Introduction
Mental health is an essential element of a person’s well-being and ability to function in society. Mental health illness hinders one’s ability to work, socialize, and complete typical daily activities necessary for survival. However, psychology and psychiatry development ensured that these problems could be addressed either through medication or by using different types of therapy. While this partially resolves the problem of mental health illnesses, because it allows individuals to get help, not everyone can receive these services. One predeterminant of whether an individual will address their mental health concerns is the socioeconomic factors (SES), which include income, social class, financial security, and perceptions of one’s social status. This research aims to determine the SES factors that impact a member of a minority community’s decision to seek professional mental health help.
The broader context of access to the services for mental health care is the increasing prevalence of mental health illnesses in the United States and people’s lack of awareness that they have a mental health problem, which has to be addressed. Richter et al. (2018) state that globally, there is a moderate increase in the prevalence of these disorders. This trend has been present for years, and if the increase continues, the global community will have to deal with a large number of patients who require mental health help. In this light, some researchers examined the ability of different social groups to access mental health services, with an attempt to determine whether if the existing demand for these services is satisfied.
Several studies point out the fact that the needs for mental health care of different communities are satisfied disproportionately. For example, Assari (2017) states that income and ethnicity have an effect on whether a person will get mental health help. The African-Americans report is having less access to these services when compared to others. Additionally, Narendorf and Palmer (2016) state that a person’s perception of the necessity to address their mental health condition is an important aspect contributing to the prospects of obtaining care services. As a result, there is evidence suggesting that the mental health support needs of some individuals are not satisfied, and it may be connected to their socioeconomic characteristics. However, the gap in the existing studies is the decision that led to an individual choosing to access mental health care remains unclear. Therefore, the research indicates the disproportionate access to mental health care services within different communities and by researching the factors that led to the decision of people from those communities to get mental health care one can design policies and strategies for increasing the number of adults with mental illnesses who receive professional help.
The examination of this side of the problem will help understand how, in certain communities, the need to access mental health care can be promoted, which can help reduce the number of severe mental illnesses or adverse effects associated with mental illnesses that remain untreated for extensive periods. Hence, empirically, the exploration of this topic for a Ph.D. study can help determine the actual relationship between ethnicity, age, and decision to obtain mental health care. From a practical perspective, this study will help develop programs that target increasing the awareness about mental health problems and
Background
Mental health is an integral and important part of a person’s well-being. WHO (2018) defines mental health as “state of well-being in which an individual can realize his or her abilities, interact positively with others, cope with the stressors of life and study, work productively and fruitfully, and contribute to his or her family and community” (para. 1). Unfortunately, SES factors serve as a barrier to getting a consultation from a mental health professional for many.
In the United States, the needs of people with mental health disorders are not fully satisfied. According to Mental Health America (2020), 13 states received the lowest ranking in their evaluation of access to mental health services, based on the number of people having insurance, quality of insurance, access to the actual treatment, education, and workforce opportunities. These factors can also be considered as determinants that one can use to predict the likelihood of a person getting mental health support. Apart from insurance and the availability of services, an individual has to be cognizant of an issue and ways of addressing it.
SES factors directly impact a person’s ability to get mental health services, mainly the income and ability to get insurance. For example, about 10.3% of adult individuals with diagnosed mental health conditions remain uninsured (Mental Health America, 2020). Moreover, the same statistics show that 22.3% of individuals who sought mental health help did not receive it, and this number has remained the same since 2011. This indicates that the nation’s mental health is not adequately addressed through the existing systems. However, these statistics consider people who have a diagnosed condition and who tried to get help. However, it is unclear how many individuals are unaware of the need to contact a mental health professional. Besides, little research is dedicated to examining the SES factors, such as the perception of self and one’s social status, that either promote or distort one’s perception of mental health care.
When examining the effect that unaddressed mental health condition has on an individual, several studies indicate that the issue continues to affect the daily lives of people. Haileamlak (2017) reports that mental health problems lead to loss of productivity, improper functioning, stigma, and social stress. An individual’s ability to work, communicate with others, and with their family is impaired as a result. The most prevalent mental health conditions that account for 75% of all cases globally are “depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, alcohol, and illegal drug abuse, and pediatric mental disorders” (Haileamlak, 2017, p. 1). These diseases have a direct impact on a person’s ability to function in society, and by determining the SES-related factors, one can identify how the percentage of adults getting mental health help can be increased. The annotated bibliography in the Appendix provides a more thorough examination of the existing literature on SES and mental care.
Problem Statement
The problem that will be addressed through this research is the access to mental care services because the demands of the modern lifestyle lead to increased cases of anxiety and depression, requiring people to have access to mental health care to support their psychological well-being. Delgadillo et al. (2016) and Evans-Lacko et al. (2018) reported that socioeconomic challenges and pressure faced by people in the modern world are the main factors leading to the increasing prevalence of mental health problems. However, not every person can access mental health care in the sate. This study aims to examine the factors that obstruct one from accessing the mental health care, especially the minority populations, and the effect that this has on their well-being to help design programs and strategies that will allow these people to fully address their psychological needs.
Different researchers have aimed to examine the impact of socioeconomic factors on the perceived need to obtain mental health care, for example, Brenes et al. (2015) and Wuthrich and Frei (2015), and the researchers identified factors, such as low income, age, community characteristics, and use of psychotherapy as the primary factors impacting access to mental health care. Therefore, the SES factors that hinder one’s access to mental health care have been examined thoroughly, but the specifics of what helped people from the minority communities and vulnerable populations address their mental care needs remain unclear.
If the problem of access to these services is not resolved, the prevalence of psychological disorders will increase, especially when considering vulnerable populations and communities. Becker et al. ( 2017) and Manstead (2018) advise using the social class theory together with the solipsism versus contextualism models to try and find a resolution. As a result of this problem, vulnerable populations, for example, minorities and people with low income are affected by this problem because they may be either unaware of the need to dress a mental health condition, or have no ability to do so.
Purpose Statement
The purpose of this qualitative study is to explore the SES – ethnicity and age and the perceived need for accessing psychotherapy. The rationale for researching the problem is connected to the increasing prevalence of mental health disorders and a continuous trend of approximately 20% of adults who have a mental condition not being able to address it (Mental Health America, 2020). The intent is to enahcne the promotion of delivering mental health services to people. The goal is to identify SES factors that promote the decision to obtain mental health care among the African-American population.
The study method will include collection responses from patients using questionnaires and interviews and descriptive statistics. The study design is qualitative descriptive research with the use of surveys and interviews. Constructs and variables that will be studied are ethnicities, age, and the patient’s perception of the need to access mental health care services. The target population is African-Americans because, as researched by Assari et al. (2017), this population is often underserved in terms of healthcare in general and mental health care in particular. The research setting is two hospitals from which the study participants will be recruited.
The sampling frame is individuals of African-American ethnicity who have mental health conditions. The age of the participants will vary in accordance with the design and aim of this study. The sampling method chosen for this research is direct element sampling – where each participant has an equal chance of participating. The sample size is 12-18participants, enrolled through mental health care hospitals. This sample size was selected because, according to Brenes et al. (2015) and Villatoro et al. (2018), in qualitative studies, this is the minimal number of individuals that need to be enrolled to collect sufficient data. Data collection method and instrumentation is a survey and interviews, the results of which will be uploaded to the software for analyzing qualitative data.
The data analysis method is descriptive statistics, where the survey answers will be analyzed by the researcher to answer the research questions. Since this is a descriptive study, hence the software to be used for analysis in NVivo, the step-by-step process of conducting this study is as follows – the researcher will contact the two hospitals, and the agreement from the manager will be obtained. Next, the existing patients will be sampled and contacted. The patients who agree to participate will receive their questionnaires and responses will be analyzed by the researcher. The study results may inform theory by clarifying what factors impact the decision of an individual to get mental health care.
Research Questions
The following questions were designed with the purpose of identifying the key factors that influenced the decision of the participants to seek mental health help in a professional institution. The questions mainly target the perceptions of people with mental health disorders because they have the experience of adressing their illness and overcoming the barriers. Presented below are the research questions for this study:
- RQ1. How older adults of ethnic minority groups with low SES, having depression, anxiety, and other mental disorders, identify their need for mental health care?
- RQ2. What are the perceived barriers of ethnic minority groups with low SES regarding the use of psychotherapy?
- RQ3. How to make mental health care more accessible for older adults of ethnic minority groups with low SES, having depression, anxiety, and other mental disorders?
Research Method and Design
This study will employ qualitative methods and descriptive statistics to analyze the outcomes of the study. Qualitative researches help obtain cohesive data regarding a problem because they allow analyzing hypothesis and concepts beyond what the researcher may determine when designing questions. Hence, this method will allow uncovering some elements of the mental health care that were not evaluated in previous studies or provide some new insight into the matter (Assari et al., 2017). In addition, prior studies have focused on the problem of SES in relation to mental health care access, mainly using quantitative methods to determine what factors have the biggest impact on the issue, for example, studies by Assari et al. (2017) and You et al. (2019).
With qualitative studies, the issue of ethics and bias is especially important because the interpretation of the researcher or a person who will be collecting the data is essential and can affect the results. As noted by Noble and Smith (2015), the researcher should document the answers of the participants as they are and avoid any behavior that can impact the perception of the questions. The sample size for this study will be 12 to 18 participants becasue of the nature of the interviews and the need to manually analyze extensive amounts of data. NVivo allows storing data and using analysis tools and visualization applications to enhance the process of research (“NVivo,” n.d.). Yin’s theory will be used. Hence the data will be compline, disassemble, assemble, and analyze the findings. NVivo software will help analyze the data because this is a program specifically designed to address qualitative research needs.
Theoretical Framework
This research aims to utilize several theories that describe the impact of SES and self-identification of individuals. The theoretical framework guiding this research is the social class theory together with the solipsism versus contextualism models. Solipsism is philosophical teaching in accordance with which the knowledge outside a person’s perception of self cannot be considered as certain (D’amico, 2017). This theory helps understand how an individuals’ perception of themselves impacts their ability and willingness to get mental health care. Conceptualism theory implies that an individual uses their experiences and common factors to create a unified concept of the world (D’amico, 2017). As a result, the perception of healthcare and mental care, in particular, may be largely affected by the environment and individual factors, which is what this study aims to explore.
The social class theory regards people that possess the same or comparable socioeconomic characteristics. In accordance with the design of this study, the social class – minorities of African-American descent will be explored in relation to how their socioeconomic status affects their ability to obtain mental health care, mainly the rationale for choosing to address the mental health concerns that they have. The social class is connected to a variety of factors, for example, income or ethnicity. These elements, as suggested by the research conducted by Becker et al. (2017) and have a significant impact on the possibility of a person obtaining a mental health care service. Therefore, by identifying the factors specific to a certain social group, it is possible to influence their decision to address their mental care needs in a timely manner. Social classes in America are in direct correlation with the ability of a person to access care in general, and in particular, mental health is (Becker et al., 2017). Therefore, the use of social class theory will help understand how people from different social strata obtain and perceive mental health care.
Apart from the social theories, a framework explaining the perceptions of self and how these affect a personās choices will be used as well. Another theory that helps explore the problem is the self-labeling concept, described by Villatoro et al. (2018), according to which a person identifies themselves with a particular community. This belonging to a certain group of people affects the personās perception of self. As a result, one can hypothesize that people of African-American descent can have issues accessing mental health care because of their self-identification, which predetermines their view of the issues, the ability to access care, and other related factors. Moreover, Villatoro et al. (2018) note that identity is an important factor that has been studied by researchers in the context of healthcare with an assumption that it impacts the way care is perceived and obtained. Based on this theory and assumptions, the perceived need for care can be conceptualized as part of self-labeling, helping understand how patients behave when they need mental health care and why.
Conclusion
In total, this research will apply the social class theory, the sophism and conceptualism views, and the self-labeling theory to explore the SES variables and perception of individuals connected to mental health care. These theories explain how personal views, with are connected to SES and the environment of an individual, for example, their community, may impact the willingness to address mental health concerns. As a result, a better understanding of what barriers in mental health care provision, both individual and system-wide, can be gained.
References
Assari, S. (2017). Social determinants of depression: The intersections of race, gender, and socioeconomic status. Brain Sciences, 7(12), 156-168.
Becker, J. C., Kraus, M. W., & Rheinschmidt-Same, M. (2017). Cultural expressions of social class and their implications for group-related beliefs and behaviors. Journal of Social Issues, 73(1), 158-174.
Dāamico, R. (2017). Contemporary continental philosophy. Perseus.
Delgadillo Asaria, Ali, &Gilbody, (2016). On poverty, politics and psychology: The socioeconomic gradient of mental healthcare utilisation and outcomes. The British Journal of Psychiatry, 5, 429-430.
Destin, M., Rheinschmidt-Same, M., & Richeson, J. A. (2017). Status-based identity: A conceptual approach integrating the social psychological study of socioeconomic status and identity. Perspectives on Psychological Science, 12(2), 270-289.
Epping, J., Muschik, D. & Geyer, S. (2017). Social inequalities in the utilization of outpatient psychotherapy: Analyses of registry data from German statutory health insurance. International Journal for Equity in Health, 16(1), 1-8.
Fitzpatrick, T., Rosella, L. C., Calzavara, A., Petch, J., Pinto, A. D., Manson, H., Goel, V., & Wodchis, W. P. (2015). Looking beyond income and education: Socioeconomic status gradients among future high-cost users of health care. American Journal of Preventive Medicine, 49(2), 161-171.
Haileamlak A. (2017). Mental health disorders: The deserted illnesses. Ethiopian Journal of health sciences, 27(1), 1ā2. Web.
Jang, Y., Yoon, H., Chiriboga, D. A., Molinari, V., & Powers, D. A. (2015). Bridging the gap between common mental disorders and service use: The role of self-rated mental health among African Americans. The American Journal of Geriatric Psychiatry, 23(7), 658-665.
Mental Health America. (2020). Mental health in America – Access to care data. Web.
Narendorf, S. C., & Palmer, A. (2016). Perception of need and receipt of mental health treatment: A three-group comparison of young adults with psychological distress. Psychiatric Services, 67(8), 924-927.
NVivo. (n.d.). Web.
Richter, D., Wall, A., Bruen, A., & Whittington, R. (2019). Is the global prevalence rate of adult mental illness increasing? Systematic review and metaāanalysis. Acta Psychiatrica Scandinavica, 140(5), 393-407.
Villatoro, Mays, Ponce, & Aneshensel (2018). Perceived need for mental health care: The intersection of race, ethnicity, gender, and socioeconomic status.
WHO. (2018). Mental health: Strengthening our response. Web.
You, J., Zhu, Y., Liu, S., Wang, C., Wang, P., & Du, H. (2019). Socioeconomic disparities in psychological health: Testing the Reserve Capacity Model in a population-based sample of Chinese migrants. Journal of Health Psychology, 1-11.
Appendix
Annotated Bibliography
Assari, S. (2017). Social determinants of depression: The intersections of race, gender, and socioeconomic status. Brain Sciences, 7(12), 156-168.
This article is one of the major contributors to the development of the research question and hypothesis for this study. The author examined the factors that impact the development of major depressive disorder (MDD), mainly, SES, race, and gender. Household income and race were found to be a major contributor to the likelihood of developing this mental health condition. The author reports that other factors did not correlate with the development of MDD, which is inconsistent with the findings of other studies.
Becker, J. C., Kraus, M. W., & Rheinschmidt-Same, M. (2017). Cultural expressions of social class and their implications for group-related beliefs and behaviors. Journal of Social Issues, 73(1), 158-174.
This study focuses on the social class and inequalities and how these factors impact the forms of cultural expression and different types of in-group beliefs. As part of this research, two studies were conducted, with the first one involving participants who were asked to upload pictures to virtual platforms that would indicate their social class. In the second study, the in-group space was examined. The results suggest that individuals’ physiological reactions are linked to their social strata.
Delgadillo Asaria, Ali, &Gilbody, (2016). On poverty, politics and psychology: The socioeconomic gradient of mental healthcare utilisation and outcomes. The British Journal of Psychiatry, 5, 429-430.
Based on the data from English authorities and as part of the state’s program to expand access to care, the author analyzed patient records to determine the communities that under receive care. The results suggest that people living in poorer areas or individuals with low income on average have a more significant prevalence of mental health conditions, such as anxiety and depression. Moreover, the recovery rates for this population are lower, which indicates a correlation between SES, or income in particular, and the ability to get psychiatric treatment.
Destin, M., Rheinschmidt-Same, M., & Richeson, J. A. (2017). Status-based identity: A conceptual approach integrating the social psychological study of socioeconomic status and identity. Perspectives on Psychological Science, 12(2), 270-289.
This articleās focus is on the connection between SES and psychological factors, such as an individualās view of their personality. The implication is that SES can affect an individualās view of self, therefore affecting the different areas of their life. The findings indicate that some transitionary changes are present when peopleās social status and perception of it changes. Again, this article supports the hypothesis that a personās perceptions of their SES and social status significantly impact the way they see themselves, which can affect their willingness to obtain mental health care.
Epping, J., Muschik, D. & Geyer, S. (2017). Social inequalities in the utilization of outpatient psychotherapy: Analyses of registry data from German statutory health insurance. International Journal for Equity in Health, 16(1), 1-8.
The objective of Epping et al. (2017) is to explore the issue of mental health disparities instead of focusing on why certain mental illnesses occur. The authors found that societal disparities, mainly, the financial barriers and lack of guidelines affect the ability of people to get psychological care, based on the sample of 10,771 individuals.
Fitzpatrick, T., Rosella, L. C., Calzavara, A., Petch, J., Pinto, A. D., Manson, H., Goel, V., & Wodchis, W. P. (2015). Looking beyond income and education: Socioeconomic status gradients among future high-cost users of health care. American Journal of Preventive Medicine, 49(2), 161-171.
The researchers explained the relationship between SES and future high-cost users (HCUs). Mainly, the low income and living in a high-dependency neighborhoods increases the need to obtain HCU services. Other factors, such as only having secondary education, food insecurity, and overall deprivation, are also associated with HCU. The authors hypothesize that one way to improve the health of these vulnerable populations is to address their immediate needs, provide them with better housing, food security, education, and other necessities.
Jang, Y., Yoon, H., Chiriboga, D. A., Molinari, V., & Powers, D. A. (2015). Bridging the gap between common mental disorders and service use: The role of self-rated mental health among African Americans. The American Journal of Geriatric Psychiatry, 23(7), 658-665.
This article helps understand the unmet needs of ethnic minorities in the domain of mental health. The self-rated mental health (SRMH) is used to explore the problem, and the findings indicate that there is a correlation between SRMG and the use of mental help services. As a result, the self-perceptions and the view of an individual’s mental health have an impact on their pursuit of obtaining mental health services, although the authors indicate the need for further research into the matter.
This research focuses on the factors impacting an individualās decision to stop psychological treatment. The findings suggest that the factors vary depending on an individual. Moreover, the sample size of 15 participants is very small, requiring further research into this problem.
Narendorf, S. C., & Palmer, A. (2016). Perception of need and receipt of mental health treatment: A three-group comparison of young adults with psychological distress. Psychiatric Services, 67(8), 924-927.
The researchers in this study focus on the opinion of needing the mental health care using three categories – no need; the individual received treatment, the need was unmet. The data was collected from the National Survey of Drug Use and Health, and the findings suggest that 33.7% obtained care, while 55% did not think they needed treatment. However, the white population had a higher prevalence of recognizing the need to address their mental health disparities when compared to other ethnic minorities.
Villatoro, Mays, Ponce, & Aneshensel (2018). Perceived need for mental health care: The intersection of race, ethnicity, gender, and socioeconomic status.
This study confirms that ethnic minorities do not use as many ental health services when compared to other populations. This study examines the African-American communities, Asian-Americans, and immigrants. The latter category had the lowest perceived need to get mental health care.
You, J., Zhu, Y., Liu, S., Wang, C., Wang, P., & Du, H. (2019). Socioeconomic disparities in psychological health: Testing the Reserve Capacity Model in a population-based sample of Chinese migrants. Journal of Health Psychology, 1-11
This study helps comprehend the relationship between the subjective and objective perceptions of self, using the SES and social status of an individual. The results indicate that income is the main factor that may adversely affect psychological well-being. Other factors, such as education, didi not have a notable effect on the matter. More research using a larger sample is necessary to determine the exact effect of SES and the psychological well-being, however, it is evident that the two correlate.