Factors that influence access to mental health services in South-Eastern Europe

Abstract

IntroductionAccess to mental health (MH) services is unequal worldwide and changes are required in this respect.ObjectivesOur aim was to identify the delay to the first psychiatry consult and to understand patients’ characteristics and perspectives on the factors that may influence the delay, among a sample of participants from three Southeastern European Countries.Materials and methodsThe WHO Pathway Encounter Form questionnaire was applied in 400 patients “new cases” and a questionnaire on the factors influencing the access was administered to the same patients, as well as to their caretakers and MH providers.Result and discussionsThe average profile of the patient “new case” was: married female older than 40 years, with an average economic status and no MH history. The mean delay was up to 3 months and the most important factors that were influencing the delay were stigma and lack of knowledge regarding MH problems and available current treatments.ConclusionsFuture policies trying to improve the access to psychiatric care should focus on increasing awareness about MH problems in the general population.

Key Barriers to the Provision and Utilization of Mental Health Services in Low-and Middle-Income Countries: A Scope Study

“…A large body of included studies (85%) has reported that fear of being stigmatized hindered people from seeking MH services(17, 18, 20, 23-25, 31, 33, 35, 37, 39, 42, 44, 45, 48-50, 52-54).B-1-2-Personal stigma/Shame: according to the findings of current review, self-stigma and embarrassment is the second attitudinal barrier to the utilization of MH services. Self-stigma is a feeling of shame that in many cases leads to reduction in utilization of MH services(18,20,44,48,50,(52)(53)(54).B-1-3-Concerns about the effectiveness of services: this study indicates that another frequent barrier to the utilization of MH services in LMICs is concern about the effectiveness of services. Patients who suppose that MH service would not help them are less likely to seek and utilize these services(18, 23- 25, 48, 49).…”

“…B-2-3-Lack of family or social support: we found that shortage of support from others is a deterrent factor against utilization of MH services in some developing countries. Social support of patients with mental illness has different dimensions including financial, emotional, and physical supports(18,33,35,45,48,49,52,53).B-2-4-Time-related barriers: this study showed that challenges pertaining to time are another structural barrier to the utilization of MH services in LMICs. These challenges include waiting time barriers, difficulty taking time off work, and transportation time.…”

“…A-1-4-Inappropriate service types: findings of current study revealed that failure to provision of appropriate MH services is a challenges for health systems in some LMICs. Inappropriateness of MH services is related to the improper allocation of MH services resources (13,40,52) as well as incongruity between available services and needs or preferences of target population (15,43).…”

“…B-1-6-Cultural beliefs against treatment: the findings indicated that in many developing countries mental illnesses are attributed to the spirit (35). Therefore, some cultural beliefs such as fatalism (52) create a gap between personal beliefs and MH interventions that eventually leads to reduced utilization of MH services (23,35,48,52).…”

Practices and Perspectives of Mental Health in the Balkan Countries: A Narrative Review

“…It is necessary to recognize that these histories have impacted health and wellness today by influencing how research into mental health from the region is done and contextualized (i.e., almost exclusive investigation of post-war conditions and PTSD). In addition to the significant funding difficulties and out-of-pocket payments to treat somatic diseases (see demographic research section), there is a chance that mental health issues may be even more threatened to be ignored due to significant stigma surrounding these problems and a lack of current available resources and treatments (Tirintica et al, 2018). When taken together, these barriers to healthcare impose a great risk to the overall mental wellbeing of Balkan peoples.…”