This article investigates the gap in access to and quality of mental health care in the United States. This work first discusses how minority populations are most affected by the treatment gap. It summarizes recent literature on the topic for better understanding the needs of psychiatrically underserved and disenfranchised populations and the causes of mental health disparities. It reviews some of the barriers to behavioral health care, including lack of insurance coverage, lack of community-based interventions, unequal access to evidence-based practices, stigma, mental health workforce shortages, and geographical maldistribution of providers. Second, it reviews opportunities to address these disparities. The article provides examples of effective interventions that researchers worldwide have already implemented to address the gap of mental health services within the collaborative care model and global mental health initiatives. Telepsychiatry and improvements in training of the mental health workforce are also listed as useful implementations to overcome the treatment gap for patients seeking mental health care.

Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States.

Objective
With growing awareness of the impact of mental illness self-stigma, interest has arisen in the development of interventions to combat it. The present article briefly reviews and compares interventions targeting self-stigma to clarify the similarities and important differences between the interventions.

Interventions targeting mental health self-stigma: A review and comparison

BACKGROUND Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. OBJECTIVES To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. SELECTION CRITERIA We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve 'peer' individual/group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). DATA COLLECTION AND ANALYSIS The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data. We used a random-effects model for analyses. We assessed the quality of evidence and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains.All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low-quality evidence) or all-cause death in the long term (RR 1.52, 95% CI 0.43 to 5.31; participants = 555; studies = 1, very low-quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state (improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society.One trial compared peer support with clinician-led support but did not report any useable data for the above main outcomes. AUTHORS' CONCLUSIONS Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer-support interventions for people with schizophrenia and other mental illness.

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Peer support for people with schizophrenia or other serious mental illness.

Perceived suicide stigma and consequent secrecy about suicide loss could contribute to impaired mental health among suicide loss survivors. Using online survey data from 195 suicide loss survivors, higher perceived suicide stigma was associated with more grief difficulties, higher suicidality, and less personal growth. Secrecy partly mediated the association between perceived suicide stigma and grief difficulties as well as suicidality and completely mediated the association between perceived suicide stigma and personal growth. Our findings suggest that supporting suicide loss survivors in coping with perceived suicide stigma could reduce secrecy about suicide loss and by this improve their mental health outcomes.

Perceived suicide stigma, secrecy about suicide loss and mental health outcomes

Benefits and risks of suicide disclosure.

Each year, approximately 1.3 million Americans survive a suicide attempt. While stigma has been reported by suicide attempt survivors, limited research has examined how suicide stigma may differ from the stigma of mental illness. U.S. adults (n = 440) completed an online survey in which they were randomly assigned to one of four vignettes. Vignettes depicted a target individual with either past depression, past suicide attempt, death by suicide, or no information on suicide or mental illness (control). Participants completed a general measure of stigma, a suicide-specific stigma measure, and were surveyed on the recovery potential of individuals with mental illness and suicide attempt. While the general stigma measure failed to distinguish between groups, significant differences on the suicide stigma scale (SSAS-44) emerged between participants assigned in the depression and suicide conditions, especially for stereotype and prejudice subscales. Across conditions, participants believed that recovery was more realistic for someone described as having a mental illness than it was for someone described as having attempted suicide. These findings suggest that individuals who have attempted suicide are subject to differential stigma content from those with depression. Implications are discussed for combating stigma for suicide attempt survivors.

The specificity of public stigma: A comparison of suicide and depression-related stigma

Background: In their 2016 report, the National Academy of Sciences identified that the existing literature on the stigma of substance use disorder (SUD) is sparse compared to the stigma of mental i...

Exploring the public stigma of substance use disorder through community-based participatory research

Homeless African Americans with serious mental illness experience higher rates of morbidity and mortality than adults with severe mental illness alone Peer navigators, individuals with similar lived experiences, may help these individuals navigate the healthcare system to improve healthcare utilization This study examined whether the Peer Navigator Program (PNP) improved scheduling and achieving healthcare appointments compared to treatment as usual (TAU) over the course of 12 months, including three periods within that timeframe: engagement (first three months), impact (middle six months), and maintenance (final six months) Results indicated no change during the first three months of the study, a significantly greater improvement in scheduled and achieved appointments for PNP compared to TAU during the middle six months, and maintenance of appointment change improvements over the final three months of the study This research suggests peer navigators may offer a promising solution to barriers in utilizing the healthcare system for people with severe mental illness, especially those who may be homeless or from minority racial groups

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Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care.

Few empirical research studies have examined the public stigma of substance use disorder (SUD) compared to mental illness (MI). Expanding on the results of a qualitative study on the stigma of SUD, this study quantitatively examined items thought to represent the three constructs of public stigma: stereotypes, prejudice and discrimination. Additionally, exploratory factor analyses generated factor structures to provide meaning to each construct. Results indicated that some factors were endorsed significantly higher than others: for stereotypes, recklessness and threat were significantly endorsed more than unreliability and inadequacy; for prejudice, dread was endorsed the most; and for discrimination, restriction was endorsed more than invalidation. Additional oneway ANOVAs revealed that women significantly endorsed restriction more than men. Although further research is needed to confirm a complete set of factors, these results may help to establish a model for the public stigma of people with SUD.

Understanding the factor structure of the public stigma of substance use disorder

Although suicide attempt survivors report feelings of shame and stigmatization, no published scale measures self-stigma experienced by attempt survivors. This article describes the creation and val...

Rachel Dubke

Papers

The specificity of public stigma: A comparison of suicide and depression-related stigma

Exploring the public stigma of substance use disorder through community-based participatory research

Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care.

Understanding the factor structure of the public stigma of substance use disorder

The Self-Stigma of Suicide Attempt Survivors.