The purpose of this study was to describe mental health service recipients' experience of the therapeutic relationship. The research question was 'what is therapeutic about the therapeutic relationship?' This study was a secondary analysis of qualitative interviews conducted with persons with mental illness as part of a study of the experience of being understood. This secondary analysis used data from 20 interviews with community-dwelling adults with mental illness, who were asked to talk about the experience of being understood by a health-care provider. Data were analysed using an existential phenomenological approach. Individuals experienced therapeutic relationships against a backdrop of challenges, including mental illness, domestic violence, substance abuse, and homelessness. They had therapeutic relationships with nurses (psychiatric/mental health nurses and dialysis nurses), physicians (psychiatrists and general practitioners), psychologists, social workers, and counsellors. Experiences of the therapeutic relationship were expressed in three figural themes, titled using participants' own words: 'relate to me', 'know me as a person', and 'get to the solution'. The ways in which these participants described therapeutic relationships challenge some long-held beliefs, such as the use of touch, self-disclosure, and blunt feedback. A therapeutic relationship for persons with mental illness requires in-depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient, is key for practising nurses and nurse educators interested in enhancing the therapeutic potential of relationships.

Community-based participatory research bridges the gap between academic researchers and the real-life issues of communities and offers promise for addressing racial and ethnic disparities in mental health care. The purpose of this community-based participatory research was to identify factors that affect access, use, and perception of mental health services by a Latino population at individual, organizational, and community levels. Individual level factors included health beliefs about mental illness and care, suspicions of providers, financial concerns, and culturally determined gender roles. Organizational factors included problems with access to care related to cost, lack of bilingual providers, and culturally competent care; and community level factors included distance between resources and the need for services to be provided in community sites. Immigration status and acculturation were identified as factors at all levels.

The nurses had culturally competent knowledge and attitudes but were unable to fully and consistently enact these in practice. The need for appropriate cultural competence education and interpreter services addressing health disparities, as mandated in the Culturally and Linguistically Appropriate Services in Health Care standards, is emphasized.

As many as 20% of children between the ages of 0 and 18 meet the criteria for one or more mental disorders at some point in their lives, with about one half of these being described as being seriously disturbed. Only about one-third of these children and adolescents receive help from the mental health system. Negative outcome expectations toward the mental health system can prevent use of services. This study examined rural parents' expectations about outcomes related to mental health treatment, the provider-client-parent relationships, social and cultural factors, and accessibility to mental health services. The parents' knowledge of the prevalence of mental health disorders in children and adolescents was also examined. Bandura's Social Cognitive Theory served as the conceptual framework for this study. Stigma toward the use of the mental health system was evident. More than half the parents were concerned that mental health professionals would not care for their child. Although negative relationship outcome expectations were revealed, positive treatment outcome expectations also emerged. Structural outcome expectations were not shown to be a major deterrent in receiving care. The belief and hope is that positive outcome expectations toward the mental health system will encourage use of services.

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