Academic journal article Iranian Journal of Public Health

Service Users and Providers Expectations of Mental Health Care in Iran: A Qualitative Study

Academic journal article Iranian Journal of Public Health

Service Users and Providers Expectations of Mental Health Care in Iran: A Qualitative Study

Article excerpt

Abstract

Background: Mental disorders are known to be an important cause of disabilities worldwide. Despite their importance, about two thirds of mentally ill people do not seek treatment, probably because of the mental health system's inability to decrease the negative side effects of the interaction with the mental health services. The World Health Organization has suggested the concept of responsiveness as a way to better understand the active interaction between the health system and the population. This study aimed to explore the expectations of mental health service users and providers.

Methods: Six focus group discussions were carried in Tehran, the capital of Iran. In total, seventy-four participants comprising twenty-one health providers and fifty-three users of mental health system were interviewed. Interviews were analyzed through content analysis. The coding was synchronized between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility.

Results: Five common domains among all groups were identified: accessibility, quality of interpersonal relationships, adequate infrastructure, participation in decisions, and continuity of care. The importance of cultural appropriateness of care was only raised by service users as an expectation of an ideal mental health service.

Conclusions: Both users and providers identified the most relevant expectations from the mental health care system in Iran. More flexible community mental health services which are responsive to users' experiences may contribute to improving the process of care for mental health patients.

Keywords: Responsiveness, Mental health, Iran

Introduction

Mental disorders are known to be an important cause of disabilities worldwide (1). According to the World Health Organization's (WHO) multicountry study, it is estimated that about two thirds of people with mental disorders do not seek treatment (2). Differential health care access provides an important explanation of this gap. Appropriate access is defined as the availability of acceptable services. Different experiences of health care access among mentally ill patients might be explained by the quality of mental health services, the quality of rapport between service users and providers, the adherence to treatment, and the differential availability of mental health care (3).

The accessibility and cultural acceptability of mental health services will also determine the degree to which patients seeking help are able to engage with mental health providers (4).

The active interaction between the mental health system and the population is crucial for mental health care (5). Several studies have shown that when people receive appropriate mental health care and their expectations are fulfilled, the recurrence of their symptoms and their use of medical services declines (6-8). Despite the importance of having a better understanding of patients' and service providers' expectations when interacting with mental health services, little has been done to identify these expectations worldwide (5). In 2000, the WHO suggested the concept of responsiveness as a way to evaluate health systems based on the users' expectations and experiences. Responsiveness is a measure ?. . . of how the system performs relative to non-health aspects, meeting or not a population's expectations of how it should be treated by providers of prevention, care or non-personal services? (9). Although few studies have assessed the applicability of the WHO responsiveness concept to mental health care (5, 10), to our knowledge, to date, none of them have identified both users and providers expectations. This study, as part of a comprehensive investigation of mental health care responsiveness in Iran, aimed to explore the experiences and expectations of mental health service users and providers. …

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