ABSTRACT
INTRODUCTION: The Veterans Health Administration (VA) Primary Care-Mental Health Integration (PC-MHI) program aims to increase availability and acceptability of mental health (MH) care by integrating these services into primary care. Little is known about veterans' perceptions of this of method MH care delivery. This study explored the range of veterans' beliefs and perceptions of MH and MH services with the aim of describing potential facilitators and barriers to the uptake of PC-MHI services. METHOD: Team-based qualitative analysis of proceedings from focus groups. Participants included 41 veterans from across service eras. Focus groups were organized by service era and use of PC-MHI services. Codes pertaining to beliefs about MH and MH treatment were identified, grouped into subthemes, and then larger organizing themes. Barriers and facilitators to treatment seeking were identified. RESULTS: Although our study was focused on veteran perceptions of PC-MHI, participants did not appear to discriminate between PC-MHI and other MH services when discussing their decisions to seek services. Facilitators and barriers to MH treatment-seeking included systems, personal and social influences. Stigma was mentioned infrequently relative to other beliefs. DISCUSSION: Veterans with and without experience of PC-MHI services described a variety of beliefs about MH without regard to whether this service location. These findings suggest that while integration increases access, it may not in itself decrease some barriers to seeking treatment. These findings suggest that more work is needed to address the way potential PC-MHI patients decide whether or not to engage in care. (PsycINFO Database Record
Subject(s)
Mental Disorders/psychology , Mental Health Services/statistics & numerical data , Patient Acceptance of Health Care/psychology , Perception , Veterans/psychology , Adult , Aged , Delivery of Health Care, Integrated/standards , Focus Groups , Health Services Accessibility/standards , Humans , Male , Mental Disorders/therapy , Middle Aged , United States , United States Department of Veterans Affairs/organization & administration , United States Department of Veterans Affairs/standardsABSTRACT
BACKGROUND: Few studies have measured addiction-specific barriers to treatment. A measurement of barriers with psychometric support that has been tested in diverse samples and that assesses multiple components of addiction treatment barriers is needed to inform providers and treatment programs. OBJECTIVES: This paper aims to provide an initial psychometric investigation of a measure of barriers to seeking addictions treatment. METHODS: Data were collected from 196 Veterans Affairs primary care patients with Alcohol Use Disorder that participated in a randomized clinical trial. RESULTS: A Principal Components Analysis revealed that the 32-item Treatment Barriers Scale (TBS) can be reduced to 14 items, measuring 4 factors: stigma, dislike of the treatment process, alcohol problem identification, and logistical concerns. Acceptable internal consistent reliability (α = .64-.76) and excellent precision of alpha (α = 0.001-0.009) was found for each subscale. Support for the measure's concurrent validity was found, for example, participants who reported more motivation to reduce their drinking perceived significantly fewer barriers to care. Support for the measure's predictive validity was also found, including that more barriers were related to future drinking among all participants and less mental health and addictions treatment visits among participants in one treatment condition. Conclusions/ Importance: Our results provide initial support for the utility of the TBS-14 among primary care patients with Alcohol Use Disorder. Use of the TBS-14 could enable healthcare providers to better understand patient-specific treatment barriers, provide corrective information on treatment misconceptions, and inform individualized treatment plans that increase patient engagement in addiction services.