Reducing the Impacts of Mental Health Stigma Through Integrated Primary Care: An Examination of the Evidence
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Reducing the Impacts of Mental Health Stigma Through Integrated Primary Care: An Examination of the Evidence Anderson B. Rowan1 · Jessica Grove1 · Lindsay Solfelt1 · Anna Magnante1 Accepted: 15 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The reduction of mental health stigma (MHS) was an expected benefit of integrating behavioral health in primary care (IPC). However, unlike other barriers discussed in agency reports on IPC, discussions of MHS lack research support. To fill this gap, the authors conducted a literature review identifying seven studies. Given the dearth of research, we also examine general IPC research on probable indicators of MHS reduction in IPC, as well as, facets of IPC potentially influencing MHS related factors negatively associated with help-seeking. Using the data from these three types of research, the evidence suggests the potential of IPC to reduce MHS impact on care utilization, but indicates it is premature to draw firm conclusions. Given the possible benefits of primary care and the known benefits of decreased MHS, this review highlights the importance of further research examining this question and provides specific research and program development recommendations. Keywords Integrated primary care · Stigma · Mental health · Behavioral health Mental health (MH) disorders affect nearly half (47%) of all Americans at some point in their lifetime (Kessler et al., 2007); however, approximately half of those with mental illness do not seek care (Mojtabai et al., 2011; Wang et al., 2005). The high utilization of primary care (PC) for MH care has resulted in PC becoming the “de facto mental health system” (Regier et al., 1993) with 43–60% of patients with psychological problems being seen solely in PC, whereas 17–20% are treated at specialty MH clinics (Kessler & Stafford, 2008). Additionally, only 13% of individuals seeking MH care in general medical services and only about half that are seen in specialty MH clinics receive minimum threshold levels of care (Wang et al., 2005). As a result of insufficient resources for delivering MH care, general medical providers * Anderson B. Rowan [email protected] Jessica Grove [email protected] Lindsay Solfelt [email protected] Anna Magnante [email protected] 1
School of Psychology and Counseling, Regent University, 1000 Regent University Dr, CRB 161, Virginia Beach, VA 23464, USA
have historically relied heavily on referrals to MH services. Of patients referred from PC to a MH clinic approximately 30–50% do not attend the first appointment (Fisher & Ransom, 1997). This suggests the presence of significant barriers affecting follow up with MH referrals. Of the many potential barriers to seeking MH care (Gulliver, Griffiths, & Christensen, 2010; Mojtabai et al., 2011), stigma has been one of the most studied, with literature reviews consistently demonstrating the negative effects of stigma on seeking MH care (Clement et al., 2015; Corrigan et al., 2000; Corrigan, Powell, & Michaels,
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