{"title":"Health Systems Issues and the Underserved","authors":"Gordon I. Herz, C. Gaba","doi":"10.1093/med-psych/9780190912727.003.0001","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0001","url":null,"abstract":"A number of factors endemic to the U.S. health system contribute to barriers to meeting the mental health needs of the underserved. Important variables include the economic barrier of continued gaps in affordable third-party coverage for care, perceived and actual costs of care, insufficient numbers of clinicians relative to the number of individuals in need of mental health services, and training and workforce gaps to meet specific needs (e.g., culture, disability, geographical) of the population. Approaches being developed to counter the limited-access problem include increasing economic support for coverage of services, expanding the workforce, incorporating ethics and cultural competence in clinical training, educating consumers about real costs of care, and developing volunteer and charitable models of service provision. Future developments to decrease health system barriers are likely to include technological advances.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115420840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delivering Psychological Services to Religious and Spiritual Clients","authors":"G. Magyar-Russell","doi":"10.1093/med-psych/9780190912727.003.0007","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0007","url":null,"abstract":"Spiritual and religious beliefs and practices in the United States are becoming increasingly diverse. This chapter reviews some of the fundamental problems and obstacles to providing culturally competent and compassionate mental health care to religious and spiritual clients, highlights the recent progress that has been made toward better serving the mental health needs of these clients, and provides a summary of best practices and future directions. Although religious and spiritual individuals continue to be underserved, there is increasing consensus among mental health professionals that religion and spirituality represent important cultural and clinical dimensions associated with treatment outcomes. As such, the field continues to work toward narrowing the gap in service delivery for religious and spiritual individuals seeking psychotherapy.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126060953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Out of the Shadows","authors":"Douglas H. Chadwick","doi":"10.1093/med-psych/9780190912727.003.0006","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0006","url":null,"abstract":"Sexual minority and gender-diverse (SM/GD) persons experience depression, anxiety, suicidality, and substance use issues at a disproportionate rate when compared with heterosexuals. Stigma, minority stress, and prejudicial social attitudes and institutional policies are viewed as the reason for this. The disparities in access to health care for SM/GD persons is significant and is perceived as due to lack of access to competent care as well as mistrust of health care professionals on the part of SM/GD persons. SM/GD teens and elders, as well as individuals with low socioeconomic status, those living in rural areas, and those with disabilities, are particularly vulnerable. Recommendations for changes in health care policy, as well as strategies for improving the cultural competence of health care providers and evidence-based treatments, are discussed. Additionally, further research, standardizing health care training to include SM/GD persons, prevention, and inter-organizational advocacy are recommended.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116880590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Héctor Fernández-Álvarez, M. Grazioso, Diana Kirszman, Meri Lubina, R. Goodyear
{"title":"Responding to the Mental Health Needs of Underserved Latin Americans","authors":"Héctor Fernández-Álvarez, M. Grazioso, Diana Kirszman, Meri Lubina, R. Goodyear","doi":"10.1093/med-psych/9780190912727.003.0011","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0011","url":null,"abstract":"Latin Americans experience an especially large gap between their mental health needs and treatment availability. Access to treatment is limited by attitudes and stigma, the lack of substantial treatment infrastructures, and shortages of mental health professionals. The treatments that underserved populations do obtain are often informed by models imported from North America and Europe, without sufficient cultural adaptation. This chapter describes the work that Fundación Aiglé is doing to address this treatment gap. This includes its graduate training programs and supervision networks that extend regionally, beyond Argentina; its publications; and its treatment model, the integrative model of psychotherapy. The chapter also describes Aiglé’s Therapeutic Assistance Program for People with Limited Resources (PATER) as one approach to providing treatment to underserved populations. The work that Aiglé is doing provides a model for other nongovernmental agencies to adapt to their own circumstances.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126869348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychotherapy for Developmental Disabilities","authors":"Jonathan M. Campbell, A. Scarpa","doi":"10.1093/med-psych/9780190912727.003.0014","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0014","url":null,"abstract":"Psychological disorders commonly co-occur in individuals with developmental disabilities, yet mental health disorders are under-identified and mental health services are underutilized for this group. Within the larger population of individuals with developmental disabilities, this chapter focuses on individuals with intellectual disability (ID) and autism spectrum disorder (ASD). The authors review defining characteristics of ID and ASD and then describe common psychological disorders for each group, including anxiety, depression, and behavioral dysregulation disorders. A selective review is provided of evidence-based interventions, such as cognitive behavioral therapy, that address mental health concerns for both groups. Barriers to access and utilization of services are identified and potential solutions are offered to these barriers. The authors identify the important role of stigmatizing attitudes toward individuals with developmental disabilities as contributing to poor experiences with mental health providers. The intersectionality of developmental disability and mental illness is highlighted as contributing to barriers to access to mental health treatment.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123127053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delivering Mental Health Assistance in the Wake of Natural and Manmade Disasters","authors":"Alex R L Cecil","doi":"10.1093/med-psych/9780190912727.003.0003","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0003","url":null,"abstract":"Disasters, both natural and manmade, seem to be occurring with increasing frequency in the United States and around the world. A single incident may affect many thousands of people. Collectively, many millions feel the impact of disaster every year. Addressing the psychological elements of such events has become recognized as a vital component of preparation, immediate response, and long-term recovery. This chapter reviews the major psychological aspects of disasters and disaster mental health (DMH) and highlights the importance of psychosocial assistance to survivors, responders, and others. DMH is designed to comfort and stabilize those affected, to promote effective coping, and to help maintain and restore inherent functioning. Factors that inhibit greater provision and utilization of these services are discussed, as is the importance of responding appropriately within the cultural environment of affected populations.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124923904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Serving the Underserved","authors":"Changming Duan","doi":"10.1093/med-psych/9780190912727.003.0004","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0004","url":null,"abstract":"Eliminating disparities in racial/ethnic mental health care is an ethical mandate and a tall order for the field of psychotherapy. There are significant obstacles that pose challenges, and at the same time point out directions for the field to address. This chapter provides arguments and narratives illustrating that increasing racial/ethnic parity requires all practicing psychotherapists and those in training to devote themselves to personal and professional multicultural identity/competence development, continuous knowledge renewal, and expansion and improvement of interventions in and outside of counseling rooms. Some of the possible and concrete paths toward meeting such demands are discussed to aid practitioners in their pursuit of the course of racial /ethnic mental health care parity.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125363628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Providing Psychotherapy in Rural Areas","authors":"Tracy J. Cohn, Pei‐Chun Tsai","doi":"10.1093/med-psych/9780190912727.003.0010","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0010","url":null,"abstract":"Residents in rural communities experience unique challenges in accessing and utilizing mental health care services. Providing services to members of rural communities is a social justice concern. Rural areas have a distinct culture with specific contextual stressors. This chapter highlights structural and systemic stressors and challenges that rural residents encounter, including the barriers to care that characterize rural residents’ help-seeking attitudes and behaviors, clinical work, as well as training and supervision. The authors illustrate ways that psychotherapists can increase their rural cultural competence in knowledge, awareness, and skills to help overcome these barriers. Innovative and empirically supported solutions for working in rural communities are provided. Recommendations are made for future research, clinical work, training programs, and models for rural mental health care.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126884022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychotherapy with the Underserved Older Adult Population","authors":"S. Whitbourne, Bruna Martins","doi":"10.1093/med-psych/9780190912727.003.0013","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0013","url":null,"abstract":"The older adult population is steadily growing in number, and by 2050, over 20% of the U.S. population is expected to be over the age of 65. Ageism may affect both patients and providers and may limit access to mental health services. This chapter reviews the prevalence of major mental health conditions in older adults, empirically supported treatments for these conditions, and how best to tailor interventions for use with older patients. The authors suggest that psychoeducational training, increasing availability of specialty training programs for providers, intergenerational programs to promote empathy from as early as primary school to hospital staff training, and shifts in policy may boost interactions with older persons in health care settings and decrease avoidance of assessment and treatment for mental health conditions.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122191253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bringing Psychotherapy to Immigrants","authors":"H. Mirsalimi","doi":"10.1093/med-psych/9780190912727.003.0009","DOIUrl":"https://doi.org/10.1093/med-psych/9780190912727.003.0009","url":null,"abstract":"Immigrants have unique mental health challenges and treatment needs. This chapter attempts to shed light on the challenges, barriers, and potential solutions to providing psychotherapy to immigrant populations. Topics covered are language barriers, financial barriers, insurance barriers, intimate partner violence issues, cultural variables regarding disclosure issues, fear of involvement with immigration authorities, trust issues regarding political matters, limited knowledge about psychotherapy, stigma about psychotherapy, lack of knowledge about provider types, differences in symptom expression, lack of cultural sensitivity on the part of the psychotherapist, lack of adequate literature and research, and limitations posed by state licensing boards. Additionally, effective strategies and empirically supported treatments for providing mental health services to immigrants are reviewed. Future steps are recommended and reviewed, for individual clinicians and mental health professions, to reduce barriers and ensure that immigrants receive the mental health services they need and deserve.","PeriodicalId":178966,"journal":{"name":"Bringing Psychotherapy to the Underserved","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122364982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}