Young people with depression and their experience accessing an enhanced primary care service for youth with emerging mental health problems: a qualitative study

BMC Psychiatry

Dan I Lubman²  Terence V McCann¹ 

[1] School of Nursing and Midwifery, Victoria University, PO Box 14428, Melbourne, 8001, VIC, Australia;Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, 54-62 Gertrude Street, Fitzroy, 3065, VIC, Australia

关键词: Headspace;    Youth mental health;    Service access;    Qualitative research;    Interpretative phenomenological analysis;    Help-seeking;    Early intervention;    Depression;   

Others  :  1124335
DOI  :  10.1186/1471-244X-12-96

 received in 2011-07-25, accepted in 2012-07-27,  发布年份 2012

【 摘 要 】

Background

Despite the emergence of mental health problems during adolescence and early adulthood, many young people encounter difficulties accessing appropriate services. In response to this gap, the Australian Government recently established new enhanced primary care services (headspace) that target young people with emerging mental health problems. In this study, we examine the experience of young people with depression accessing one of these services, with a focus on understanding how they access the service and the difficulties they encounter in the process.

Method

Individual, in-depth, audio-recorded interviews were used to collect data. Twenty-six young people with depression were recruited from a headspace site in Melbourne, Australia. Interpretative phenomenological analysis was used to analyse the data.

Results

Four overlapping themes were identified in the data. First, school counsellors as access mediators, highlights the prominent role school counsellors have in facilitating student access to the service. Second, location as an access facilitator and inhibitor. Although the service is accessible by public transport, it is less so to those who do not live near public transport. Third, encountering barriers accessing the service initially. Two main service access barriers were experienced: unfamiliarity with the service, and delays in obtaining initial appointments for ongoing therapy. Finally, the service’s funding model acts as an access facilitator and barrier. While the model provides a low or no cost services initially, it limits the number of funded sessions, and this can be problematic.

Conclusions

Young people have contrasting experiences accessing the service. School counsellors have an influential role in facilitating access, and its close proximity to public transport enhances access. The service needs to become more prominent in young people’s consciousness, while the appointment system would benefit from providing more timely appointments with therapists. The service’s funding model is important in enabling access initially to young people from low socioeconomic backgrounds, but the government needs to reassess the model for those who require additional support.

【 授权许可】

   
2012 McCann and Lubman; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Australian Bureau of Statistics: National Survey of Mental Health and Wellbeing: Summary of results, 2007. Australian Bureau of Statistics, Canberra; 2008.
• [2]Reavley NJ, Cvetkovski S, Jorm AF, Lubman DI: Help-seeking for substance use, anxiety and affective disorders among young people: results from the 2007 Australian National Survey of Mental health and Wellbeing. Aust NZ J Psychiat 2010, 44:729-735.
• [3]Kessler RC, Foster CL, Saunders WB, Stang PE: Social consequences of psychiatric disorders, I: Educational attainment. Am J Psychiat 1995, 152(7):1026-1032.
• [4]Jorm AF, Wright A, Morgan AJ: Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents. Med J Australia 2007, 187(10):556-560.
• [5]Samargia LA, Saewyc EM, Elliott BA: Foregone mental health care and self-reported access barriers among adolescents. J Sch Nurs 2006, 22(1):17-24.
• [6]Booth ML, Bernard D, Quine S, Kang MS, Usherwood T, Alperstein G, Bennett DL: Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution. J Adolescent Health 2004, 34(1):97-103.
• [7]Hernan A, Philpot B, Edmonds A, Reddy P: Healthy minds for country youth: help-seeking for depression among rural adolescents. Aust J Rural Health 2010, 18(3):118-124.
• [8]Singh SP, Grange T: Measuring pathways to care in first-episode psychosis: a systematic review. Schizophr Res 2006, 81:75-82.
• [9]Hodges CA, O'Brien MS, McGorry PD: headspace: National Youth Mental Health Foundation: Making headway with rural young people and their mental health. Austral J Rural Health 2007, 15:77-80.
• [10]Keshavan MS, Haas G, Miewald J, Montrose DM, Reddy R, Schooler NR, Sweeney JR: Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychosis. Schizophr Bull 2003, 29:757-769.
• [11]Owens DC, Johnstone EC, Miller P, Macmillan F, Crow TJ: Duration of untreated illness and outcome in schizophrenia: Test of predictions in relation to relapse risk. Brit J Psychiat 2010, 196(4):296-301.
• [12]Gerson R, Davidson L, Booty A, Wong C, McGlashan T, Malespina D, Pincus HA, Corcoran C: Families' experience with seeking treatment for recent-onset psychosis. Psychiat Serv 2009, 60(6):812-816.
• [13]Patel V, Flisher AJ, Hetrick S, McGorry P: Mental health of young people: a global public-health challenge. Lancet 2007, 369(9569):1302-1313.
• [14]Barney LJ, Griffiths KM, Jorm AF, Christensen H: Stigma about depression and its impact on health-seeking intentions. Aust NZ J Psychiat 2006, 40(1):51-54.
• [15]Crago A, Wigg C, Stacey K: Youth-friendly practice in mental health work. Youth Studies Aust 2004, 23(2):38-45.
• [16]Tylee A, Haller DM, Graham T, Churchill R, Sanci LA: Youth-friendly primary care services: How are we doing and what more needs to be done? Lancet 2007, 369(9572):1565-1573.
• [17]Cosgrave EM, Yung AR, Killackey EJ, Buckby JA, Godfrey KA, Stanford CA, McGorry PA: Met and unmet need in youth mental health. J Ment Health 2008, 17(6):618-628.
• [18]Leavey JE, Flexhaug M, Ehmann T: Review of the literature regarding early intervention for children and adolescents aged 0–15 experiencing a first-episode psychiatric disturbance. Early Interv Psychiat 2008, 2:212-224.
• [19]Sourander A, Helstela L, Ristkari T, Ikaheimo K, Helenius H, Piha J: Child and adolescent mental health service use in Finland. Soc Psych Psych Epid 2001, 36:294-298.
• [20]Muir K, Powell A, Patulny R, Flaxman S, McDermott S, Oprea I, Gendera S, Vespignani J, Sitek T, Abello D, et al.: Headspace evaluation report. Social Policy Research Centre, University of New South Wales, Sydney; 2009.
• [21]Giorgi AP, Giorgi B: Phenomenological psychology. In The Sage handbook of qualitative research in psychology. Edited by Wallig C, Stainton-Rogers W. Sage, Los Angeles, California; 2008:165-178.
• [22]Smith JA, Flowers P, Larkin M: Interpretative phenomenological analysis: Theory, method and research. Sage, London; 2009.
• [23]Smith JA, Osborn M: Interpretative phenomenological analysis. In Qualitative psychology: A practical guide to research methods. 2nd edition. Edited by Smith JA. Sage, London; 2008:51-80.
• [24]Eatough V, Smith J: 'I was like a wild wild person': Understanding feelings of anger using interpretative phenomenological analysis. Brit J Psychol 2006, 97:483-498.
• [25]Smith JA, Osborn M: Interpretative phenomenological analysis. In Doing social psychology research. Edited by Breakwell GM. British Psychological Society and Blackwell Publishing, Oxford; 2004:229-254.
• [26]Patton MQ: Qualitative research and evaluation methods. 3rd edition. Sage, Thousand Oaks, California; 2002.
• [27]Parahoo K: Nursing research: Principles, process and issues. 2nd edition. Palgrave MacMillan, Basingstoke, Hampshire, United Kingdom; 2006.
• [28]Eatough V, Smith JA: Interpretative phenomenological analysis. In The Sage handbook of qualitative research in psychology. 1st edition. Edited by Wallig C, Stainton-Rogers W. Sage, Los Angeles, California; 2008:179-194.
• [29]Sandelowski MJ: Justifying qualitative research. Res Nurs Health 2008, 31(3):193-195.
• [30]Morse J: The significance of saturation [Editorial]. Qual Health Res 1995, 5(2):147-149.
• [31]Morse JM: "Cherry picking:" Writing from thin data. Qual Health Res 2010, 20(1):3.
• [32]Guba EG, Lincoln YS: Paradigmatic controversies, contradictions, and emerging confluences. In The Sage handbook of qualitative research. 3rd edition. Edited by Denzin NK, Lincoln YS. Sage, Thousand Oaks, California; 2005:191-215.
• [33]Holloway I, Wheeler S: Qualitative research in nursing and healthcare. 3rd edition. Wiley-Blackwell, Oxford; 2010.
• [34]Hutchinson SA: Grounded theory: The method. In Nursing research: A qualitative perspective. 2nd edition. Edited by Munhall PL, Oiler Boyd C. National League for Nursing, New York; 1993:180-212.
• [35]Hill CE, Thompson BJ, Nutt Williams E: A guide to conducting consensual qualitative research. Counseling Psychol 1997, 25(4):517-572.
• [36]Commonwealth of Australia: Better access to mental health care. AGPS, Canberra; [http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-b-better webcite]
• [37]Perry BL, Pescosolido BA, Martin JK, McLeod JD, Jensen PS: Comparison of public attributions, attitudes, and stigma in regard to depression among children and adults. Psychiat Serv 2007, 58(5):632-635.
• [38]Altamura AC, Buoli M, Albano A, Dell'Osso B: Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: A naturalistic study. Int Clin Psychopharm 2010, 25(3):172-179.
• [39]Okuda A, Suzuki T, Kishi T, Yamanouchi Y, Umeda K, Haitoh H, Hashimoto S, Ozaki N, Iwata N: Duration of untreated illness and antidepressant fluvoxamine response in major depressive disorder. Psychiatry Clin Neurosci 2010, 64(3):268-273.
• [40]de Diego-Adelino J, Portella MJ, Puigdemont D, Perez-Egea R, Alvarez E, Perez V: A short duration of untreated illness (DUI) improves response outcomes in first-depressive episodes. J Affect Disorders 2010, 120(1–3):221-225.
• [41]Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H: 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust NZ J Psychiat 2009, 43:594-605.
• [42]Bowden MP, Doughney J: Socio-economic status, cultural diversity and the aspirations of secondary students in the Western Suburbs of Melbourne, Australia. Higher Educ 2010, 59(1):115-129.
• [43]Kravitz RL, Paterniti DA, Epstein RM, Rochlen AB, Bell RA, Cipri C, Fernandez y Garcia E, Feldman MD, Duberstein P: Relational barriers to depression help-seeking in primary care. Patient Educ Counseling 2011, 82(2):207-213.
• [44]Green J: Generalisability and validity in qualitative research. Brit Med J 1999, 319:421.
• [45]Polit DF, Beck CT: Generalization in quantitative and qualitative research: Myths and strategies. Int J Nurs Stud 2010, 47:1451-1458.