Tiffany Haynes

Mental health stigma and primary health care decisions

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

The Pew Versus the Couch: Relationship Between Mental Health and Faith Communities and Lessons Learned from a VA/Clergy Partnership Project

The history of the relationship between religion and mental health is one of commonality, conflict, controversy, and distrust. An awareness of this complex relationship is essential to clinicians and clergy seeking to holistically meet the needs of people in our clinics, our churches, and our communities. Understanding this relationship may be particularly important in rural communities. This paper briefly discusses the history of this relationship and important areas of disagreement and contention. The paper moves beyond theory to present some current practical tensions identified in a brief case study of VA/Clergy partnerships in rural Arkansas. The paper concludes with a framework of three models for understanding how most faith communities perceive mental health and suggests opportunities to overcome the tensions between “the pew” and “the couch.”

Building Partnerships With Rural Arkansas Faith Communities to Promote Veterans' Mental Health: Lessons Learned

Background: The Mental Health–Clergy Partnership Program established partnerships between institutional (Department of Veterans’ Affairs [VA] chaplains, mental health providers) and community (local clergy, parishioners) groups to develop programs to assist rural veterans with mental health needs.Objectives: Describe the development, challenges, and lessons learned from the Mental Health–Clergy Partnership Program in three Arkansas towns between 2009 and 2012.Methods: Researchers identified three rural Arkansas sites, established local advisory boards, and obtained quantitative ratings of the extent to which partnerships were participatory.Results: Partnerships seemed to become more participatory over time. Each site developed distinctive programs with variation in fidelity to original program goals. Challenges included developing trust and maintaining racial diversity in local program leadership.Conclusions: Academics can partner with local faith communities to create unique programs that benefit the mental health of returning veterans. Research is needed to determine the effectiveness of community based programs, especially relative to typical “top-down” outreach approaches.

A rural African American faith community's solutions to depression disparities.

OBJECTIVE The aim of this study was to explore how a rural African American faith community would address depression within their congregations and the community as a whole. DESIGN AND SAMPLE A qualitative, interpretive descriptive methodology was used. The sample included 24 participants representing pastors, parishioners interested in health, and African American men who had experienced symptoms of depression in a community in the Arkansas Delta. MEASURES The primary data sources for this qualitative research study were focus groups. RESULTS Participants identified three key players in the rural African American faith community who can combat depression: the Church, the Pastor/Clergy, and the Layperson. The roles of each were identified and recommendations for each to address depression disparities in rural African Americans. CONCLUSIONS The recommendations can be used to develop faith-based interventions for depression targeting the African American faith community.

“Too Blessed to be Stressed”: A Rural Faith Community’s Views of African-American Males and Depression

Among African-Americans, the faith community has a long history of providing support to its members. Because African-American men tend to delay and decline traditional depression treatment, the faith community may be an effective source of support. The aim of this study was to determine how a rural African-American faith community describes and perceives experiences of depression among African-American males. A convenience sample of 24 men and women participated in focus groups and interview. Four themes were identified: defining depression, etiology of depression, denial of depression, and effect of masculine roles on depression experience.

Addressing Mental Health Needs: Perspectives of African Americans Living in the Rural South

OBJECTIVE Rural African Americans are disproportionately affected by social stressors that place them at risk of developing psychiatric disorders. This study aimed to understand mental health, mental health treatment, and barriers to treatment from the perspective of rural African-American residents and other stakeholders in order to devise culturally acceptable treatment approaches. METHODS Seven focus groups (N=50) were conducted with four stakeholder groups: primary care providers, faith community representatives, college students and administrators, and individuals living with mental illness. A semistructured interview guide was used to elicit perspectives on mental health, mental health treatment, and ways to improve mental health in rural African-American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data. RESULTS Stressful living environments (for example, impoverished communities) and broader community-held beliefs (for example, religious beliefs and stigma) had an impact on perceptions of mental health and contributed to barriers to help seeking. Participants identified community-level strategies to improve emotional wellness in rural African-American communities, such as providing social support, improving mental health literacy, and promoting emotional wellness. CONCLUSIONS Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and provision of mental health education to the general public may improve use of services in this population.

Rural African Americans' Perspectives on Mental Health: Comparing Focus Groups and Deliberative Democracy Forums

Abstract:A number of approaches have been used to obtain community members’ health perspectives. Health services researchers often conduct focus groups while political scientists and community groups may hold forums. To compare and contrast these two approaches, we conducted six focus groups (n = 50) and seven deliberative democracy forums (n = 233) to obtain the perspectives of rural African Americans on mental health problems in their community. Inductive qualitative analysis found three common themes: rural African Americans (1) understood stresses of poverty and racism were directly related to mental health, (2) were concerned about widespread mental illness stigma, and (3) thought community members could not identify mental health problems requiring treatment. Deductive analyses identified only minor differences in content between the two approaches. This single case study suggests that researchers could consider using deliberative democracy forums rather than focus groups with marginalized populations, particularly when seeking to mobilize communities to create community-initiated interventions.

Measuring HIV-related stigma among healthcare providers: a systematic review

ABSTRACT In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.

Lessons learned from using an audience response system in a community setting for research data collection

OBJECTIVES A community-academic team implemented a study involving collection of quantitative data using a computer-based audience response system (ARS) whereby community partners led data collection efforts. The team participated in a reflection exercise after the data collection to evaluate and identify best practices and lessons learned about the community partner-led process. DESIGN & SAMPLE The methods involved a qualitative research consultant who facilitated the reflection exercise that consisted of two focus groups-one academic and one community research team members. The consultant then conducted content analysis. Nine members participated in the focus groups. RESULTS The reflection identified the following themes: the positive aspects of the ARS; challenges to overcome; and recommendations for the future. CONCLUSION The lessons learned here can help community-academic research partnerships identify the best circumstances in which to use ARS for data collection and practical steps to aid in its success.

Using Deliberative and Qualitative Methods to Mobilize Community Around the Mental Health Needs of Rural African Americans

Abstract Abstract—Deliberative methods obtain informed and well-reasoned public input on health topics but are rarely accompanied by rigorous qualitative methods that can ground findings in community members’ shared experiences. In this project, we used Deliberative Democracy Forums, a deliberative process, to bring diverse community members together to collectively discuss mental health among rural African Americans, brainstorm solutions to address mental health needs, deliberate alternate solutions, and indicate steps for future action. By using rigorous qualitative methods to document the deliberative process and analyze deliberative dialogue, we produced a strong evidence base to inform future health care policy and research. In this article, we document our approach, present forum findings, and discuss the impact of deliberation on policy and research. We conclude that the combination of deliberative process and qualitative methods used in our project can produce a deeply contextualized understanding of mental health and identify community-initiated solutions to address mental health needs in resource-poor communities, which can help guide public health research and provide an evidence base for public health policy.