(023) Perceived Barriers to Outpatient Mental Health Access in Hospitalized Traumatically Injured Patients

Abstract:

Background: Approximately 20-30% of patients hospitalized after physical injury develop post-traumatic stress disorder (Zatzick, 2007). The University Medical Center New Orleans (UMCNO) Level 1 Trauma Center screens every admitted trauma patient for referral to the Trauma Recovery Clinic (TRC) which provides psychiatric, psychological, and psychosocial care. The purpose of this study is to assess the prevalence of stigma and logistical obstacles as barriers to accessing outpatient mental health services for patients hospitalized for traumatic injuries.

Methods: We conducted an observational study of patients referred to TRC from October 2020 to May 2021. Prior to discharge, consented patients completed the Perceived Stigma and Barriers to Care for Psychological Problems (PSBCPP) Scale which contains 11 items regarding stigma and logistical obstacles limiting access to mental health care (Britt, 2008). Likert scale scores (1-5) were computed for each subscale per participant, with one stigma score and one obstacle score. Scores were treated as continuous variables in subsequent analyses.

Results: Data were collected from a total of 80 participants. No difference was observed in the obstacles or stigma subscales according to race (p=0.44, p=0.13 respectively) or gender (p=0.84, p=0.73 respectively). Of 80 total participants, 27.5% indicated “strongly agree” or “agree” for items “I don’t have adequate transportation” and “Getting treatment costs too much money”. Twenty-five percent indicated “strongly agree” or “agree” for the item “I don’t know where to get help.”

Discussion: Barriers did not significantly differ between gender or among racial groups. One in four participants agreed that logistical obstacles (lack of transportation, treatment cost, and not knowing where to get help) limited access to care. Stigma was not typically reported as a barrier, despite stigma being reported in the literature as a significant factor preventing care-seeking behaviors (Williamson, 2019).

Conclusion: Positive deviance from stigma as a traditional barrier constitutes a critical shift in cultural paradigms and should be explored further to understand the mechanisms of this change. Future interventions should center around addressing logistical concerns of patients. UMCNO is a safety net hospital treating low-income, Medicaid or non-insured patients. As Medicaid does provide transportation and payment for treatment, this suggests that further exploration regarding patient knowledge of services is needed to facilitate access to mental health services.

References:
Britt TW, Greene-Shortridge TM, Brink S, et al. Perceived Stigma and Barriers to Care for Psychological Treatment: Implications for Reactions to Stressors in Different Contexts. Journal of Social and Clinical Psychology. 2008;27(4):317-335.

Williamson V, Greenberg N, Stevelink SAM. Perceived stigma and barriers to care in UK Armed Forces personnel and veterans with and without probable mental disorders. BMC Psychology. 2019;7(75).

Zatzick DF, Rivara FP, Nathens AB, et al. A nationwide US study of post-traumatic stress after hospitalization for physical injury. Psychological Medicine. 2007;(37):1469-1480.