Access and sucess in drug services

Health services in England have been urged to develop integrated care pathways for both drug and alcohol misusers in order to standardize elements of care, improve treatment efficiency and effectiveness and deliver value for money. However, the factors that influence client access to treatment and subsequent completion of detoxification programmes are complex. A study of 6,745 people admitted to an independent sector inpatient detoxification service between January 1995 and March 2003 looked into the factors that influenced completion of treatment and compared those who had referred themselves to the service with those who had been referred by GPs or other health professionals. Factors predictive of treatment completion were found to be older age, being female, being employed and being referred by a GP. People with a stable address were more likely to be referred to the service by a GP, leading to fears that young men, with an unstable housing situation, could be excluded from treatment.

Webb, Lucy, Ryan, Tony and Meier, Petra - Care pathways to in-patient alcohol detoxification and their effects on predictors of treatment completion Journal of Substance Use August 2008, 13(4), 255-267

Stigma and help-seeking

Many people do not seek the help they need for their mental-health problems. One theory as to why this might be is that the stigma associated with mental illness puts people off looking for help. A survey of 2,782 college students in the U.S. found that perceived stigma was higher among men, older students, students from lower socio-economic backgrounds and students with current mental-health problems. Perceived stigma was also higher among those whose friends and family had not used mental-health services and among those who believed that therapy or medication are not very helpful. Those who saw the most stigma in mental illness thought that they were the least likely to need help. Among those people with depression and anxiety there was no link between perceived stigma and the propensity to seek help.

Golberstein, Ezra, Eisenberg, Daniel and Gollust, Sarah E. - Perceived stigma and mental health care seeking Psychiatric Services April 2008, 59(4), 392-399

Help-seeking behaviour and depression in adolescence

It is widely recognised that adolescence is a developmental period with fluctuating levels of psychological distress often in the form of depression and anxiety. Seeking appropriate help for these psychological problems before they become severe can reduce adolescents' risk for developing more severe psychological problems such as suicidal thoughts. However, only about a third of young people with mental-health problems receive professional mental-health care. One reason for this is a phenomenon called help negation in which people become more withdrawn and less likely to seek help from others as they become more depressed. A study of 1,766 children between the ages of 12 and 18 in Australia found that the more depressed children were the less likely they were to seek help from their parents. The researchers found a 'consistent trend for students to report being more likely to seek help from no one as depressive symptoms increased'.

Wilson, Coralie Joy, Rickwood, Debra and Deane, Frank Patrick - Depressive symptoms and help-seeking intentions in young people Clinical Psychologist November 2007, 11(3), 98-107

Australian women - who seeks counselling ?

Despite the increasing incidence of mental-health problems in the population a growing body of research suggests that the great majority of those who are psychologically distressed receive no mental health care. Women report much higher rates of mental-health problems than men and middle-aged women report more problems than other age groups. An Australian study of 11,201 women between the ages of 50 and 55 examined which of them had consulted a counsellor, psychologist or social worker in the past 12 months. The study used data from the Australian Longitudinal Study on Women's Health and found that although studies have found 36% of the Australian population to be suffering from psychological distress only 7% of the women had consulted someone about their mental health in the previous year. The women who had had counselling were found to be more stressed and less optimistic but to have higher levels of satisfaction with their lives and a greater feeling of control. They were also more likely to have had significant life events over the previous year, changed health status, to be taking more medication, to live in urban areas, to be university educated and to live alone.

Schofield, Margot J. and Khan, Asaduzzaman - Australian women who seek counselling: psychosocial, health behaviour, and demographic profile Counselling and Psychotherapy Research March 2008, 8(1), 12-20

Children and mental health services - who seeks help ?

Not all children with emotional and behavioural problems get the help they require. A study of 2,461 children by researchers at the Institute of Psychiatry looked at the relationship between a variety of different factors and the use of mental health services by children over the following three years. Contact with most services was predicted by three factors: the impact of the children's mental-health problems, contact with teachers or primary health care and parents' and teachers' perceptions that the child had significant difficulties.

Ford, Tamsin ... [et al] - Predictors of service use for mental health problems among British schoolchildren Child and Adolescent Mental Health 2008, 13(1), 32-40

Depression and anxiety - who seeks help ?

Depression and anxiety are common mental-health problems and can have a substantial impact on people's functioning and quality of life. There are effective psychological and drug treatments for both these conditions but about half of the people suffering from severe depression and anxiety do not seek treatment and more than half of the people suffering from less-severe depression and anxiety do not look for help. A Finnish study of 6,005 people screened them for depression and anxiety and asked them about their use of mental-health services in the last 12 months. The researchers found 298 people with depression and 242 with anxiety disorders. Of participants with depression, anxiety or both 34%, 36 % and 59% respectively used health services. Greater severity and perceived disability, other mental-health problems and living alone predicted healthcare use for depressed people while greater perceived disability, other mental-health problems, younger age and parents' mental-health problems predicted healthcare use for people with anxiety.

Hamalainen, J. ... [et al] - Use of health services for major depressive and anxiety disorders in Finland Depression and Anxiety 25(1), 27-37