Abstract
Despite progress made under California’s Mental Health Services Act, limited access to care for cultural and linguistic minority groups remains a serious issue in community mental health. In this qualitative study we report findings from a large-scale community-level assessment that explored barriers to accessing care from the perspectives of multiple stakeholders including county advisors, advocates, community members, and consumers representing a range of cultural and linguistic communities in Orange County, California. We conducted 14 focus groups with N = 112 participants. Qualitative analysis revealed that system fragmentation, limited availability of linguistically appropriate care, and stigma continue to undermine access to mental health care. Peer health navigation and culturally responsive peer support are potential ways to promote service engagement with persons from cultural and linguistic minority groups that encounter barriers when accessing mental health services.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Amelia Seraphia, Derr (2016) Mental Health Service Use Among Immigrants in the United States: A Systematic Review. Psychiatric Services 67(3) 265-274 10.1176/appi.ps.201500004
Alegría, M., Alvarez, K., Ishikawa, R. Z., DiMarzio, K., & McPeck, S. (2016). Removing obstacles to eliminating racial and ethnic disparities in behavioral health care. Health Affairs, 35(6), 991–999. doi:https://doi.org/10.1377/hlthaff.2016.0029
Ashwood, K., Chamberlain, et al. (2018). Evaluation of the Mental Health Services Act in Los Angeles County: implementation and outcomes for key programs.Rand Health Quarterly,
Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., & Pomey, M. P. (2018). Engaging patients to improve quality of care: a systematic review. Implementation Science, 13(1), 1–22. doi: https://doi.org/10.1186/s13012-018-0784-z
Boivin, A., Lehoux, P., Lacombe, R., Burgers, J., & Grol, R. (2014). Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. Implementation Science, 9(1), 24. doi: https://doi.org/10.1186/1748-5908-9-24
Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. Sage Publications, Inc.
Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care. Health Affairs, 39(3), 395–402. doi:https://doi.org/10.1377/hlthaff.2019.01394
Cabassa, L. J., Siantz, E., Nicasio, A., Guarnaccia, P., & Lewis-Fernández, R. (2014). Contextual factors in the health of people with serious mental illness. Qualitative Health Research, 24(8), 1126–1137. doi: https://doi.org/10.1177/1049732314541681
Cashin, C., Scheffler, R., Felton, M., et al. (2008). Transformation of the California mental health system: stakeholder-driven planning as a transformational activity. Psychiatric Services, 59, 1107–1114. doi:https://doi.org/10.1176/ps.2008.59.10.1107
Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatric Services, 65(4), 429-441. https://doi.org/10.1176/appi.ps.201300244
Coleman, K. J., Stewart, C., Waitzfelder, B. E., Zeber, J. E., Morales, L. S., Ahmed, A. T., & Hunkeler, E. M. (2016). Racial-ethnic differences in psychiatric diagnoses and treatment across 11 health care systems in the mental health research network. Psychiatric Services, 67(7), 749–757. doi: https://doi.org/10.1176/appi.ps.201500217
County Funding Request for Mental Health Services Act (MHSA) Community Program Planning. Letter No. 05 – 01. Sacramento, State of California, Department of Mental Health, Jan 18, 2005. Available at: https://www.dhcs.ca.gov/formsandpubs/MHArchiveLtrs/MH-Ltrs05-01.pdf
Derr, A. S. (2016). Mental health service use among immigrants in the United States: A systematic review. Psychiatric Services. 67(3), 265–274
Felton, M. C., Cashin, C. E., & Brown, T. T. (2010). What does it take? California county funding requests for recovery-oriented full service partnerships under the Mental Health Services Act. Community Mental Health Journal, 46(5), 441–451. Doi: https://doi.org/10.1007/s10597-010-9304-6
Gilmer, T. P., Stefancic, A., Tsemberis, S., et al. (2014). Full-service partnerships among adults with serious mental illness in California: impact on utilization and costs. Psychiatric Services, 65, 1120–1125. https://doi.org/10.1176/appi.ps.201300380
Gilmer, T. P., Henwood, B. F., Goode, M., Sarkin, A. J., & Innes-Gomberg, D. (2016). Implementation of integrated health homes and health outcomes for persons with serious mental illness in Los Angeles County. Psychiatric Services, 67(10), 1062–1067. doi https://doi.org/10.1176/appi.ps.201500092
Health Resources Service Administration: Retrieved from:https://data.hrsa.gov/tools/shortage-area/hpsa-find Accessed 6/23/2022
Kelly, E., Fulginiti, A., Pahwa, R., Tallen, L., Duan, L., & Brekke, J. S. (2014). A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. Community mental health journal, 50(4), 435–446
Macdonell, K., Christie, K., Robson, K., Pytlik, K., Lee, S. K., & O’Brien, K. (2013). Implementing family-integrated care in the NICU: engaging veteran parents in program design and delivery. Advancing Neonatal Care, 13(4), 262–269. doi: https://doi.org/10.1097/ANC.0b013e31829d8319
Manuel, J. I. (2018). Racial/ethnic and gender disparities in health care use and access. Health Services Research, 53(3), 1407–1429. doi: https://doi.org/10.1111/1475-6773.12705
Miles, M. B., & Huberman, A. M. (1994). Qualitative Data Analysis: An Expamded Sourcebook (2nd ed.). Thousand Oaks: Sage
Sunderji, N., Nicholas Angl, E., Polaha, J., & Gao, C. (2019). Why and how to use patient-oriented research to promote translational research
Ojeda, V. D., Hiller, S. P., Hurst, S., Jones, N., McMenamin, S., Burgdorf, J., & Gilmer, T. P. (2016). Implementation of Age-Specific Services for Transition-Age Youths in California. Psychiatric Services, 67(9), 970–976. doi: https://doi.org/10.1176/appi.ps.201500084
Ojeda, V. D., Munson, M. R., Jones, N., Berliant, E., & Gilmer, T. P. (2021). The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness. Administration and Policy in Mental Healthand Mental Health Services Research, 48(2), 290–298. doi: https://doi.org/10.1007/s10488-020-01073-8
Park-Lee, E., Lipari, R. N., Hedden, S. L., Kroutil, L. A., & Porter, J. D. (2012). 2017 Sep. CBHSQ Data Review. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). Receipt of Services for Substance Use and Mental Health Issues Among Adults: Results from the 2016 National Survey on Drug Use and Health
Siantz, E., Henwood, B., & Baezcondi-Garbanati, L. (2018). From physical wellness to cultural brokering: Unpacking the roles of peer providers in integrated health care settings. Community Mental Health Journal, 54(8), 1127–1135. doi: https://doi.org/10.1007/s10597-018-0320-2
Starks, S. L., Arns, P. G., Padwa, H., Friedman, J. R., Marrow, J., Meldrum, M. L., & Braslow, J. T. (2017). System transformation under the California Mental Health Services Act: Implementation of full-service partnerships in LA County. Psychiatric Services, 68(6), 587–595. doi: https://doi.org/10.1176/appi.ps.201500390
Substance Abuse and Mental Health Services Administration (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Retrieved from https://www.samhsa.gov/data/
Substance Abuse and Mental Health Services Administration, Racial. (2015). Ethnic Differences in Mental Health Service Use among Adults. HHS Publication No. SMA-15-4906. Rockville, MD: Substance Abuse and Mental Health Services Administration
Nadiya, Sunderji Allyson, Ion Annie, Zhu Athina, Perivolaris David, Rodie Benoit H., Mulsant (2019) Challenges in conducting research on collaborative mental health care: a qualitative study. CMAJ Open 7(2) E405-E414 /cmajo/7/2/E405.atom https://doi.org/10.9778/cmajo.20180172
Palinkas, L. A., Criado, V., Fuentes, D., Shepherd, S., Milian, H., Folsom, D., & Jeste, D. V. (2007). Unmet needs for services for older adults with mental illness: comparison of views of different stakeholder groups. The American Journal of Geriatric Psychiatry, 15(6), 530-540
Patton, M. Q. (2005). Qualitative research. In Encyclopedia of statistics in behavioral science. Hoboken: Wiley.
Report to the Governer and Legislature (Dec 2013). Sacramento, CA,Mental Health Services Oversight and Accountability Commission,
Tran, L. D., & Ponce, N. A. (2017). Who gets needed mental health care? Use of mental health services among adults with mental illness in California. California Journal of Health Promotion, 15(1), 36–45. https://doi.org/10.32398/cjhp.v15i1.1887
Villamil-Grest, C., Siantz, E., & Cederbaum, J. A. (2021). Behavioral health services use among racial and ethnic groups: Results from the California Health Interview Survey. Journal of Immigrant and Minority Health. 1-7. doi: https://doi.org/10.1007/s10903-021-01250-3
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Siantz, E., Hiller, S., Ojeda, V.D. et al. Barriers to Accessing Mental Health Care Under the Mental Health Services Act: A Qualitative Case Study in Orange County, California. Community Ment Health J 59, 381–390 (2023). https://doi.org/10.1007/s10597-022-01016-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-022-01016-7