Abstract
Objectives
To describe the current constraints, facilitators, and future prospects for addressing mental health and substance use (MHSU) concerns within sexual health clinics in two cities in British Columbia, Canada.
Methods
We conducted in-depth interviews with 22 providers (14 nurses, 3 physicians, 3 administrators, 2 other health professionals) from six sexual health clinics.
Results
Providers consistently affirmed that MHSU-related concerns co-occur with sexual health concerns among clients presenting to sexual health clinics. Three factors constrained the providers’ abilities to effectively address MHSU service needs: (1) clinic mandates or funding models (specific to sexually transmitted infections (STI)/HIV or reproductive health); (2) “siloing” (i.e., physical and administrative separation) of services; and (3) limited familiarity with MHSU service referral pathways. Mental health stigma was an additional provider-perceived barrier for sexual health clinic clients. The low barrier, “safe” nature of sexual health clinics, however, facilitated the ability of clients to open up about MHSU concerns, while the acquired experiences of sexual health nurses in counselling enabled clinicians to address clients’ MHSU needs. In response to this context, participants described actionable solutions, specifically co-location of sexual health and MHSU services.
Conclusion
Sexual health clinicians in British Columbia generally affirm the results of previous quantitative and client-focused research showing high rates of MHSU-related needs among sexual health clinic clients. Providers prioritized specific short-term (referral-focused) and long-term (healthcare re-organization, co-location of sexual and MHSU services) solutions for improving access to MHSU services for those using sexual health services.
Résumé
Objectifs
Décrire les contraintes, opportunités et les idées novatrices pour adresser les problèmes de santé mentale et de toxicomanie dans des cliniques de santé sexuelle dans deux villes de la Colombie-Britannique au Canada.
Méthodes
Nous avons effectué des entrevues en profondeur avec 22 professionnels de la santé (14 infirmières, 3 médecins, 3 administrateurs et 2 autres professionnels en santé) provenant de six cliniques de santé sexuelle.
Résultats
Les professionnels confirmaient que les problèmes de santé mentale et de toxicomanie surviennent de façon concurrente avec les problèmes de santé sexuelle parmi les usagers des cliniques de santé sexuelle. Trois facteurs contraignaient la capacité des professionnels à adresser efficacement les besoins en santé mentale et en toxicomanie des usagers : 1) le mandat ou le modèle de financement (mandat de clinique précis, traitant les ITS/VIH et la santé sexuelle); 2) le fait de travailler en isolation (la séparation physique et administrative des services); et, 3) le manque de connaissance pour l’aiguillage vers les services en santé mentale et de toxicomanie. Les professionnels ont aussi souligné que la stigmatisation des problèmes de santé mentale est un obstacle important pour les usagers des cliniques de santé sexuelle. Par contre, l’accessibilité et la nature « sécuritaire » des cliniques de santé sexuelle et l’expérience des infirmiers en counseling permettaient aux usagers de partager leurs préoccupations en matière de santé mentale et toxicomanie. Les professionnels ont suggéré des solutions réalisables, notamment, la cohabitation des services de santé sexuelle, de santé mentale et de toxicomanie.
Conclusion
Les professionnels en santé sexuelle de la Colombie-Britannique sont généralement en accord avec les résultats des études quantitatives antérieures et des études sur les usagers qui indiquent des taux élevés de besoins non comblés de santé mentale et toxicomanie parmi les usagers de cliniques de santé sexuelles. Les professionnels ont privilégié des solutions à court terme (l’aiguillage des usagers vers d’autres services) et à long terme (la réorganisation des services de santé, et la cohabitation des services de santé sexuelle, de santé mentale et de toxicomanie) pour améliorer l’accessibilité aux services de santé mentale et toxicomanie pour les usagers des services de santé sexuelle.
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Acknowledgements
We wish to thank the participants of this study, as well as Troy Grennan and Dean Mirau, who provided input on preliminary results and analyses.
Funding
This study was funded by The BC Centre for Disease Control Foundation for Public Health.
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Black, S., Salway, T., Dove, N. et al. From silos to buckets: a qualitative study of how sexual health clinics address their clients’ mental health needs. Can J Public Health 111, 220–228 (2020). https://doi.org/10.17269/s41997-019-00273-6
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DOI: https://doi.org/10.17269/s41997-019-00273-6
Keywords
- Sexual health
- Counselling
- Mental health services
- Mental health
- Public health
- Sexually transmitted diseases