Overcoming Barriers to Sustained Engagement in Mental Health Care: Perspectives of Rural Veterans and Providers

• Published in: The Journal of rural health Vol. 32; no. 4; pp. 429 - 438
• Main Authors: Fischer, Ellen P., McSweeney, Jean C., Wright, Patricia, Cheney, Ann, Curran, Geoffrey M., Henderson, Kathy, Fortney, John C.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.09.2016; Wiley Subscription Services, Inc
• Subjects: Access; Adolescent; Adult; Aged; Ancient Greek philosophy; Attitudes; Barriers; Belief systems; Beliefs; Caregiving; Centrality; Community Mental Health Services - utilization; Constraints; Content analysis; Cultural values; Facilitators; Female; Health care; Health care policy; Health Knowledge, Attitudes, Practice; Health Personnel - psychology; Health Services Accessibility - statistics & numerical data; Help seeking behavior; Humans; Illnesses; Independence; Interviews; Male; Medical personnel; Medical treatment; Mental disorders; Mental health; Mental health care; Mental health professionals; Mental health services; Middle Aged; Military personnel; Patient Acceptance of Health Care - psychology; peer support; Qualitative Research; Reliance; Religion; Religious beliefs; Rural areas; Rural communities; Rural Population; self-reliance; Semistructured interviews; Service provision; Services; Social services delivery; Stigma; Stigmas (botany); Stoicism; Transcription; trust; Trust - psychology; Underuse; United States; United States Department of Veterans Affairs - organization & administration; Unmet needs; Veterans; Veterans - psychology; trust; veterans; self-reliance; mental health care; peer support
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12203

Purpose To better understand the attitudes, beliefs, and values that influence use of mental health care among rural veterans. Methods In‐depth, semistructured interviews were conducted with 25 rural veterans and 11 rural mental health care providers in 4 states. Experienced qualitative interviewers asked participants about the attitudinal factors they thought most influenced rural veterans’ decisions to seek and sustain mental health care. Verbatim transcriptions were analyzed using content analysis and constant comparison. Findings Rural veterans and their mental health care providers reported the same major attitudinal barriers to veterans’ mental health treatment‐seeking. Pre‐eminent among those barriers was the importance rural veterans place on independence and self‐reliance. The centrality of self‐reliance was attributed variously to rural, military, religious, and/or gender‐based belief systems. Stoicism, the stigma associated with mental illness and health care, and a lack of trust in the VA as a caring organization were also frequently mentioned. Perceived need for care and the support of other veterans were critical to overcoming attitudinal barriers to initial treatment‐seeking, whereas critical facilitators of ongoing service use included “warm handoffs” from medical to mental health care providers, perceived respect and caring from providers, as well as provider accessibility and continuity. Conclusions Attitudes and values, like self‐reliance, commonly associated with rural culture may play an important role in underutilization of needed mental health services. System support for peer and provider behaviors that generate trust and demonstrate caring may help overcome attitudinal barriers to treatment‐seeking and sustained engagement in mental health care among rural veterans.