The digital divide: factors impacting on uptake of remote therapy in a South London psychological therapy service for people with psychosis.

BACKGROUND: Remote therapy promises a cost-effective way of increasing delivery of psychological-therapy in underserved populations. However, research shows a "digital divide", with some groups experiencing digital exclusion. AIMS: To assess whether technology, accessibility, and demographic factors influence remote therapy uptake among individuals with psychosis, and whether demographic factors are associated with digital exclusion. METHODS: Remote therapy uptake and demographics were assessed in people (n = 51) within a psychology-led service for psychosis, using a survey of access to digital hardware, data and private space. RESULTS: The majority of individuals had access to digital devices, but 29% did not meet minimum requirements for remote therapy. Nineteen (37%) individuals declined remote therapy. Those who accepted were significantly younger and more likely to have access to technology than those who declined. The mean age of those with access to smartphones and large screen devices was younger than those without access. CONCLUSIONS: A subgroup of people with psychosis face barriers to remote therapy and a significant minority are digitally excluded. Older age is a key factor influencing remote therapy uptake, potentially related to less access to digital devices. Services must minimize exclusion through provision of training, hardware and data, whilst promoting individual choice.

Pathways into mental health care for UK veterans: a qualitative study.

Background: It is well established that veterans suffering from mental health difficulties under use mental health services. Objective: This study aimed to understand more about the barriers that prevent veterans from seeking professional help and the enablers that assist veterans in seeking professional help. It also aimed to explore potential mechanisms to improve veterans' help-seeking and pathways to care. Method: The study employed a qualitative design whereby 17 veterans who had recently attended specialist veteran mental health services took part in semi-structured interviews. The resultant data were analysed using grounded theory. Results: Participants described two distinct stages to their help-seeking: initial help-seeking and pathways through treatment. Specific barriers and enablers to help-seeking were identified at each stage. Initial barriers included recognizing that there is a problem, self-stigma and anticipated public stigma. Initial enablers included being in crisis, social support, motivation and the media. Treatment pathway barriers included practical factors and negative beliefs about health services and professionals. Treatment pathway enablers included having a diagnosis, being seen in a veteran-specific service and establishing a good therapeutic relationship. Participants provided some suggestions for interventions to improve veterans' help-seeking in future; these focussed on enhancing both veterans and health professionals' knowledge regarding mental health difficulties. Conclusions: This study identified a number of barriers and enablers that may impact a veteran's journey in seeking help from professional services for mental health difficulties. Enablers such as reaching a crisis point, social support, the media, having a diagnosis of PTSD and veteran-specific mental health services appeared to be important in opposing stigma-related beliefs and in supporting veterans to engage in help-seeking behaviours.

Planteamiento: Está bien establecido que los veteranos que sufren de problemas de salud mental infrautilizan los servicios de salud mental. Objetivo: Este estudio estaba dirigido a comprender más sobre las barreras que impiden que los veteranos busquen ayuda profesional y aquello que les facilita su búsqueda de ayuda profesional. También tenía como objetivo explorar posibles mecanismos para mejorar la búsqueda de ayuda y las vías que llevan a dicha atención de los veteranos. Método: El estudio empleó un diseño cualitativo mediante el cual 17 veteranos, que habían asistido recientemente a servicios especializados de salud mental para veteranos, participaron en entrevistas semiestructuradas. Los datos resultantes se analizaron utilizando una teoría fundamentada. Resultados: Los participantes describieron dos etapas distintas en su búsqueda de ayuda: búsqueda inicial de ayuda; y vías del tratamiento. En cada etapa se identificaron las barreras específicas y los facilitadores para dicha búsqueda de ayuda. Las barreras iniciales incluyeron el reconocimiento de que existe un problema, el autoestigma y el estigma público anticipado. Los facilitadores iniciales incluyeron estar en crisis, apoyo social, motivación y los medios de comunicación. Las barreras a recibir tratamiento incluían factores prácticos y creencias negativas sobre los servicios de salud y los profesionales. Lo que facilitaba el recibir tratamiento incluía tener un diagnóstico, ser vistos en un servicio específico para veteranos y establecer una buena relación terapéutica. Los participantes proporcionaron algunas sugerencias de intervenciones para mejorar la búsqueda de ayuda de los veteranos en el futuro; estos se enfocaron en mejorar el conocimiento sobre las dificultades de salud mental. tanto de los veteranos como el de los profesionales de la salud. Conclusiones: Este estudio identificó una serie de barreras y facilitadores que pueden influir en que los veteranos busquen ayuda de servicios profesionales para las dificultades de salud mental. Facilitadores como llegar a un punto de crisis, el apoyo social, los medios de comunicación, tener un diagnóstico de TEPT y servicios de salud mental específicos para veteranos parecían ser importantes a la hora de enfrentarse a creencias estigmatizadas y de apoyar a los veteranos a implicarse en conductas de búsqueda de ayuda.