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心理健康治疗的可及性:经验、假设与公众意见

Mental Health Treatment Access: Experience, Hypotheticals, and Public Opinion.

作者信息

Haselswerdt Jake

机构信息

Truman School of Government and Public Affairs, University of Missouri.

出版信息

Milbank Q. 2025 Mar;103(1):100-129. doi: 10.1111/1468-0009.12726. Epub 2024 Dec 24.

Abstract

UNLABELLED

Policy Points Policymakers should consider both material (e.g., cost) and attitudinal (e.g., skepticism) barriers to mental health treatment access. Public support for government action on mental health is high but varies based on experience-based and hypothetical beliefs about barriers to treatment. Appeals to personal experience and perspective-taking may be successful in building support for government action on mental health.

CONTEXT

Mental health problems represent a major public health issue for the United States, and access to mental health treatment is both inadequate and unevenly distributed. There is a strong justification for government action on mental health treatment, but it is unclear whether there is a political constituency for such action. Existing work suggests that stigma and othering of people with mental illnesses contributes to reduced support for intervention. I expand on the existing literature by focusing on mental health as an issue that may apply to Americans' own lives rather than only to a stigmatized outgroup.

METHODS

Using original questions on a nationally representative 2023 survey of 1,000 American adults, I measured agreement with statements about barriers to mental health treatment access that respondents have experienced or, if they have not sought treatment, their hypothetical assessment of these barriers. I also measured their support for statements in favor of change to address mental health. I analyzed the demographic and political correlates of agreement with the barrier statements and used regressions to examine their possible causal effect on support for change.

FINDINGS

Agreement with statements about access barriers follows expected patterns in some cases (e.g., socioeconomic status) but not in others (e.g., race/ethnicity). I also documented a notable partisan and ideological divide in these experiences and beliefs. I found that Americans who agreed that material factors are a barrier to access were more supportive of action on mental health, whereas those who agreed with statements suggesting discomfort or skepticism were less supportive.

CONCLUSIONS

These findings suggest that personal experience and perspective-taking should be integrated into the study of public opinion on mental health, complementing existing work on stigma and othering. Appeals to experience and perspective-taking may be a successful strategy for building public support for action on mental health.

摘要

未加标注

政策要点 政策制定者应考虑心理健康治疗获取方面的物质(如成本)和态度(如怀疑)障碍。公众对政府在心理健康方面采取行动的支持度很高,但会因基于经验和对治疗障碍的假设性信念而有所不同。诉诸个人经验和换位思考可能会成功地为政府在心理健康方面的行动赢得支持。

背景

心理健康问题是美国的一个重大公共卫生问题,获得心理健康治疗的机会既不足且分布不均。政府有充分理由在心理健康治疗方面采取行动,但尚不清楚是否存在支持此类行动的政治选民群体。现有研究表明,对精神疾病患者的污名化和区别对待导致对干预措施的支持减少。我通过将心理健康视为一个可能适用于美国人自身生活而非仅适用于被污名化的外部群体的问题,对现有文献进行了拓展。

方法

利用2023年对1000名美国成年人进行的具有全国代表性的调查中的原始问题,我衡量了受访者对关于他们所经历的心理健康治疗获取障碍陈述的认同程度,或者,如果他们没有寻求过治疗,衡量了他们对这些障碍的假设性评估。我还衡量了他们对支持变革以解决心理健康问题陈述的支持度。我分析了与障碍陈述认同度相关的人口统计学和政治因素,并使用回归分析来检验它们对变革支持度可能产生的因果效应。

研究结果

在某些情况下(如社会经济地位),对获取障碍陈述的认同遵循预期模式,但在其他情况下(如种族/族裔)则不然。我还记录了在这些经历和信念中存在明显的党派和意识形态分歧。我发现,那些认同物质因素是获取障碍的美国人对心理健康行动的支持度更高,而那些认同表明不适或怀疑的陈述的人支持度较低。

结论

这些发现表明,个人经验和换位思考应纳入对心理健康方面公众舆论的研究中,以补充现有的关于污名化和区别对待的研究。诉诸经验和换位思考可能是为心理健康行动赢得公众支持的成功策略。

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