Abstract
This study qualitatively explored the past treatment experiences of uninsured young adults who sought public emergency psychiatric care. Qualitative interviews were conducted with a racially diverse sample of 55 young adults (ages 18–25) using a semi-structured interview guide, and analyzed using a team-based open coding approach. Findings emerged in three broad areas—provider-related factors, treatment-related factors, and environmental factors. Young adults talked about the importance of providers respecting and listening to them, the perceived advantages and disadvantages of therapy and medication treatment, and aspects of the environment that resulted in positive and negative experiences, particularly in inpatient settings. Providers need to convey respect and caring that transcends job duties and provide tangible skills and supports.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buhumaid, R., Riley, J., Sattarian, M., Bregman, B., & Blanchard, J. (2015). Characteristics of frequent users of the emergency department with psychiatric conditions. Journal of Health Care for the Poor and Underserved, 26(3), 941–950.
Deegan, P. E. (2010). A Web application to support recovery and shared decision making in psychiatric medication clinics. Psychiatric Rehabilitation Journal, 34(1), 23–28. doi:10.2975/34.1.2010.23.28.
Delman, J., Clark, J. A., Eisen, S. V., & Parker, V. A. (2015). Facilitators and barriers to the active participation of clients with serious mental illnesses in medication decision making: The perceptions of young adult clients. The Journal of Behavioral Health Services & Research, 42(2), 238–253. doi:10.1007/s11414-014-9431-x.
Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of mental health treatment: Patterns and predictors among epidemiological survey respondents in the United States and Ontario. The American Journal of Psychiatry, 159(5), 845–851. doi:10.1176/appi.ajp.159.5.845.
Ellis, L. A., Collin, P., Hurley, P. J., Davenport, T. A., Burns, J. M., & Hickie, I. B. (2013). Young men’s attitudes and behaviour in relation to mental health and technology: Implications for the development of online mental health services. BMC Psychiatry, 13. doi:10.1186/1471-244X-13-119.
Gabbard, G. O. (2005). Patient-therapist boundary issues. Psychiatric Times, 22(12). Retrieved December 31, 2016, from http://www.psychiatrictimes.com/articles/patient-therapist-boundary-issues.
Green, C. A., Wisdom, J. P., Wolfe, L., & Firemark, A. (2012). Engaging youths with serious mental illnesses in treatment: STARS study consumer recommendations. Psychiatric Rehabilitation Journal, 35(5), 360–368. doi:10.1037/h0094494.
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry. doi:10.1186/1471-244X-10-113.
Institute of Medicine (2001). Improving the quality of health care for mental and substance-use conditions. Washington DC: The National Academies Press.
Institute of Medicine & National Research Council (2014). Investing in the health and well-being of young adults. Washington, D. C.: The National Academies Press.
Lau, J. S., Adams, S. H., Boscardin, W. J., & Irwin, C. E. Jr. (2014). Young adults’ health care utilization and expenditures prior to the Affordable Care Act. Journal of Adolescent Health, 54(6), 663–671. doi:10.1016/j.jadohealth.2014.03.001.
Lee, B. R., Munson, M. R., Ware, N. C., Ollie, M. T., Scott, L. D. Jr., & McMillen, J. C. (2006). Experiences of and attitudes toward mental health services among older youths in foster care. Psychiatric Services, 57(4), 487–492. doi:10.1176/appi.ps.57.4.487.
Lin, M.-T., Burgess, J. F. Jr., & Carey, K. (2012). The association between serious psychological distress and emergency department utilization among young adults in the USA. Social Psychiatry and Psychiatric Epidemiology, 47(6), 939–947. doi:10.1007/s00127-011-0401-9.
Liu, S. W., Nagurney, J. T., Chang, Y., Parry, B. A., Smulowitz, P., & Atlas, S. J. (2013). Frequent ED users: Are most visits for mental health, alcohol, and drug-related complaints? American Journal of Emergency Medicine, 31(10), 1512–1515. doi:10.1016/j.ajem.2013.08.006.
Martin, C. E., Houston, A. M., Mmari, K. N., & Decker, M. R. (2012). Urban teens and young adults describe drama, disrespect, dating violence and help-seeking preferences. Maternal and Child Health Journal, 16(5), 957–966. doi:10.1007/s10995-011-0819-4.
Muir, K., Powell, A., & McDermott, S. (2012). ‘They don’t treat you like a virus’: Youth-friendly lessons from the Australian national youth mental health foundation. Health & Social Care in the Community, 20(2), 181–189. doi:10.1111/j.1365-2524.2011.01029.x.
Munson, M. R., Cole, A., Jaccard, J., Kranke, D., Farkas, K., & Frese, F. J. III (2016). An engagement intervention for young adults with serious mental health conditions. The Journal of Behavioral Health Services and Research, 43(4), 542–563. doi:10.1007/s11414-014-9424-9.
Munson, M. R., & Lox, J. A. (2012). Clinical social work practice with former system youth with mental health needs: Perspective of those in need. Clinical Social Work Journal, 40(2), 255–260. doi:10.1007/s10615-012-0381-6.
Munson, M. R., Scott, L. D. Jr., Smalling, S. E., Kim, H., & Floersch, J. E. (2011). Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust. Children and Youth Services Review, 33(11), 2261–2266. doi:10.1016/j.childyouth.2011.07.015.
Narendorf, S. C., Munson, M. R., & Floersch, J. (2015). Perspectives on psychotropic medication treatment among young adults formerly served in public systems of care: A thematic and narrative analysis. Journal of the Society for Social Work and Research, 6(1), 121–143. doi:10.1086/680318.
Narendorf, S. C., & Palmer, A. (2016). Perception of need and receipt of mental health treatment: A three-group comparison of young adults with psychological distress. Psychiatric Services, 67(8), 924–927. doi:10.1176/appi.ps.201500230.
Patient and Family Resource Centers. (2016). Key principles of patient- and family-centered care. Institute for Patient- and Family-Centered Care. Retrieved December 31, 2016, from http://www.ipfcc.org/advance/topics/pafam-resource.html.
Schwartz, K., & Schwartz, T. (2008). Uninsured young adults: A profile and overview of coverage options. (7785). Retrieved December 31, 2016, from https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7785.pdf.
Simmons, M. B., Hetrick, S. E., & Jorm, A. F. (2011). Experiences of treatment decision making for young people diagnosed with depressive disorders: A qualitative study in primary care and specialist mental health settings. BMC Psychiatry. doi:10.1186/1471-244X-11-194.
Stiffman, A. R., Horwitz, S. M., Hoagwood, K., Compton, W. III, Cottler, L., Bean, D. L., ... Weisz, J. R. (2000). The Service Assessment for Children and Adolescents (SACA): Adult and child reports. Journal of the American Academy of Child and Adolescent Psychiatry, 39(8), 1032–1039. doi:10.1097/00004583-200008000-00019.
Strauss, A., & Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, CA: Sage.
Thompson, S. J., Bender, K., Lantry, J., & Flynn, P. M. (2007). Treatment engagement: Building therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy: An International Journal, 29(1–2), 39–55. doi:10.1007/s10591-007-9030-6.
Traver, A. (2013). The promise of care coordination: Transforming health care delivery. Retrieved from http://familiesusa.org/sites/default/files/product_documents/Care-Coordination.pdf.
Vanheusden, K., Mulder, C. L., van der Ende, J., van Lenthe, F. J., Mackenbach, J. P., & Verhulst, F. C. (2008). Young adults face major barriers to seeking help from mental health services. Patient Education and Counseling, 73(1), 97–104. doi:10.1016/j.pec.2008.05.006.
Yu, J. W., Adams, S. H., Burns, J., Brindis, C. D., & Irwin, C. E. Jr. (2008). Use of mental health counseling as adolescents become young adults. Journal of Adolescent Health, 43(3), 268–276. doi:10.1016/j.jadohealth.2008.01.009.
Acknowledgements
This study was funded by the Hogg Foundation for Mental Health, JRG-199, and a University of Houston New Faculty Grant. Special thanks to Dr. Sara K. Flores and the staff at the Crisis Stabilization Unit and the Harris Center for Mental Health and IDD.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Narendorf, S.C., Wagner, R., Fedoravicius, N. et al. Prior Experiences of Behavioral Health Treatment among Uninsured Young Adults Served in a Psychiatric Crisis Setting. Community Ment Health J 53, 782–792 (2017). https://doi.org/10.1007/s10597-017-0150-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-017-0150-7