MENTAL HEALTH ACROSS CULTURES

ACCESS, TREATMENT ENGAGEMENT, AND STIGMA PROGRAM (MH ACCESS PROGRAM)

(Photo by Brett Zeck on Unsplash)

The majority of individuals with mental health needs do not access effective mental health treatment. Further, 20% to 70% of individuals who initiate mental health services disengage and discontinue treatment prematurely. Mental health interventions and services are likely to be ineffective with individuals who do not access, drop out of treatment prematurely, or fail to engage to intervention protocols. Despite annual investments of millions of dollars to develop and disseminate these interventions, nonengagement remains a significant threat to treatment effectiveness. Research has identified a range of attitudinal and structural barriers and promoters for individuals seeking and remaining engaged in treatment. Many of these treatment barriers and promoters are similar across cultures, while many more are entrenched in the culture that influences the help-seeking process and service utilization. Stigma and exclusion in all communities can often exert a destructive effect on the lives and functioning of people with mental health issues, including their recovery, functioning, and participation in society at large. A need exists for greater understanding and cultural sensitivity to identify specific experiences, attitudes, and perceptions regarding mental illness to deliver services more effectively to underrepresented and stigmatized populations.

The Mental Health across Cultures: Access, Treatment Engagement, and Stigma (MH Access) Program seeks to use scientific methods to research barriers, promoters, stigma, treatment beliefs, perceptions, and the varied formal and informal pathways to care across ethnic and cultural populations nationally and internationally, specifically in underserved communities. The investigations of this program will identify and develop common components of help-seeking and engagement strategies while examining specific culturally bound components that can be leveraged to improve access and engagement, as well as inform evidence-based mental health treatments to meet the unique needs of the community. Acknowledging health inequities, the MH Access Program includes a focus on strategies to resolve unequal access, engagement, and retention to mental health services across stigmatized and underrepresented populations.

MH ACCESS PROGRAM OBJECTIVES

• To increase mental health service access, delivery, and utilization for underrepresented racial, ethnocultural, and stigmatized populations both nationally and internationally

• To understand and develop strategies for positively addressing barriers and enhancing promoters to utilizing mental health services specific to racial, ethnocultural, and disenfranchised populations

• To identify and examine cultural perceptions, stigma, and patterns of service delivery, service utilization, and treatment engagement

• To develop and disseminate population-specific and generalizable strategies, knowledge, and interventions to engage and maintain individuals in mental health treatment, and improve outcomes and recovery.

MH ACESS PROGRAM CHAIRS

Dr. Kathryne B. Brewer
Dr. Brewer, LMSW is an Assistant Professor in the Department of Social Work at the University of New Hampshire. Her work focuses on the intersection of stigma and identity beliefs in help-seeking, resilience, and behavioral change; and the resulting implications for intervention research, program development, and policy change. Specifically, Dr. Brewer’s scholarship seeks to build our understanding of how to best leverage personal and public belief systems to promote help-seeking for behavioral health needs, sustained behavioral change, increased resilience and improved long-term outcomes, particularly for women and adolescents with heightened vulnerability due to marginalization. Her program of research includes two lines of inquiry. The first focuses on how helping professionals can leverage an individual’s self-perception by examining the mechanisms by which self-concept (self-stigma, identity beliefs, possible selves) translates into intentional self-regulation (goal-setting behaviors and skills) to support and strengthen resilience and to increase intrinsic motivation to change. Her second line of inquiry focuses on the larger socio-cultural context, examining how to best adapt evidence-based practices in light of public perceptions and attitudes toward behavioral health (public stigma, help-seeking norms) and of structural barriers (access to services, availability of resources).  

Dr. Robin E. Gearing
Dr. Gearing is a Professor of Social Work and the Director of The MH-RITES Research Center. Dr. Gearing’s research focuses on improving the mental health outcomes of adolescents and young adults with serious mental illnesses and their families. His research is driven by an interest in informing and improving engagement to empirically-supported psychosocial and medication treatment and developing evidence-based interventions. This interest is the result of more than 25 years of clinical work with youth, resulting in firsthand professional knowledge of the needs and gaps in the field. As a researcher, his areas of expertise are schizophrenia spectrum disorders, depressive disorders, and suicide intervention. Dr. Gearing’s work focuses on engagement with mental health services, including culturally informed adaptations of empirically-supported interventions. His research collaborations nationally and internationally concentrate on innovative strategies for treatment engagement, addressing mental health stigma, and facilitating service utilization. 

NATIONAL RESEARCH

Latin American identity (cultural or ethnic) Communities

Increasing Engagement, Breaking down Barriers, and Reducing Stigma around Service Utilization.
Researchers: R. Gearing (PI), K. Brewer, M. Washburn, and L. Torres

Research Objectives:
• To examine attitudes, experiences, and perceptions of people with Latin American identity (cultural or ethnic) toward mental illness, including stigma beliefs, treatment beliefs, and perceived barriers and promoters to access and engagement;

• To explore the impact of Latin American identity (cultural or ethnic) characteristics (e.g., gender, acculturation, religiosity, and education) on stigma;

• To investigate the differential impact of type of mental illness (depression, bipolar disorder, psychosis, suicide, and substance use), type of treatment (formal versus informal), and gender on stigma related to individuals with disorders.

Funding: NIDA-R24DA019798-08 - National Institute on Drug Abuse;
Small Grant Mechanism, University of Houston Drug Abuse Research Development Program II, 08/2016-09/2018

Photo by Andrew Butler on Unsplash

Latin American Health and Behavioral Health Services Utilization: A Mixed Methods Study Using Experimental Vignette Survey, Qualitative Methods, and Pilot Testing of an Electronic Fotonovela Intervention.
Researchers: S. Borja (PI), R. Gearing, M. Valdovinos, and L. Torres

Research Objectives:
• To examine attitudes, experiences, and perceptions of adult Hispanics toward diabetes, hypertension, obesity, and comorbid depression and anxiety;

• To identify barriers and promoters to Hispanic health services access and engagement;

• To engage community health clinic staff, patients and their natural supports in the planning, design, and production of electronic fotonovelas for a 6-week mobile-based intervention to increase engagement in post-hospitalization health services and improve symptom management and treatment adherence among adult Hispanics in Houston, TX.

Funding: 1W1CMS331632-01-00 - U.S. Department of Health and Human Services (DHHS), Centers for Medicare & Medicaid Services, Office of Minority Health Minority Health Research Program, 09/2018-08/2021

Indigenous Communities

Engaging Indigenous Populations in Health and Mental Health Services: Mental Health and Cultural Implications of Chronic Exposure to Environmental Changes.
Researchers: R. Gearing (PI) and S. Billiot

Research Objectives:
• In recognition of significant historical and environmental conditions, and the health and behavioral health inequalities, this research examines health and mental health issues and perceptions within indigenous populations to improve access and engagement to needed health and mental health services.

Funding: University of Houston Small Grants Program, 06/2019-09/2020

Jewish Communities

Enhancing and Improving the Engagement of Jewish Houstonians and Israelis in Mental Health and Suicide Treatment and Services.
Researchers: R. Gearing (PI), K. Brewer, D. Roe, and L. Smith

Research Objectives:
• To examine attitudes, experiences, and perceptions of Jewish Houstonians toward mental illness, stigma, treatment beliefs, and barriers and promoters to access and engagement;

• To investigate the differential impact of type of mental illness (depression, psychosis, and substance use), type of treatment (formal versus informal), and gender on stigma related to individuals with disorders;

• To investigate the impact of Jewish Houstonian demographic characteristics on stigma;

• To identify barriers and improve promoters to access and engagement in mental health treatment for Jewish Houstonians.

Funding: Stanford & Joan Alexander Foundation, and Harness Creek, 09/2018-09/2020

INTERNATIONAL RESEARCH

China

Engaging Chinese Individuals in Health and Mental Health Services
(中国人行为健康服务参与情况).
Researchers: R. Gearing, K. Brewer, P. Leung, M. Cheng, W. Chen, X. Li, and X. He

Research Objectives:
• To examine health (e.g., diabetes, etc.) and mental health (e.g., depression, trauma, psychosis, substances use, etc.), access to services, stigma, barriers to access and engagement, and promotors of access and engagement among Chinese people in the Shanghai region of China;

• To identify and promote effective strategies to engage Chinese people who need mental health support and services.

Funding: Shanghai University of Science and Technology (ECUST) Grant, 12/2017-06/2019

Photo by Nareeta Martin on Unsplash

Mexico

Engaging and Maintaining Latin American identity in Needed Mental Health Services: Examining Stigma, Barriers, and Facilitators.

Researchers: R. Gearing (PI), K. Brewer, M. Washburn, L. Torres, and P. de la Cruz

Research Objectives:
• To examine attitudes, experiences, and perceptions of Mexicans toward mental illness, stigma, treatment beliefs, and barriers and promoters to access and engagement;

• To explore the differential impact of type of mental illness (depression, bipolar disorder, psychosis, suicide, and substance use), type of treatment (formal versus informal), and gender on stigma related to individuals with disorders;

• To identify promoters and barriers to access and engagement of Mexicans to effective mental health treatment and services.

Funding: The Center for Mexican American Studies (CMAS), 06/2016-05/2018

Jordan

Community-Based Services and Interventions for Children and Adolescents in Jordan: Examining Community Intervention Strategies for Reducing Stigma.
Researchers: R. Gearing (PI), M. MacKenzie, C. Schwalbe, and K. Brewer

Research Objectives:
• To examine stigma and mental health attitudes toward institutional versus community-based approaches to child welfare and juvenile justice among adults across Amman, Jordan. This research supported efforts to develop sustainable and effective community-based alternatives to institutional care for children and adolescents in Jordan in partnership with UNICEF, NGOs, and the Ministry of Social Development (MOSD), the government agency responsible for the care of institutionalized children in Jordan.

Funding: The United Nations International Children's Fund (UNICEF), 08/2010-07/2014