Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.
Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium.
Int J Equity Health. 2020 Sep 29;19(1):169. doi: 10.1186/s12939-020-01287-0.
An unmet mental health need exists when someone has a mental health problem but doesn't receive formal care, or when the care received is insufficient or inadequate. Epidemiological research has identified both structural and attitudinal barriers to care which lead to unmet mental health needs, but reviewed literature has shown gaps in qualitative research on unmet mental health needs. This study aimed to explore unmet mental health needs in the general population from the perspective of professionals working with vulnerable groups.
Four focus group discussions and two interviews with 34 participants were conducted from October 2019 to January 2020. Participants' professional backgrounds encompassed social work, mental health care and primary care in one rural and one urban primary care zone in Antwerp, Belgium. A topic guide was used to prompt discussions about which groups have high unmet mental health needs and why. Transcripts were coded using thematic analysis.
Five themes emerged, which are subdivided in several subthemes: (1) socio-demographic determinants and disorder characteristics associated with unmet mental health needs; (2) demand-side barriers; (3) supply-side barriers; (4) consequences of unmet mental health needs; and (5) suggested improvements for meeting unmet mental health needs.
Findings of epidemiological research were largely corroborated. Some additional groups with high unmet needs were identified. Professionals argued that they are often confronted with cases which are too complex for regular psychiatric care and highlighted the problem of care avoidance. Important system-level factors include waiting times of subsidized services and cost of non-subsidized services. Feelings of burden and powerlessness are common among professionals who are often confronted with unmet needs. Professionals discussed future directions for an equitable mental health care provision, which should be accessible and targeted at those in the greatest need. Further research is needed to include the patients' perspective of unmet mental health needs.
当一个人有心理健康问题但未接受正规护理，或接受的护理不足或不充分时，就存在未满足的心理健康需求。流行病学研究已经确定了导致心理健康需求未得到满足的结构性和态度性障碍，但已有的文献综述表明，在未满足的心理健康需求的定性研究方面存在差距。本研究旨在从为弱势群体服务的专业人员的角度探讨普通人群中未满足的心理健康需求。
2019 年 10 月至 2020 年 1 月，在比利时安特卫普的一个农村和一个城市初级保健区，对 34 名参与者进行了 4 次焦点小组讨论和 2 次访谈。参与者的专业背景包括社会工作、精神卫生保健和初级保健。使用主题指南来提示讨论哪些群体有较高的未满足的心理健康需求以及原因。使用主题分析对转录本进行编码。
出现了 5 个主题，这些主题又细分为几个子主题：（1）与未满足的心理健康需求相关的社会人口决定因素和障碍特征；（2）需求方障碍；（3）供应方障碍；（4）未满足的心理健康需求的后果；（5）满足未满足的心理健康需求的建议改进。
流行病学研究的发现得到了广泛证实。还确定了一些其他具有较高未满足需求的群体。专业人员认为，他们经常遇到复杂到无法接受常规精神科护理的病例，并强调了回避护理的问题。重要的系统层面因素包括补贴服务的等待时间和非补贴服务的费用。专业人员经常面临未满足的需求，他们普遍感到负担过重和无能为力。专业人员讨论了公平提供精神卫生保健的未来方向，该方向应具有可及性，并针对最需要的人。需要进一步研究，以纳入患者对未满足的心理健康需求的看法。
