Academic journal article The Israel Journal of Psychiatry and Related Sciences

Attitudes, Knowledge and Preferences of the Israeli Public regarding Mental Health Services

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Attitudes, Knowledge and Preferences of the Israeli Public regarding Mental Health Services

Article excerpt

Abstract: We examined the publics preferences regarding the site of provision of mental health care and the basis for those preferences. A representative sample of the adult Israeli population (N= 1,583) was interviewed by telephone about their knowledge and attitudes. Self-referral to mental health professionals and primary medical doctors for milder disorders was low. Psychiatric clinics were preferred by 46% of the public; 35% preferred the general clinics, and the remaining 19% were indifferent. Quality of care was noted by 78% of respondents for their preference for psychiatric clinics. General hospitals were preferred for psychiatric inpatient care by 51% of the respondents compared to 23% who opted for psychiatric hospitals. Despite reasonable familiarity with mental health care, one-third of the respondents did not know whether there was a clinic in their neighborhood. Implications for action are discussed in light of the transfer of responsibility for psychiatric care from the Ministry of Health to the health maintenance organizations (HMOs).

Significant developments in mental health care and rehabilitation have taken place in recent decades (1, 2). However, their benefit remains limited since not all individuals who need care receive it (1, 3-6). Recently, Levinson et al. confirmed these worldwide findings for Israel with regard to the common mental disorders (7). Seeking care for psychotic disorders may constitute an exception, at least for Jews born in Israel (6). Failure to receive timely and appropriate treatment might have adverse consequences, e.g., it may lead to a more severe situation (3, 8) and to the overuse of general medical services (9-11).

What impedes the receipt of care? Obstacles e.g., financial constraints, lack of services, limited knowledge about the existence or nature of treatment, the potential service user's beliefs, and stigma (3,4,12,13) - may be classified on the basis of their derivation from two main factors: the objective and the subjective availability and accessibility of services. In the absence of either factor, the individual will not seek care

Objective availability of services indicates whether services exist. Obviously, their mere existence does not suffice. High costs, a long waiting list, or too distant a location would render the services essentially inaccessible to the potential user. The importance of objective availability notwithstanding, this article will address other issues seldom covered in the local literature, namely, three aspects of subjective availability.

Goals

This inquiry has several goals. The paper addresses three aspects of subjective availability: ( 1 ) subjective accessibility (as expressed, for instance, in knowledge, perceptions and cognitive accessibility); (2) preferences; (3) stigma.

First, we explored the subjective accessibility with regard to mental health services in the Israeli public. This composite construct includes both knowledge and perceptions about the existence and cost of services - and cognitive accessibility. For example, if a service exists but the public does not know it, then in practical terms it is not accessible (i.e., it is subjectively inaccessible). Similarly, if a service is free of charge, but the public believes it is not, it will be subjectively inaccessible, regardless of its objective availability. Cognitive accessibility to receiving care refers to the degree to which a concept is accessible in the individual's mind and memory (14). This may be expressed in the tendency to seek professional care for different mental conditions.

Secondly, we explored an additional aspect of the construct of subjective availability in the Israeli public, namely, preferences with regard to care. The degree to which services suit the individual's preferences may affect their subjective availability. Clearly, if services are unavailable, subjective accessibility has little meaning. However, when services do exist, as is usually the case in Israel, it is important to examine subjective accessibility in order to improve their use. …

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