A new study finds that people who independently seek mental health care are more likely to rate their treatment as effective, compared to those ordered into care.

Researchers from Lehigh University in Pennsylvania looked at data from the 2010-2014 National Survey on Drug Use and Health (NSDUH) to better understand how individuals enter mental health care — via individual choice or coercion — and whether or not that path is associated with how the patient perceives the care.

Coercion into mental health care occurs when people are required to get care regardless of their own choice. The findings show that patients who are pressured by family members (informal coercion) or legally coerced into care by court order (formal coercion) are both entering mental health care outside of their own will, and both of these tend to have a negative effect on the patient’s perception of care.

The findings suggest three important points:

  • demographic and socioeconomic characteristics shape how one enters mental health care and the perceptions of the effectiveness of treatment;
  • the pathway to mental health care is to perceptions of the effectiveness of treatment;
  • the severity of a mental illness impacts the strength of the relationship between the pathway to care and the perceived effectiveness of treatment.

Researcher Dr. Sirry Alang, an assistant professor of sociology and anthropology at Lehigh, said “social characteristics associated with social status shape whether one chooses to receive care, was pressured by others, or was ordered into care.”

According to the findings, patients ordered into mental health care are more likely to be African-American and Latino compared to persons who entered care independently. Those who reported being ordered into care also face greater socioeconomic disadvantages including lower educational attainment and high unemployment rates than those who entered into care independently.

According to Alang, “our finding that whites, persons with a college degree, and persons who were employed were less likely to enter into care as a result of an order suggests that pathways into care might reflect positions within the social hierarchy.”

People who independently sought mental health care were more likely to rate treatment as effective compared to those ordered into care.  In addition, patients who perceived treatment or counseling as effective were also more likely to rate their overall health as good, and were less likely to have a substance use problem or severe mental illness in the past year.

Overall, the researchers found that positive outcomes are more likely to occur when people enter care on their own or through encouragement from peers rather than being ordered into care.

Among those with severe mental illness, the probability of rating treatment as effective is lowest among those ordered into care.

“Our study shows that severe mental illness was associated with a 29 percent increase in the probability of being ordered into care compared to seeking care independently,” Alang said.

In the absence of a severe mental illness, Alang said the predicted probability of rating treatment as effective is 9 percent higher if entry to care was independent rather than if individuals were ordered to seek care.

Alang and her co-author suggest implementing programs that promote self-entry into care as empowering is important. “This is particularly relevant for Blacks, Latinos, young persons between 18 and 34, and persons without a high school education who are disproportionately coerced into care,” they write.

The findings are published online in the journal Society and Mental Health.

Source: Lehigh University