Child trauma exposure (CTE) is an important public health concern in the U.S.; more than two-thirds of children report experiencing a traumatic event by the age of 16. CTE may have important acute and long-term physiological, developmental, behavioral, and psychological implications if not addressed. Trauma-focused cognitive behavioral therapy (TF-CBT) is the gold standard for treatment of child trauma and is well-supported for resulting in significant decreases in negative mental health outcomes associated with CTE. Despite the efficacy of evidence-based interventions such as TF-CBT, many children do not receive treatment due to a variety of contextual, logistical, and interpersonal barriers. This mixed-methods exploratory study examines possible predictors of enrollment and completion of TF-CBT, specifically parental trauma exposure, at a community organization that serves abused and traumatized children in the metro Atlanta area. Data were collected during individual assessments consisting of a computer survey and semi-structured interview (n=41). Data analysis focused on parental trauma exposure, and qualitative interviews were examined for common themes regarding intentions for their child’s enrollment and completion of services. Results indicated that caregivers of children referred to services had relatively high (56.1%) rates of trauma exposure. Results from logistical regression indicate that parents with a trauma history were 10.5 times more likely to have a child enroll in therapy. These results indicate that parents with personal trauma histories may be more committed to their child receiving services, therefore public health efforts aimed towards educating parents without trauma histories may be beneficial.

The enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 sought to eliminate longstanding discriminatory insurance practices against behavioral health disorders by requiring health insurers of large group plans to apply no more restrictive financial requirements and treatment limitations to mental health and substance use disorder benefits relative to those applied to medical/surgical benefits. Since the parity act went into effect in 2010, the prevalence of mental health conditions has continued to rise while the proportion of those seeking mental health services has remained stagnant. As a result, an increasing trend in the percentage of Americans with a perceived unmet need for behavioral health services has been observed over the past decade. Many of those with an unmet need for services cite an inability to afford the cost of care, no insurance/underinsurance, and/or lack of available behavioral health clinicians as some of the primary reasons for not obtaining wanted care. This suggests a disconnect exists between the policy and practice of parity that warrants further investigation. Understanding the history of behavioral health coverage and parity in the United States and the current structure of America’s health insurance system provides context for why healthcare reform legislations, like the MHPAEA, are necessary. Furthermore, dissecting the provisions and limitations of the MHPAEA and the Affordable Care Act’s impact on behavioral health parity exposes barriers that perpetuate the disconnect between policy and practice. The various barriers that continue to limit access to behavioral health care despite the MHPAEA will be evaluated to better understand why they exist and how they facilitate a persistent unmet need. Mental health in America is a critical medical and public health concern as the prevalence of poor mental health has continued to grow, especially amidst the COVID-19 pandemic. The shortcomings of current legislation and the mental health care delivery system need to be addressed to develop future legislation that can be better equipped to deliver true parity in practice.

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The mental health of healthcare workers during the Ebola outbreak in West Africa was a serious concern for healthcare professionals and the mental health field. One area in West Africa where healthcare workers played a significant role during the Ebola outbreak of 2014 and 2015 was Sierra Leone. This qualitative research study was designed to explore the perceptions of Sierra Leoneans healthcare workers' mental health, how they coped, and treatment they received while providing care for Ebola virus patients. This study, with a phenomenological research approach, used purposeful sampling to recruit 10 healthcare workers to participate in semi structured, open-ended interviews. The stress theory model and a hermeneutic phenomenology conceptual framework were used as a lens of analysis to understand the views of healthcare workers who worked directly with Ebola virus patients in Freetown, Sierra Leone. The results of the analysis of the collected data produced 9 major themes. The major themes suggest that healthcare workers experienced mental health symptoms such as depression and anxiety, personal thoughts and feelings such as insomnia, and suicidal ideation. Strategies for coping included using the Bible; and the detrimental impact included facing discrimination after the Ebola outbreak. Most of the healthcare workers blame the government for not providing adequate coping resources, which led to the personal consequence of hopelessness. This study may benefit mental health professionals working in an epidemic. Additionally, this study may contribute to social change by providing a deeper understanding of the mental health system and healthcare workers in Freetown, Sierra Leone.

BACKGROUND: Women in Pakistan experience a high prevalence of depression; yet make negligible use of mental health services. Information about the barriers and facilitators to mental health services for women is scarce. The present study explored the barriers and facilitators in accessing mental health services and potential strategies to increase the access for women in Karachi. METHODS: A qualitative study was conducted with the help of 78 interviews. Women from primary care were screened for depression and thirty in-depth interviews were conducted with those who were not accessing mental health services. Twenty-nine interviews were conducted with women accessing mental health services for depression at mental health clinics. Nineteen key informant interviews were conducted with various stakeholders. Interviews were transcribed verbatim and coded for thematic analysis. RESULTS: Themes elicited were categorized into family and household, health services, and socio-cultural levels. At family and household level, lack of awareness, normalization of depression, lack of empowerment, burden of looking after children and threats of divorce discouraged women from seeking professional care. Stigma, discouragement to seek mental health care and religious interpretations of depression were reported as broader socio-cultural issues, driving many to visit faith healers instead. Gaps in medical education, general practitioners’ case overload, and poor quality of health care, gender bias, poor resource allocation and dearth of referral systems were highlighted as barriers at health services level. For facilitators themes of awareness, concern for children, the severity of the symptoms, family support, receiving a referral, affordability and organizational support were identified as factors that enabled women to access services. Both women and key-informants suggested that providing community-based interventions could be a viable option to increase the access. CONCLUSION: Study findings suggest that providing mental health services in communities, and reforming medical education through the training of health workers can improve access to mental health services for women. An intervention is proposed to provide mental health services through community based lady health workers in Karachi. This may provide more accessible, and potentially cost effective, mental health services to better address the mental health needs of the population. / 2018-12-08T00:00:00Z