Faculty of Education, University of British Columbia, 2125 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Can J Public Health. 2020 Apr;111(2):220-228. doi: 10.17269/s41997-019-00273-6. Epub 2020 Jan 31.
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.
We conducted in-depth interviews with 22 providers (14 nurses, 3 physicians, 3 administrators, 2 other health professionals) from six sexual health clinics.
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.
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.
描述加拿大不列颠哥伦比亚省两个城市的性健康诊所解决心理健康和物质使用（MHSU）问题的当前限制因素、促进因素和未来前景。
我们对来自六个性健康诊所的 22 名提供者（14 名护士、3 名医生、3 名管理人员、2 名其他卫生专业人员）进行了深入访谈。
提供者一致认为，在向性健康诊所就诊的客户中，MHSU 相关问题与性健康问题同时存在。有三个因素限制了提供者有效满足 MHSU 服务需求的能力：（1）诊所任务或资金模式（特定于性传播感染（STI）/艾滋病毒或生殖健康）；（2）服务的“隔离”（即物理和行政分离）；（3）对 MHSU 服务转介途径的熟悉程度有限。心理健康污名是性健康诊所客户的另一个提供者认为的障碍。然而，性健康诊所的低障碍、“安全”性质促进了客户公开谈论 MHSU 问题的能力，而性健康护士在咨询方面的经验使临床医生能够满足客户的 MHSU 需求。针对这种情况，参与者描述了可采取的解决方案，特别是性健康和 MHSU 服务的共同定位。
不列颠哥伦比亚省的性健康临床医生普遍肯定了先前的定量和以客户为中心的研究结果，这些研究表明，性健康诊所客户中存在高比例的 MHSU 相关需求。提供者优先考虑具体的短期（以转介为重点）和长期（医疗保健重新组织、性健康和 MHSU 服务的共同定位）解决方案，以改善使用性健康服务者获得 MHSU 服务的机会。
