption of mental healthcare resources and consequent morbidity, mortality, and functional decline. The phenomenology design allows researchers to gain insight into a population and individual-specific problems that interplay in their suffering. In mental healthcare, this methodology can help the interrogation of intraindividual factors predisposing them to suffering.

There is a consensual finding on the role of phenomenology research in mental healthcare. Neubauer et al. (2019) note that the phenomenological research design aligns with the principles of contemporary mental healthcare, as mental healthcare approaches at all levels are skewed toward person-centered care. In mental healthcare research, the phenomenological research design is better positioned to not only highlight apparent issues within mental healthcare but also gain insight into experiences and perceptions of mental healthcare. It also gives voice to the otherwise silent voices within the community, thereby enabling the recognition of deep-seated and unresolved mental health and mental healthcare concerns. This makes phenomenology an appropriate research design in mental healthcare.

Phenomenology research design also aligns with the purpose statement. The purpose of the proposed research is to explore factors contributing to poor access to mental healthcare within an identified community. The phenomenology research design allows researchers to obtain the lived experiences of individuals within their communities. These include aspects of lived experiences such as emotions, perceptions, imaginations, and social activities that modify the behavior of individuals within a population (Alhazmi & Kaufmann, 2022). In mental health research, lived experiences may encompass intraindividual factors that either promote or impede mental health-seeking behavior. By interrogating the lived experiences, researchers can obtain insights into factors that may be influencing mental healthcare within a community. The proposed research seeks to utilize interview techniques to interrogate the lived experiences of individuals within the identified communities to ascertain whether there are factors within the group that suppressed their mental health-seeking tendencies. This further justifies using the research design in the proposed research study.

Moreover, the phenomenology research design is also aligned with the research questions. The research questions that will be utilized in the proposed study include questions of the perceptions of ethnic minority groups on the existing mental healthcare services and resources within the community, the perceived barriers to mental healthcare in the community, the cultural influence on mental health-seeking behavior of members of the community, and how the identified barriers be addressed. The phenomenology research design provides a framework for addressing the questions.

Furthermore, the phenomenology design will allow researchers to obtain information on the community’s perception of the existing mental healthcare services and resources. As Alhazmi and Kaufmann (2022) report, phenomenology research design focuses on lived experiences, such as perceptions and the thought processes of individuals and communities. By interrogating these perceptions and tailoring the questions towards mental health, the researchers will be able to identify the communities’ perceptions of mental healthcare and extrapolate from the findings the causal factors for their poor mental health-seeking behavior. The design also allows researchers to identify perceived barriers to mental healthcare. The phenomenology design utilizes techniques such as interviews to obtain the lived experiences of individuals and communities (Emiliussen et al., 2021). Semi-structured interviews that insert clauses on the perceived barriers to mental healthcare can enable researchers to have an insight into population-specific barriers to mental health consumption. The design also allows researchers to learn about the cultural influences on mental healthcare-seeking behavior. Culture is an important aspect of the lived experiences of a group. By interrogating aspects of culture, such as the definition of health, beliefs on mental health illnesses, and perceptions of mental healthcare, the researcher can gain insight into cultural aspects that lower or promote access to mental healthcare. As well as how to address various mental health illnesses.

In general, the phenomenology design remains aligned with the problem statement, purpose statement, and research questions. By focusing on lived experiences, this design provides a framework for interrogating factors contributing to poor mental healthcare per the problem and purpose statements and research questions. This affirms its use in the proposed research.

5. Research Population and Sample and other Data Sources

The study will draw 15 participants from a community in Akron, OH. The community predominantly consists of ethnic minority groups, with African Americans constituting the majority. The research participants will be subjected to a semi-structured interview to investigate their perception of the potential barriers to mental healthcare and their perceptions of the available mental healthcare resources in the community. The sample size of 15 was selected because of its attainability and feasibility. There is a higher guarantee of finding 15 African-American male adults within the community under scrutiny. With qualitative design being used in the study, smaller sample sizes can allow the researcher to have insight into the lived experiences of the participants, and in turn, develop meaningful conclusions on the study topic. Using a small sample size is thus warranted.

6. Significance of the Study

The SPL model provides a route towards personal effectiveness. It employs a leadership alchemy, combining personal qualities, skills, and knowledge to build personal and professional networks and attain the widest possible reach by utilizing research (Smith & Wilkins, 2018).  A reflection of the proposed research study through the lens of the SPL model reveals that the study is likely to be significant for the scholarly community as it builds on the knowledge base on mental healthcare. Findings from the study are likely to cement the scholarly beliefs on the causal factors for poor access to mental healthcare. They may also widen scholars’ knowledge on aspects of mental healthcare, thereby increasing the meaningful impact of their knowledge base in informing interventions for apparent challenges in mental healthcare.

The study is also likely to be significant for practitioners in mental healthcare. Findings from the study are likely to either challenge the normative approaches to addressing challenges in mental healthcare or affirm the position of current approaches utilized in managing these illnesses. In their pursuit of better mental healthcare, they can employ a participatory approach to the research study to help inform potential improvement areas.

The study is also likely to be significant for nursing leaders and other healthcare leaders. The research forges a ground of commonality on healthcare improvement by postulating patient and population-specific areas that can be tapped into to elevate the level of mental healthcare. Healthcare leaders, as change agents, utilize a dynamic approach to enhancing healthcare quality and efficiency of care delivery (Drew & Pandit, 2020). The research, by informing the potential areas of improvement, complements their role in quality improvement.

7. Research Questions/Hypotheses

The research questions that will be utilized in the study include: What are the perceptions of ethnic minority groups on the existing mental healthcare services and resources within the community? What are the barriers contributing to poor access to mental healthcare in the community, how does culture influence the mental health-seeking behavior of members of the community, and how can the identified barriers be addressed?

8. Topic Literature

There is a consensual finding on the impact of poor access to mental healthcare on wellness. A literature search of articles relevant to the proposed study yielded several articles. The articles that were selected were those that met the criteria for currency, relevance, authority, accuracy, and purpose.

• Snowden et al.  (2022) investigate the underlying racial and ethnic disparities among persons with unmanaged psychiatric illnesses. Findings from the article show that ethnic minorities with mental health illnesses suffer pervasive adversity compared to whites. This article maintains relevance as it points to the existing mental health-related problems among ethnic minority groups and informs the target population for the research.
• Ilozumba et al. (2022) investigate the experiences of mental health services among ethnic minority groups. Findings from the article revealed that ethnic minority groups are still impacted by traditional problems of poor availability of mental healthcare services. This article maintains relevance to the topic of study as it gives insight into the perceived barriers to mental healthcare among ethnic minority groups.
• Thomeer et al. (2022) investigate disparities in health and mental healthcare. The article revealed that ethnic minority groups are unlikely to receive high-quality mental health care compared to their White counterparts. This affirms poor access to mental healthcare as a barrier to mental healthcare among these communities.
• Muhorakeye and Biracyaza (2021) explore the barriers to mental health utilization. Findings from the article revealed stigmatization, poor awareness, financial strains, and sociocultural and religious awareness as some of the barriers to mental health service utilization among ethnic minorities. The article is relevant to the study as it highlights other scholar’s findings on the specific barriers to mental healthcare. It gives the researcher an insight into what to expect during the study.
• Cortina & Hardin, (2023) investigate how social groupings and geography interplay in poor access to mental healthcare. Low socio-income and geographical remoteness were identified as barriers to mental healthcare access. The article is relevant to the topic under study as it highlights some of the perceived barriers to mental healthcare.
• Marbin et al. (2022) draw a nexus between poverty and mental health services utilization. The economic baggage associated with managing mental health illnesses makes it unattractive to some. Addressing the high cost of mental healthcare can thus help in enhancing access to mental healthcare. The article gives insight into areas to focus on in the pursuit of strengthening mental healthcare and is thus relevant to the research topic.

9. Topic Theories

There is a consensus on the significance of mental healthcare in individual and community wellness. There exists extensive research on mental healthcare and how it shapes health and wellness across societies. The thematic areas of perceived barriers to

mental healthcare across ethnic minority groups, disparities in mental healthcare across ethnic minority groups, and quality improvement in mental healthcare apply to the proposed research. The proposed research study will significantly borrow from the literature on the perceived barriers to mental healthcare. It will interrogate the participant’s perception of mental health illnesses as well as the perceived barriers to mental healthcare to establish a nexus between the highlighted factors and the poor state of mental health and mental healthcare in the target population. By adopting the provisions on the highlighted barriers for mental healthcare, the research will be able to either prove or disprove that the identified factors maintain applicability across all populations and thereby lay a groundwork for addressing measures and quality improvement in mental healthcare in the healthcare system in its entirety. The highlighted theme will, in this respect, inform the working hypotheses and help evaluate the research study (Frandsen et al., 2021).

The thematic area of disparity in mental healthcare across ethnic minority groups highlights the traditional problem of poor access to mental healthcare and how mental healthcare is skewed away from ethnic minorities. Subsequently, the thematic area of quality improvement in mental healthcare affirms the significance of improving mental healthcare. Research studies that highlight barriers to mental healthcare enable quality improvement efforts by informing the basis for improvement areas in mental healthcare.

10. Research Data Collection Strategy

Data will be collected from the research participants through interviews. The research participants will be subjected to a semi-structured interview. The interview will investigate their perception of the potential barriers to mental healthcare and mental healthcare resource utilization and their perceptions of the available mental healthcare resources in the community. Their responses will be obtained and further analyzed to draw meaningful conclusions.

References

Alhazmi, A. A., & Kaufmann, A. (2022). Phenomenological qualitative methods applied to the analysis of cross-cultural experience in novel educational social contexts. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.785134 

Bazen, A., Barg, F. K., & Takeshita, J. (2021). Research techniques made simple: An introduction to qualitative research. Journal of Investigative Dermatology, 141(2). https://doi.org/10.1016/j.jid.2020.11.029 

Cortina, J., & Hardin, S. (2023). The geography of mental health, urbanicity, and affluence. International Journal of Environmental Research and Public Health, 20(8), 5440. https://doi.org/10.3390/ijerph20085440

Dodgson, J. E. (2020). Quality in research: Asking the right question. Journal of Human Lactation, 36(1), 105–108. https://doi.org/10.1177/0890334419890305

Drew, J. R., & Pandit, M. (2020). Why healthcare leadership should embrace quality improvement. BMJ, m872. https://doi.org/10.1136/bmj.m872

Emiliussen, J., Engelsen, S., Christiansen, R., & Klausen, S. H. (2021). We are all in it!: Phenomenological qualitative research and embeddedness. International Journal of Qualitative Methods, 20, 160940692199530. https://doi.org/10.1177/1609406921995304

Frandsen, T. F., Lindhardt, C. L., & Eriksen, M. B. (2021). Performance of conceptual framework elements for the retrieval of qualitative health literature: A case study. Journal of the Medical Library Association, 109(3). https://doi.org/10.5195/jmla.2021.1150

Ilozumba, O., Koster, T. S., Syurina, E. V., & Ebuenyi, I. (2022). Ethnic minority experiences of mental health services in the Netherlands: An exploratory study. BMC Research Notes, 15(1). https://doi.org/10.1186/s13104-022-06159-022

Marbin, D., Gutwinski, S., Schreiter, S., & Heinz, A. (2022). Perspectives in poverty and mental health. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.975482

Medeiros, S., Coelho, R., Millett, C., Saraceni, V., Coeli, C. M., Trajman, A., Rasella, D., Durovni, B., & Hone, T. (2023). Racial inequalities in mental healthcare use and mortality. A cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010–2016. BMJ Global Health, 8(12). https://doi.org/10.1136/bmjgh-2023-013327

Mekonen, T., Chan, G. C., Belete, T., Menberu, M., Davidson, L., Hides, L., & Leung, J. (2022). Mental Health Service Utilization in a low resource setting: A qualitative study on perspectives of health professionals in northwest Ethiopia. PLOS ONE, 17(11). https://doi.org/10.1371/journal.pone.0278106

Muhorakeye, O., & Biracyaza, E. (2021). Exploring barriers to mental health services utilization at Kabutare District Hospital of Rwanda: Perspectives from patients. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.638377 

Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education, 8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2

Smith, L. S., & Wilkins, N. (2018). Mind the gap: Approaches to addressing the research-to-practice, practice-to-research chasm. Journal of Public Health Management and Practice, 24. https://doi.org/10.1097/phh.0000000000000667

Snowden, L. R., Cordell, K., & Bui, J. (2022). Racial and ethnic disparities in health status and community functioning among persons with untreated mental illness. Journal of Racial and Ethnic Health Disparities, 10(5), 2175–2184. https://doi.org/10.1007/s40615-022- 01397-1

Thomeer, M. B., Moody, M. D., & Yahirun, J. (2022). Racial and ethnic disparities in mental health and mental health care during the COVID-19 pandemic. Journal of Racial and Ethnic Health Disparities, 10(2), 961–976. https://doi.org/10.1007/s40615-022-01284-9

Tomaszewski, L. E., Zarestky, J., & Gonzalez, E. (2020). Planning qualitative research: Design and decision making for new researchers. International Journal of Qualitative Methods, 19, 160940692096717. https://doi.org/10.1177/1609406920967174

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