1Factors Influencing Individuals Decision to Utilize Mental H.docx

1
Factors Influencing Individuals' Decision to Utilize Mental
Health in South Texas
Submitted by
James Dada
A Dissertation Presented in Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy
Grand Canyon University
Phoenix Arizona
March 25, 2020
Chapter 2: Literature Review
Introduction
Hester (2017) noted that there is a huge gap between
patients experiencing mental health illnesses and individuals
who access treatment in the United States. As a result, there is
the need to identify the factors that influence individuals to
seek or not to utilize or not to utilize mental health services.
Kohn et al., (2018) expressed the need for more studies to
establish why people suffering from mental illnesses avoid
getting treatments. Platt, Wolf & Scheitle, (2018) suggested that
more studies need to be conducted to determine why individuals
decide to utilize or reject mental health services. This study
aims to evaluate the factors influencing an individuals' decision

to utilize or reject mental health services in South Texas.
Background of the Problem
Sampogna et al., (2017), found that mental health is one of
the major public health concerns in the United States. However,
there is a considerable gap in research as to why people utilize
or reject the treatment of mental health. According to Stanley,
Hom & Joiner, (2018) there are numerous factors that influence
people to utilize mental health services. Additionally, Irteja et
al., (2020), indicated the need for more studies to be conducted
to establish the factors that influence people to seek mental
health services.
This problem has a long history In the United States dating
back to when mental health services were established in the
country (Calear et al., 2017). A lot has been done over the years
to encourage individuals to utilize mental health services. Most
notable, mental health America was established in 1909n to help
address major mental health issues at the time including
schizophrenia, bipolar disorder, and Dementia (Chang & Biegel,
2018). Historically, mental health was described as mental
hygiene, a term used since 1843. At the time research indicated
that mental hygiene would work best through religion, culture,
and education (Chang & Biegel, 2018).
Theoretical Foundations/Conceptual Framework and Review of
the Literature/Themes
Theoretical literature
Social cognitive theory is used to address the gap
identified in this research. According to Kohn et al., (2018),
social cognitive theory can be applied to encourage people
experiencing mental health problems to utilize mental health
services. This theory describes how individuals believes and the
environment influence people’s behaviors. The theory holds that
people’s believes affect how people behave. The theory
suggests that people need to have the skills to be able to
perform some behaviors. Regarding utilization or rejection of
mental health services, behavioral capability can help people to
change their intentions and behaviors.

Literature Themes
Various themes were identified in the literature review
including
Mental Health Infrastructure Comment by Dr. Seymour: Good
job James.
This section is now done.
You can repeat the process for the next section and submit one
more section for me to check on. Then you’ll be ready to do the
rest on your own.
Excellent work,
Dr. Seymour
This involves mental health workers including
psychiatrists, counselors, psychiatric nurses, and psychologists
(Anderson, 2018). Over the past few years, the US health sector
has experienced various challengers due to the lack of enough
health professionals. This increases the challenges of
encouraging people to utilize mental health. In addition,
individuals residing in remote areas are unable to access mental
health care because they are scarce. The following articles
conducted studies on the infrastructure. For example, there is an
overall lack of infrastructure (Andreucci, Russo & Olszewska-
Guizzo , 2019) and this leads to less than half of those in need
having access (Cummings et al., 2017). When researchers look
for specific issues with infrastructure the issues of hiring, space
(National Academies of Sciences, Engineering, and Medicine,
2018), and lack of youth services are noted (Cummings et al.,
2016).
Andreucci, Russo & Olszewska-Guizzo (2019) noted that mental
health is a significant health problem in the US. They collected
data from 14 studies using systematic review methods. They
analyzed their data using meta-analysis. Overall, they found
that poor infrastructure made it difficult to address the problem.
The study suggested that creating an urban environment can

help address the issue. Indeed, this lack of infrastructure means
that more than half of the people suffering from mental health
issues in the United States are unable to access mental health
services (Cummings et al, 2017). Cummings et al.’s (2017)
study was conducted using national data on mental health
treatment resources availability from 2013 to 2015. Data was
obtained from the Substance Abuse and Mental Health Services
Administration (SAMHSA) Behavioral Health Treatment
Services Locator. They found that 42.5% (3382 of 7959) of
communities in the highest income quartile had specialty mental
health treatment resource vs 23.1% (1841 of 7959) of
communities in the lowest income quartile. This lack of
infrastructure has significant consequences.
National Academies of Sciences, Engineering, and Medicine,
(2018) (NASEM) collected data from 9,986 facilities using
meta-analysis methods. They analyzed their data using content
analysis. They found that mental health professionals hire a
wide range of mental health professionals including care
navigators, peer specialist, therapists, social workers and
psychiatric nurses. However, lengthy hiring process and
problems to do with retention have significantly contributed to
shortage of mental health professionals. In addition, NASEM
(2018) reported that some locations do not have enough
physical space needed to fill some vacancies and consequently
accommodate all their clients. In addition, infrastructure
problems include a lack of mental health specialists for youth.
Cummings et al., (2016) collected data from the 2008 National
Survey of Mental Health Treatment Facilities. They analyzed
their data using content analysis. They found that there is poor
specialist treatment infrastructure for youth with mental health
illness in the US (Cummings et al., 2016). Thus, there are
several aspects that result in a lack of providers.
In addition to lack of providers, there are also problems with
where the facilities are located. Kilbourne et al., (2018) that
reported that people from poor communities are unable to
access mental healthcare services due to distance and their

social economic status. This study included 123 participants and
used a qualitative interview format to collect reasons for lack of
services. Themes included travel time, social economic status,
and lack of enough mental health professionals. In summary,
there are many problems with the infrastructure including
number of providers, hiring and retention of providers, and
location of providers.
Synthesis. There are several studies that have convergent
findings regarding the current factors influencing the utilization
of mental health including Hester (2017) systematic review, and
the Kohn et al., (2018) large national survey. Areas of
convergence (similar findings) are that the main factors
affective individual’s decisions to utilize mental health include
distance, socioeconomic status and space for healthcare
facilities. That is these studies found similar things including:
poor utilization of mental health in poor communities and lack
of finances to access mental health services. They found some
divergent findings such as increased utilization of mental health
among women as compared to men.
They were strong because of their large numbers and
geographic reach. This study had many strengths including it
created openness and provided detailed information about
people attitudes, feelings and behaviors. Limitations were
reported including small sample size (REFS) and AUTHOR
(year) reported researcher bias. They were limited by the
inability to gain context on the survey numbers they were
collecting. There are several empirical studies reviewed
regarding the integration of mental health in schools including
Andreucci, Russo & Olszewska-Guizzo (2019), Anderson,
(2018), and Kohn et al.( 2018). Some were limited by small
sample sizes Calear et al., (2017). Comment by Dr. Seymour:
Put the references of WHICH studies were strong. Not all of
them were. Comment by Dr. Seymour: Again, references
needed. Comment by Dr. Seymour:
Additional articles not in the above section speak to these
issues. For example Wang, & Xie, (2019) found that most

regions have developed infrastructure for the provision of
mental health services similar to the Hester (2017) study
reviewed here. Another study by Chang & Biegel, (2018), found
that women are more likely to utilize mental health services as
compared to men. Another study by (Anderson, 2018) was
divergent/ different in that it focused on ethnicity instead on
gender and found that people from minority groups are less
likely to access mental health services as compared to people
from major communities. Comment by Dr. Seymour: You
can leave this section here, but it should not be included in
future synthesis. It is actually advised for a different university
that is not as stringent as GCU. Sorry.
Synthesis.
Synthesis rough example JUST TO GIVE YOU AN IDEA:
There are several studies that have convergent findings
regarding the current mental health situation in schools
including AUTHOR, YEAR crime study, and the AUTHOR
YEAR large national survey. Areas of convergence (similar
findings) are: xxxxxx That is these studies found similar things
including: xxxx. They found some divergent findings (different
things) such as xxxxxxx.
They were strong because of their large numbers and geographic
reach. This study had many strengths including xxxxx.
Strengths should be noted everywhere they can apply to an
article. Limitations were reported xxxxx. They were limited by
the inability to gain context on the survey numbers they were
collecting. There are several empirical studies reviewed
regarding the integration of mental health in schools including
AUTHOR YEAR about xxxx, AUTHoR YEAR about xxxxx,
AUTHOR YEAR about xxxx. Some were limited by small
sample sizes including author year and author year.
Additional articles not in the above section speak to these
issues. For example REF found XXX similar to the REF study
reviewed here. Another study by xxx found that xxxxx. Another

study by xxx was divergent/different in that it focused instead
on xxxxxx and found xxxxx.
Literature. There were three studies investigating the prevalence
of spotted fish. The first collected 259 in person interviews
about people’s memories of fish they’ve seen throughout their
lifetime. Thematic analysis found two themes that people didn’t
remember well and two that almost all fish had been spotted.
The second study collected 3029 direct observations of fish in
an aquarium and found that a statistically significant amount at
the p< .001 level were spotted. The final study surveyed people
on the internet and asked them to count how many fish were in
their tank and what portion were spotted. An ANOVA found a
statistically significant difference between men and women,
indicating that men had more spotted fish at the p >.05 level.
Overall, the findings provide convergent evidence that most fish
are spotted, but the final study provided some divergent
evidence indicating that women may have fewer spotted fish
than men. Overall, the evidence seems clear that most fish are
spotted. Comment by Dr. Seymour: Silly example so that you
know how to write up the articles as a whole.
Synthesis. There are several studies that cover a wide array of
the influence of police education and accountability on use of
force and related outcome measures. These include Stickle’s
(2016) police education and training study, Wetherington’s
(2018) police pre-employment standards study, Shjarback’s
(2015) police early warning system study, Huff et al.’s, (2018)
and Donner’s (2018) research on police officer misconduct.
There is some convergence in the findings of Stickle (2016) and
Huff et al., (2018). That is these studies found increased
education and training are associated with decreased use of
force and reported misconduct. Divergent findings included
Wetherington’s (2018) research showing increased education
had no association with police disciplinary problems. There is
also some disagreement between Huff et al.’s, (2018) findings
that early warning systems were one of many elements reducing
police misconduct while Shjarback (2015) finding no effect of

the system’s on rates of complaints. A unique finding in this
series is Donner’s (2018) significant and positive correlations
between previous misconduct and future misconduct.
Most of the studies on this topic were not strong indicators of
the effect of police education and accountability on use of force
or related outcome measures. For instance, Stickle (2016)
correlated archival survey data with use of force complaints
which are not an accurate measure of the rate of incidents or
their justification. Another example is found in Huff et al.,
(2018) who’s results are overly broad in identifying a long list
of elements which appeared to be associated with reduced
complaints. However, both Stickle (2016) and Huff et al.,
(2018) used large sample sizes which increased their power. The
strongest of the studies reviewed is Shjarback (2015) who used
a pre/posttest design to determine the effect of early warning
systems on rates of force. Many of the authors intimated a need
for stronger measures and methodologies in research
accountability or hiring standards (Huff et al., 2018; Shjarback,
2015).
Follow these steps:
1. Finding research that goes under those subheadings.
2. Writing up each article as an annotated bibliography FIRST –
later you will pull them together and synthesize them.
Each Annotation includes: type of study, number of
participants, what data was collected, how it was analyzed,
several sentences about the findings with specific numbers and
themes reported, limitations.

3. Group articles together into paragraphs if they go together
with transition sentences --- add topic sentences and summary
sentences for every paragraph.
4. SYNTHESIS paragraphs at end of subsection that lists,
compares, contrasts, similarities noted, all of the articles in that
section. See example.
INTRODUCTIONS- now that you know about the whole
subsection go back and write a short introduction to each
subsection. This is required by the rubric.
You need 50 articles (2014 or later), 25% can be older.
You need 30+ pages.
Introductions to Sections
Example: The articles include in this section are on several
subtopics including xxxxxx (REFSSS), xxxx (REFS), and xxxx
(REFS). Some articles about jumping beans focused on how
high they jump (refs, ref, refs), while other articles focused on
the colors of the jumping beans (refs, refs, refs). In the first
subsection(IF YOU HAVE SUBSECTIONS IN A BIG
SECTION< YOU MIGHT NOT) called xxxxx, there are three
articles about xxxxxx and xxxx (Ref, Ref, Ref). In the second
subsection called xxxx, there are six articles about xxxx, xxxx
and xxxx (Ref, Ref, Ref). Comment by Dr. Seymour: Read
the synthesis of this section
Write a 3-4 sentence introduction to the research in this
section.
Use the general idea in this introductory sentence I wrote.
Include ALL subheadings in the section.
Be sure to reference EVERY article from the section at least
once.
Reasons for Lack of Access to Mental Health
According to (Kohn et al., 2018) there are numerous
factors that have been identifies as the reasons why people are

unable to access mental health services. Lack of insurance is
one of the reasons why people cannot access these services.
Poor socioeconomic status particularly for families in rural
areas makes it difficult for them to access mental health
services. Distance has also been found to be another reason as
to why people are unable to utilize these services (Kohn et al.,
2018).
In the United States, 42% of the population believe that
cost and poor insurance coverage are the top barriers that
prevents them from accessing mental health care (Kohn et al.,
2018). While only 25% reported that they make decisions
between using mental health treatment or paying for daily
necessities (Calear et al., 2017). Getting face-to-face services
remains a top priority for many Americans who are seeking
mental health treatment than getting access to medication.
Approximately 38% of Americans, or 96 million, on several
occasions have waited longer than a week for mental health
treatment services. Distance is another barrier in that about 46%
of the population have experienced or knew someone who has
had to travel for over one-hour roundtrip to seek treatment
(Calear et al., 2017).
Although many Americans have tried seeking mental
health treatment, in addition to the 29% of the population who
want to; however, failed to seek the treatment for either
themselves or loved ones due to lack of knowing where to go
for the services. Statistics also indicate that 21% of adults in the
US have tried to see a professional but were unable to do so
because of reasons outside of their control (Calear et al., 2017).
Populations that Use Mental Health Services
According to (Kohn et al., 2018),Numerous studies
indicate that women are at a higher risk of developing mental
health issues due to drug abuse and sexual abuse, As a result, a
high number of women seek mental health services as compared
to their male counterparts.
Populations that Reject Mental Health services
Calear et al., (2017) noted that people from minority

groups have been found to be the people who fail to utilize
mental health services. Asian women have particularly been
linked to lower utilization of mental health in the country.
People who do have Access to Mental Health
According to Calear et al., (2017), Medicaid, Medicare,
Obamacare started covering mental health care after the
implementation of the Affordable Care Act. The shortage of
healthcare professionals means they are not willing to
participate in treating insured patients because the payments are
too low.
Populations that Use Mental Health Services
Chang & Biegel, (2018), in their research found out that
women who had been exposed to sexual abuse and drug abuse
formed the high numbers of people who utilize mental health
services among the Hispanic and non-white people in the
county.
Reasons for Use of Mental Health Services
Calear et al., (2017) reported that behavioral health
treatment, such as psychotherapy and counseling. Mental and
behavioral health inpatient and outpatient treatment services
(Hester, 2017). Substance use disorder (commonly known as
substance abuse) treatment (Wang, & Xie, 2019).
Reasons for Rejection of Mental Health Services
According to Wang, & Xie, (2019), 31% of Americans are
worried about being judged for seeking mental health services,
and 21% of the population, have lied to people about seeking
mental health services. The stigma is accurate among young
Americans, who of course worried of being judged by others
when they confess of seeking mental health services (Wang, &
Xie, 2019).
Advancing Scientific Knowledge and Significance of the Study
This study will help in addressing the existing gap in
literature concerning utilization of mental health services in US.
The study will significantly provide insights as to why
individuals reject or utilize mental health services. The study
will also narrow down to certain factors that hinder people from

utilizing mental help despite those services being accessible. In
addition, the study will provide important background
information for defining the problem and addressing issues
associate with lack of utilizing mental health services
(Anderson, 2018).
The results will help mental health providers with
significant knowledge to help them determine effective
strategies in encouraging individuals to seek mental health
services. The information obtained will be used by healthcare
professionals for mental healthcare promotion. The findings of
this study will also be important for social workers helping
mental health patients cope with their situations in the
community setting. In addition, the study will provide insights
on how social cognitive theory may be used to help in
promoting mental health. This is especially important
considering the increased cases of individual with mental
illnesses failing to utilize these services (Chang & Biegel,
2018).
Rationale for Methodology
This study utilized qualitative methodology to solve the
problem identified. This methodology was selected because it
allows researchers to evaluate feelings and believes of the study
subjects. It also helps the subjects of the study to provide
responses based on their personal experiences. In addition, this
approach reduces the researcher’s biasness increasing the
reliability of the findings obtained. It is appropriate for
answering the research questions that ask about the reasons that
contribute to mental health patients to accept or reject treatment
because it provides primary verbal data that is collected in
detail (André et al., 2017).
Nature of the Research Design for the Study
A descriptive research design was used for this study. This
design is the most appropriate design for the present study since
it not known how mental health providers describe the factors
influencing individual decisions to utilize or reject mental
health services in South Texas. This is because the method is

appropriate for the research to collect data from the mental
health providers in depth. It is appropriate for the research
questions because it gives the participant an opportunity express
the points in length by choosing their own words. As a
researcher more understanding is achieved through open-ended
questions.
Ethical Considerations
Before the commencement of the study, the researcher will
contact his organization to explain the proposed study. Once the
organizational and IRB approvals are given, the organization
will provide a list of qualified candidates and an email
invitation will be sent to the mental health professionals
regarding participation in the study. Participants will be
recruited by asking the staff secretaries to forward an email
from me to the staff.
References
Anderson, M. S. (2018). Barriers to the Utilization of Mental
Health Services on College Campuses by African-American
Students. McNair Scholars Research Journal, 11(1), 3.
André Queirós, Daniel Faria, & Fernando Almeida. (2017).
Strengths and limitations of qualitative and quantitative
research methods. doi:10.5281/zenodo.887088
Calear, A. L., Banfield, M., Batterham, P. J., Morse, A. R.,
Forbes, O., Carron-Arthur, B., & Fisk, M. (2017). Silence is
deadly: A cluster-randomized controlled trial of a mental health
help-seeking intervention for young men. BMC Public
Health, 17(1), 834. doi:10.1186/s12889-017-4845-z
Chang, C., & Biegel, D. E. (2018). Factors affecting mental
health service utilization among Latino Americans with mental
health issues. Journal of Mental Health, 27(6), 552-559.
doi:10.1080/09638237.2017.1385742
Hester, R. D. (2017). Lack of access to mental health services
contributing to the high suicide rates among
veterans. International Journal of Mental Health Systems, 11(1),
47. doi:10.1186/s13033-017-0154-2

Kohn, R., Ali, A. A., Puac-Polanco, V., Figueroa, C., López-
Soto, V., Morgan, K., . . . Vicente, B. (2018). Mental health in
the Americas: An overview of the treatment gap. Revista Pan
Americana De Salud Publica = Pan American Journal of Public
Health, 42, e165. doi:10.26633/RPSP.2018.165
Kohl, D. (2018). Examining the relationship between health
behaviors and mental health in a Luxembourg sheltered work
environment: A quantitative study Available from ProQuest
Dissertations & Theses: UK & Ireland: Business. Retrieved
from https://search.proquest.com/docview/2189019177
Wang, N., & Xie, X. (2019). Associations of health insurance
coverage, mental health problems, and drug use with mental
health service use in US adults: An analysis of 2013 national
survey on drug use and health. Oxfordshire: Routledge.
doi:10.1080/13607863.2018.1441262
Cesar Ritz Colleges – Assignment Document
1
Subject: Current Global and Social Issues
Course Code: GEN230
Lecturer: Beverley Gould
Term: Spring 2020
Issue Date: Week 10

Submission Date: Week 11 Spring 2020
Feedback Date: Week 11
Assignment Value: 30% of Course
APPROVED BY:
GENERAL INSTRUCTIONS: IMPORTANT, PLEASE READ
CAREFULLY
1. Read the assignment brief, assignment, and the assessment
criteria through
carefully.
2. Plan and organize your work carefully.
3. When you have completed your work, check it against the
assessment criteria
below.
4. Plagiarism or other forms of cheating will receive a ‘0’ grade
and the matter will
be referred to the Academic Committee.
5. Papers submitted with more than a 20% Plagiarism score will
not be graded.
6. Work submitted late will only receive the maximum of a
(marginal fail) passing

grade. (60%)
7. Re-submitted work will only receive the maximum of a
(marginal fail) passing
grade. (60%)
2
1. Assignment Title: GEN230 Mid Term SP20
2. Assignment Objectives:
Students are required to submit a structured 5 paragraph essay
on the topic
below.
The essay must be minimum 1,000 / maximum 1,200 words
counting content
only (without cover page, reference list, etc.). You are required

to research a
central question on the chosen topic and present and discuss
origins and issues.
Through your research findings, you are to conclude on the
impact the topic has
/ has had on people, communities, and environments.
3. Topic:
Write your essay on this topic following all the guidelines in
this brief. Essays that
do not follow the brief will receive fewer marks!
Is democracy the best political system when it comes to
protecting human
rights?
Upload your essay into elearning week 11 by the due date.
Essays submitted
late may not be graded.
Additional Requirements:
Research well and present your evidence using Harvard citation
in your paragraphs
and a full reference list.
Write using formal language, avoiding contractions (it’s, don’t)
and personal
pronouns (I, you, we) and only give your opinion in the

conclusion.
Include a cover page and automatic table of contents.
Check grammar and spelling.
Check your essay against the assessment criteria below before
submission.
3
4. Suggested Reading and Resources
Revisit the topics in elearning week 9. Some useful links (but
you MUST research
your own in addition)
https://www.ohchr.org/en/Issues/RuleOfLaw/Pages/Democracy.
aspx
https://www.un.org/en/sections/issues-
depth/democracy/index.html
https://www.ohchr.org/en/Issues/RuleOfLaw/Pages/Democracy.
aspx
https://www.un.org/en/sections/issues-

depth/democracy/index.html
4
5. Assessment Criteria / Grading Scale
Marks
Layout Have you included :-
• Correct cover page
• Table of Contents
• Page numbers
• Introduction
• Conclusion
• Reference List
5
Introduction
Does your introduction explain the purpose of
this paper and state the question you will be
answering?
10

Flow of Ideas
Are your points clear, under a relevant heading
with, one point leading to the next?
5
Conclusion
Is your conclusion a good summary of all of the
points that you have made in the paper?
10
Quality of research Have you:-
• Used a range of sources?
• Are your sources reliable and up to
date?
10
Evidence based? Have you found evidence for what you say?

10
Referencing
Have you included a reference in the text and a
full reference in your list at the end, for every
fact, quote and citation?
10
Critical analysis Have you:-
• Found evidence for your topic
question?
10
Quality of Writing
Is your writing:
• Well structured, with meaningful
headings?
• Clear and easy to read?
• With ideas clearly stated?
• With a minimum of grammatical errors?
• Have well-structured sentences and
paragraphs?

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