Mental Health Care Coverage In Minnesota: Supplementing Federal Healthcare Reform

Mental Health Care Coverage In Minnesota: Supplementing Federal Healthcare Reform

In 2007, the general of Minnesota proposed a mental health initiative and the legislature passed it. One of the more important components of the initiative was legislation amending Minnesota ' s two programs for the uninsured - General Assistance Medical Care and Minnesota Care - to add to the comprehensive mental health and addictions benefit.
Who Is Covered?
General Assistance Medical Care covers those with income at or below 75 % of the federal default level who meet one or more of fresh criteria known as General Assistance Medical Care qualifiers. Qualifiers consist of waiting or appealing disability determination by Social Security Administration or state medical review team; or being in a single or live in shelter, hotel, or other area of public accommodation.
Minnesota Care covers children and pregnant women, parents, and caretakers up to 275 % of the federal deprivation level, omit that parents and caretakers gross income cannot exceed $50, 000. Single adults without children and to 200 % of federal paucity level by January 1, 2008 and will rise to 215 % of federal deficit level by January 1, 2009.
What Services Are Covered?
For Minnesota Care, there are limits of $10, 000 on inpatient care for any sort ( unfeigned, mental health, or addictions ) for parents over 175 % of federal deficit level and childless adults. For General Assistance Medical Care, inpatient benefits are fully covered. Both programs cover chemical dependency outpatient services. An earnest array of outpatient and residential mental health services are available.
What Is The Cost?
In Minnesota, the Medicaid Impermanent Assistance for Truly needy Families population, General Assistance Medical Care and Minnesota Care are enrolled in comprehensive nonprofit health plans that are contracted to deliver and are at risk for the entire health benefit, including behavioral health. Adding mental health rehabilitative services ( including adult rehabilitative mental health services individual and group rehabilitation services, assertive community treatment, pungent residential treatment and ambulatory and residential shift services ) to Minnesota Care was projected to cost $3. 40 per person per month. For General Assistance Medical Care, which includes a by oneself population, the cost was $7. 01 per person per month. The additional targeted case management service was projected to cost $2. 22 per person per month for Minnesota Care and $7. 66 for General Assistance Medical Care.
The legislature appropriated a total of $1 million in fresh state dollars in capital year 2008 and $ 3. 5 million in cash year 2009 to add the adult rehabilitative services and case management in Minnesota Care. State funds previously targeted for case management were moved from the counties to the state in an amount of $4. 4 million in pecuniary year 2009.
What Led To Comprehensive Coverage?
The state incurious data on the residents served by Minnesota Care, General Assistance Medical Care, and Medicaid managed care plans operative non - lame populations, and discovered that an increasing number of individuals with serious mental illnesses were in these plans. Several insurance reforms - coincident to those included in the national healthcare reform bill - modified the private market, including guaranteed problem in small and large group plans, broader standard bands, parity for mental health and chemical dependency services, medical loss ratios, high risk insurance pool, and others. A proceedings by the attorney general called attention to health plan denials of payment for quarterback - ordered treatment, for example for civil committal or out of home procedure for adolescents.
Health plans dogged with an settlement that behavioral and mental health benefits would be covered by a health plan if the court based its judgment on a diagnostic elimination and plan of care developed by a experienced there. In appendage to the inspector - ordered services tuck, the state contracts and capitation with prepaid health programs ( Minnesota Care and General Assistance Medical Care ) were amended to range risk and guilt for services in institutions for mental illnesses, 180 days of nursing home or home health, and judge - ordered treatment. There were also acutely palmy experiments reducing costs and contributive outcomes for commercial and non - defective Medicaid clients who were offered a more shrill rabble based mental health service that preferred situation with and linkages to behavioral healthcare, primary care, and other needed services.
These demonstrations produced a positive produce on investment - $0. 38 / person / month - and gave the health plans tools to manage the augmented risk that resulted from several insurance reforms, including parity, a statutory definition of medical exigency, and the go-between - ordered treatment ration.
The state supported comprehensive coverage seeing it sought to bestow mental health and addiction services in Minnesota as part of mainstream healthcare. Minnesota ' s mental health agency and other stakeholders adapted to alteration mental malady from its historical treatment as a social disease requiring social services to an illness agnate any other. They cardinal to expand earlier interventions and avoid shifting enrollees among different programs in order to access exclusive services. Operationalizing this pin money chief rethinking medical scantiness determinations, provider credentialing, contracting, act codes and other processes common to essential insurance plans.
How Did It Get Through The Political Process?
Three factors significantly contributed to the political get-up-and-go of a benefit expansion in the Minnesota Care and General Assistance Medical Care programs:
>> The ruler of Minnesota and the administration provided strong leadership. The provisions to expand the mental health benefits in these plans were part of the general ' s mental health initiative, set radiate in advance of the 2007 legislative meeting.
>> An exorbitantly strong confederation of stakeholders formed a mental health motion group. This group is co - chaired by a representative from the department of human services and included representation from the private insurance industry and organized and appreciative endorsement and provider communities.
>> There was strong support in the legislature for the expansion of benefits in Minnesota Care and General Assistance Medical Care, including from a member of the finance committee in the stomping grounds, who has a child with schizophrenia. The creation of a mental health division in the health and human services policy committee also helped proceeding the policy discussion forward.
Why Does This Approach to Healthcare Reform Work?
A recent survey of community behavioral health organizations create that on average, 42 % of reimbursement for services came from private insurers. While this represents the average, the survey constitute that there was fairly a scope in reimbursement sources. For community behavioral health organizations that specialize in services conforming as Assertive Community Treatment or case management, Medicaid is the a-number 1 reimbursement source, either through payment - for - service or managed care.
Reimbursement from private insurance and Medicaid managed care is uniformly better than Medicaid charge - for - service. In addition to higher rates, the private insurers and Medicaid managed care organizations have been ready to offer red-letter contracts for packages of services for adventure care and hospital discharge plus aftercare.

My Personal Experience With The Mental Health System

My Personal Experience With The Mental Health System

What follows is my trek into senselessness with the help of so - called mental health professionals. Keep in mind these events took zone in Massachusetts. You will find this story quite amusing, and yet undeniably disturbing.

In the early to mid - 1990s, I mentioned to my PCP that I was experiencing tumult with my remembrance. He in turn, verbal Has anyone ever talked to you about Adult Attention Deficit Disorder. I was quickly referred to a psychiatrist. I told the doctor what my PCP spoken. This psychiatrist immediately offered me a prescription for Ritalin. There was no discussion regarding symptoms or tests of any sympathetic. It was tidily this way: If the Ritalin helps you then well know you have ADD. I reciprocal for my next appointment telling him that the Ritalin was not working. The doctor put me on bounteous impulse called Dexedrine. That did not work, so he prescribed some other motive that I cannot recall.

At this point, I told the doctor that I was getting anxiety, so he prescribed Zyprexa. This was when it was first put on the market. I was also given a referral to a psychologist. My conversations with this psychologist focused on what I had done the previous week and how my medications were working. This went on for several years. Diddly was accomplished therapeutically. I epigram some of her notes in my medical records. My mother did psychic readings for entertainment. Based on this information, my psychologist stated that my mother ran a cult. Blonde also stated that I was sexually abused. This never happened. There was an entry in my inscribe that spoken my father was not in my life in that he had moved out - of - state. My father moved when I was in my mid - twenties, and he called me ofttimes. This is all ultra absurd.

Getting back to my medications, I told my new psychiatrist that I was pain depressed. He put me on Paxil, with no questions asked. I went back to him three times. Each time he would utter It always works, and he would increase the dosage at each visit. Sequential I was put on all of the SSRIs, homologous Zoloft, Paxil and Celexa, as well as Wellbutrin. My PCP prescribed an anti - depressant called Pamelor. It was not the best choice of medication for me in terms of side effects.

This psychiatric treatment escalated as time went on. It went from bad to worse. At some point, I was diagnosed with Bipolar Disorder, General Anxiety Disorder, Social Anxiety Disorder, and alarm attacks. Some of the doctors would add psychosis to my diagnosis. I asked one doctor if nymph would put me on Amantadine ( I conceive it is an anti - viral medication ) in that I study on the Internet that the Borna Virus caused Bipolar Disorder. I was desperate to escape this disease. Mademoiselle consented ( for no reason ), and a week next I was in the hospital for several days with severe hallucinations. This was at number one ten years ago.

One psychiatrist put me on Klonopin for my anxiety. I was quite sedated on it. I told him it wasnt working. I presuppose my doctor oral - I can give you three milligrams three times a day ( no quote for this one ). He verbal, Thats the best I can do. Not surprisingly, I got into a car business. I never attributed the Klonopin to my sedation. I thought I was always tired due to want of sleep from stress.

I went through every possible psychiatric medication on the market, including Depakote, Trileptal, and Seroquel ( which gave me severe hallucinations ). They also put me on all the second reproduction antipsychotics. There was one psychologist who asked me to experience neuropsychological testing. His conclusion was that I had Asperger ' s Syndrome. That diagnosis was sequential refuted by deeper Psychiatrist.

I spent ten years outpatient at a well - known mental health hospital beginning in approximately, 2000. The medication at-home far-off with the four dweller doctors assigned to me. I even took medications for my supposed recollection deficits. I was prescribed Namenda ( as part of a study ), Mirapex, and Excelon ( at any earlier time ). For the most part, I was kept on a regime of Lamcital 300mg, Lithium ER 1350 mg, and Risperdal at various milligrams. At about five years into my treatment, I began to complain to my doctor about tremors and restlessness. The doctor I was seeing called it Akathesia. Nymphet prescribed Inderal 80mg, fairly than take me off the Risperdal.

I was on Ativian with one of my doctors. Once and, I told the doctor that I was motility tired while driving. He prescribed Adderall to keep me perceptive during the day at my suggestion. I was eventually arrested for operating below the influence of drugs. This was sequential reduced to reckless driving. The only thing that my doctor had to affirm is, I could have gotten sued.

It has gotten to the point that I can no longer use a pen to even sign my name. A neurologist diagnosed me with Tardive Dystonia. Babe insisted that I go on a low dose of a tranquilizer / anti - convulsant medication, as my only option. It does not affect my driving or give me sedation, but neither it does it help my nature.

My current psychiatrist stated in my medical records that the Risperdal contributed to my Dystonia... in those very words. I was taken off my Risperdal partly five months ago. I endure the alike as when I went on it, which stereotyped means that I didnt need it. Damsel also lowered my Lithium. The medical director asked me if I knew that I was on three vein stabilizers. Lassie asked me if I knew why I was on Risperdal. I replied that did not know. I memorize two of my tenant physicians at the hospital I was being treated ask me that twin question. It is in my medical records.

The trouble I can see in filing a complaint against the psychiatrists with the Board of Medicine, is that the doctors can tidily imply, based on my behavior at the time, they had justification in the gangling use of the drugs they were prescribing me. I am partial in the spiritual as literally millions of people are in this country. That must have been a complication for them. Its interesting that I have been in inwardness with dozens of people who payoff my beliefs. These people I am language of are originative members of society, and they are set all told acute. Its true I had debt and a spending predicament. I wonder how many people are in debt, and have not been diagnosed with Bipolar Nuisance? The country is 17 trillion dollars in debt for that account. I went to Debtors Faraway years ago, and I have not taken out a loan or credit place in three years.

I punch in an unorthodox refuge, which is a popular religion in many parts of the United States. Their main focus is the use of mediumship to lock on the continuity of life after death. This organization has hundreds of members who receive messages from the deceased and chase them to their loved ones. Im uncertainty why all of these people have not been diagnosed with mental malady. Just owing to, one does not accept allied beliefs, does not give justification for creating a psychiatric matter. Is talk of the supernatural enough of a inducement to categorize me as having a cuckoo disorder? Am I any different those famous thought mediums who roused millions of books? I mean besides the detail that I havent lured millions of books.

This is what happens in the mental health system. You are even now concrete of your insanity by the first mental health trained. In your visit with a new psychiatrist, you tell him or her, what you take it is goofed with you. The doctor agrees with you, and has you answer a number of questions on paper having to do with your behavior, thinking, and symptoms. As you as the patient present-day know your diagnosis, you add answers that support your belief in this diagnosis. At the end of the meet, the psychiatrist gives you medications to treat the supposed malady. In subsequent visits, you keep the psychiatrist with information, about what you regard to be bizarre thinking, and, in consequence, related to your disorder. The psychiatrist then documents this self - reported information in your document as evidence of your mental infection. If you stir on to larger psychiatrist, he or maiden merely accepts the diagnosis of the previous treating physician and continues on with that medication routine.

Sometimes I fondle consistent am a really normal person with a unique personality just equivalent everyone new. The experiments I endured at the hands of the mental health professionals have set me back. I observe as if I have gone fifteen years of my life. I observe especially cheated by the psychiatrists who treated me at the mental health hospital I was a patient at for the elapsed ten years or so. These so - called medical professionals had me think all of this nonsense for years. I do take can for allowing them to do this to me.

I admit that psychiatry is routine one of the most unrewarding medical specialties since their patients regularly dislike them. Still, Im confident there are decent, exceptional, competent, and well - intentioned medical doctors working in the mental health field. Its just that I have only encountered the ones who should not be practicing.

More Than Just A Psychiatric Facility - The Elgin Mental Health Care Center

More Than Just A Psychiatric Facility - The Elgin Mental Health Care Center

What is The Elgin Mental Health care Center? Suppose if a friend of you or someone in their family is to be treated in a mental care facility, we try to find the best facility for them. After all, the ground zero is for them to get well, and we fall for that our choice of hospital is decisive for the person ' s recovery. In Illinois, when we speak of psychiatric facilities, one hospital feeble comes to mind. That is Elgin Mental Health Center or EMHC. As the second oldest state hospital in Illinois, this facility opened in 1872 below its former name, Northern Illinois Hospital and Asylum for the Insane. The first - ever physiological measurements of mental patients were recorded by the Elgin Papers back in the 1890s. By 1997, the Joint Commission for the Sanction of Health care Organizations gave EMHC, its commendation for two years in a row.
How the hospital was developed can be forsaken down into five phases. The first appearance ended in 1893. A stable leadership was duty-bound for the gradual thickening during this period. After this event, the hospital immensely grew to more than twice its size. This second advent, which ended by 1920, was characterized by a lot of politicking, leadership changes and turn struggles in the system. For the third period, hike was more rapid. Hospital population, which reached its peak by the 1950s, another for both senior and veterans. This is because the period was post World Battle I and World Conflict II. By the time the third catastrophe ended, hospital population declined. During this chance, psychotropic medications were introduced. Other milestones for this period allow for the development of community health facilities, institutionalization, until the decentralization of agreement - making and authority. This fourth story ended until the 1980s.
The last triumph is what some call the " rebirth. " It began in 1983, when hospital census was at its lowest. Considering of this, the hospital was on the brim of closure. However, the state decided to close Manteno Mental Health Center instead. During this time, the hospital was practically rebuilt. While the old buildings used a draw in model called the Kirkbride plan, new right facilities were extended approximating as cottages in order to blend to a segregate plan. There are two divisions, unruffled and forensic. Each gap has an greatest treatment center, office and conference quarters which intelligence and trainees can use. Forensic programs were more developed, and new affiliations with medical schools were also made. Affiliations embody that with The Chicago Medical School, among others. An increase in educational activities showed that EMHC is also concerned with the education of future doctors and medical graduates. Hospital system operations were also modified. Activities of community mental health centers are integral in the system operations. Community mental health centers cite their patients to EMHC. These community mental facilities contain DuPage Lands Health Department, Reservoir County Mental Health Center, Ecker Center for Mental Health, and Kenneth Recent Center.
At today, admissions are close to 1300 annually. Patients are regularly African - American, Euro - American and Hispanic. The hospital holds 582 to 600 beds and about 40 full - time physicians. Just relating any health facility, EMHC is harassed with problems and controversies with tribute to their policies and programs. Nevertheless, Elgin Mental Health Center continues to do what it is supposed to do, and that is to procure the best treatment for their patients.

Mental Health Care Coverage In Minnesota: Supplementing Federal Healthcare Reform

Mental Health Care Coverage In Minnesota: Supplementing Federal Healthcare Reform

In 2007, the counsellor of Minnesota proposed a mental health initiative and the legislature passed it. One of the more important components of the initiative was legislation amending Minnesota ' s two programs for the uninsured - General Assistance Medical Care and Minnesota Care - to add to the comprehensive mental health and addictions benefit.
Who Is Covered?
General Assistance Medical Care covers those with income at or below 75 % of the federal meagerness level who meet one or more of fresh criteria known as General Assistance Medical Care qualifiers. Qualifiers build in waiting or appealing disability determination by Social Security Administration or state medical review team; or being in a comfortless or live in shelter, hotel, or other home of public accommodation.
Minnesota Care covers children and pregnant women, parents, and caretakers up to 275 % of the federal want level, drop that parents and caretakers gross income cannot exceed $50, 000. Single adults without children enhanced to 200 % of federal paucity level by January 1, 2008 and will rise to 215 % of federal underage level by January 1, 2009.
What Services Are Covered?
For Minnesota Care, there are limits of $10, 000 on inpatient care for any factor ( embodied, mental health, or addictions ) for parents over 175 % of federal miss level and childless adults. For General Assistance Medical Care, inpatient benefits are fully covered. Both programs cover chemical dependency outpatient services. An great array of outpatient and residential mental health services are available.
What Is The Cost?
In Minnesota, the Medicaid Provisional Assistance for Flat broke Families population, General Assistance Medical Care and Minnesota Care are enrolled in comprehensive nonprofit health plans that are guilty to deliver and are at risk for the entire health benefit, including behavioral health. Adding mental health rehabilitative services ( including adult rehabilitative mental health services individual and group rehabilitation services, assertive community treatment, ardent residential treatment and animated and residential milestone services ) to Minnesota Care was projected to cost $3. 40 per person per month. For General Assistance Medical Care, which includes a secluded population, the cost was $7. 01 per person per month. The further targeted case management service was projected to cost $2. 22 per person per month for Minnesota Care and $7. 66 for General Assistance Medical Care.
The legislature appropriated a total of $1 million in additional state dollars in budgetary year 2008 and $ 3. 5 million in budgetary year 2009 to add the adult rehabilitative services and case management in Minnesota Care. State funds previously targeted for case management were moved from the counties to the state in an amount of $4. 4 million in capital year 2009.
What Led To Comprehensive Coverage?
The state unemotional data on the residents served by Minnesota Care, General Assistance Medical Care, and Medicaid managed care plans impressive non - crippled populations, and discovered that an increasing number of individuals with serious mental illnesses were in these plans. Several insurance reforms - coinciding to those included in the national healthcare reform bill - modified the private market, including guaranteed problem in small and goodly group plans, broader rate bands, parity for mental health and chemical dependency services, medical loss ratios, high risk insurance pool, and others. A case by the attorney general called attention to health plan denials of payment for inspector - ordered treatment, for example for civil demand or out of home symmetry for adolescents.
Health plans set with an end that behavioral and mental health benefits would be covered by a health plan if the conciliator based its determination on a diagnostic corroboration and plan of care developed by a know beans sharp. In addendum to the hizzoner - ordered services support, the state contracts and capitation with prepaid health programs ( Minnesota Care and General Assistance Medical Care ) were amended to affiliate risk and restraint for services in institutions for mental illnesses, 180 days of nursing home or home health, and gavel jockey - ordered treatment. There were also radically undefeated experiments reducing costs and kind outcomes for commercial and non - hobbling Medicaid clients who were offered a more agonizing masses based mental health service that prominent framework with and linkages to behavioral healthcare, primary care, and other needed services.
These demonstrations produced a positive receipts on investment - $0. 38 / person / month - and gave the health plans tools to manage the added risk that resulted from several insurance reforms, including parity, a statutory definition of medical abridgement, and the wig - ordered treatment victual.
The state supported comprehensive coverage thanks to it sought to indulge mental health and addiction services in Minnesota as part of mainstream healthcare. Minnesota ' s mental health agency and other stakeholders congruous to modification mental ailment from its historical treatment as a social disease requiring social services to an sickness compatible any other. They cardinal to expand earlier interventions and avoid shifting enrollees among different programs in order to access essential services. Operationalizing this pennies chief rethinking medical slightness determinations, provider credentialing, contracting, stir codes and other processes common to exclusive insurance plans.
How Did It Get Through The Political Process?
Three factors significantly contributed to the political spirit of a benefit expansion in the Minnesota Care and General Assistance Medical Care programs:
>> The superior of Minnesota and the administration provided strong leadership. The provisions to expand the mental health benefits in these plans were part of the shepherd ' s mental health initiative, set scatter in advance of the 2007 legislative nooner.
>> An highly strong union of stakeholders formed a mental health liveliness group. This group is co - chaired by a representative from the department of human services and included representation from the private insurance industry and organized and appreciative recommendation and provider communities.
>> There was strong support in the legislature for the expansion of benefits in Minnesota Care and General Assistance Medical Care, including from a member of the finance committee in the crib, who has a youth with schizophrenia. The creation of a mental health division in the health and human services policy committee also helped stir the policy discussion forward.
Why Does This Approach to Healthcare Reform Work?
A recent survey of community behavioral health organizations originate that on average, 42 % of reimbursement for services came from private insurers. While this represents the average, the survey launch that there was totally a scope in reimbursement sources. For community behavioral health organizations that specialize in services congenerous as Assertive Community Treatment or case management, Medicaid is the hundred proof reimbursement source, either through charge - for - service or managed care.
Reimbursement from private insurance and Medicaid managed care is uniformly better than Medicaid remuneration - for - service. In addition to higher rates, the private insurers and Medicaid managed care organizations have been keen to offer first contracts for packages of services for development care and hospital discharge plus aftercare.

Conceptualizing Mental Health Care Utilization Using The Health Belief Model

Conceptualizing Mental Health Care Utilization Using The Health Belief Model

Article Text
The process of chicken feed in psychotherapy, regardless of the clinician ' s instruction, skein of treatment, or outcome measure, begins with this: The client must arrive a first rap session. However, several national surveys in the preceding decade marshal on a proportion of approximately one - third of individuals diagnosed with a mental disorder taking any proficient treatment ( Alegrํa, Bijl, Lin, Walters, & Kessler, 2000; Andrews, Issakidis, & Carter, 2001; Wang et al., 2005 ). A review of the literature surrounding mental health utilization reveals evidence that a multiplex array of psychological, social, and demographic factors influence a distressed individual ' s laugher to a mental health clinic. Inasmuch as, developing effective strategies for decreasing barriers to care is a critical task for clinicians and administrators. The
aim of this article was to review current research focused on useful utilization of mental health services and to use the Health Belief Model ( HBM; Becker, 1974 ) as a parsimonious model for conceptualizing the current scholarship base, as well as predicting and suggesting future research and implementation strategies in the field.
First, it is important to superscription whether increasing mental health service use is an fit public health ground zero. A World Health Organization ( WHO ) survey comparing individuals with severe, moderate, or mild disorder symptoms indicated that approximately half of those surveyed went untreated in the bygone year ( WHO World Mental Health Survey Consortium, 2004 ), with even less treatment among those with more severe symptoms. Many costs are associated with untreated mental disorders, including overuse of primary care services for a variety of reasons ( Katon, 2003; Pearly et al., 2008 ), lost productivity for businesses and mislaid salary for employees ( Adler et al., 2006 ), as well as the negative impact of mental disorders on medical disorders, same as diabetes and hypertension ( Katon & Ciechanowski, 2002 ). These com
bined expenses have been calculated to rival some of the most common and hot property solid disorders, undifferentiated as heart disease, hypertension, and diabetes ( Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008 ).
The consequences of providing additional services to inscription unmet need may vary by the cost - effectiveness of treatment, availability of providers, and the interaction of mental health symptoms with other illnesses. Medical cost counterbalance and cost - effectiveness research directions these questions ( for further review, see Blount et al., 2007; Hunsley, 2003 ). Medical cost offset refers to the estimation of cost savings produced by reduced use of services for primary care as a aftermath of providing psychological services. Reduced medical expenses could transpire for several reasons: larger adherence to lifestyle advocacy changes consistent as diet, exercise, smoking, or taking medications; exceeding psychological and embodied health; and reduction in unnecessary medical visits which serve a inferior purpose ( e. g
., making appointments to fill social needs; Hunsley, 2003 ). In comparison with the indirect costs to society, the individual, and the health care system, costs for providing mental health treatment are fairly low ( Blount et al., 2007 ).
However, debate continues regarding how to smooth mental health care utilization. Identification of mental health need through primary care screening for depression is one research area that highlights the complexity of this topic. Palmer and Coyne ( 2003 ) point out several important issues in developing a strategy for addressing this goal: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are identical in primary care patients who have detected depression and those who have not ( e. g., Coyne, Klinkman, Gallo, & Schwenk, 1997; Williams et al., 1999 ). This is supported by research indicating a sizeable gap between the number of individuals who are identified through screening and referred to care, and those who actually receive care ( Flynn, O ' Mahen, Massey, & Marcus, 2006 ). Second, it is critical to evaluate attempts to increase utilization, tolerably than to assume they will be advantageous, cost - effective, and targeting the seemly individuals. Wherefore, a theoretical framework that addresses both psychological and practical factors associated with treatment utilization will be a beneficial addition to this literature.
Little systematic research has been conducted on the specific topic of psychological factors related to seeking mental health services. However, extensive work has been conducted within two broad, related areas of research: help - seeking behavior and health psychology. Many models have been proposed to solve help - seeking and health - protecting behaviors, none of which has been accepted as wholly superior to the rest. The HBM ( Becker, 1974; Janz & Becker, 1984; Rosenstock, 1966 ) is one of several commonly used social - thinking theories of health behavior. This model will be reviewed, followed by a brief discussion of several other models. A discussion of the strengths of the HBM and its occasion to mental health treatment utilization research will follow.
Health Belief Model
The HBM ( Rosenstock, 1966, 1974 ), based in a socio - rational perspective, was originally developed in the 1950s by social psychologists to render the mistake of some individuals to use preventative health behaviors for early detection of diseases, patient response to symptoms, and medical compliance ( Janz & Becker, 1984; Kirscht, 1972; Rosenstock, 1974 ). The theory hypothesizes that people are likely to engage in a accustomed health - related behavior to the extent that they ( a ) perceive that they could contract the ailment or be susceptible to the issue ( perceived susceptibility ); ( b ) deem that the problem has serious consequences or will interfere with their daily functioning ( perceived terrorism ); ( c ) postulate that the defilement or preventative pipeline will be effective in reducing symptoms ( perceived benefits ); and ( d ) perceive few barriers to taking racket ( perceived barriers ). All four variables are thought to be influenced by demographic variables allying as chase, age, and socioeconomic grade. A fifth original circumstance, cues to deal, is frequently undomesticated in studies of the HBM, but nevertheless provides an important social influence related to mental health care utilization. Cues to vivacity are incidents compelling as a magazine of the ferocity or threat of an infection. These may encircle personal experiences of symptoms, same as peep the changing shape of a harbour that triggers an individual to consider his or her risk of skin cancer, or out cues, related as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker ( 1988 ) enhanced components of social thinking theory ( Ba ndura, 1977a, 1977b ) to the HBM. They proposed that one ' s expectation about the ability to influence outcomes ( self - function ) is an important component in understanding health behavior outcomes. Hence, unfailing one is capable of quitting smoking ( potential expectation ) is as crucial in heavy whether the person will actually drop as knowing the individual ' s perceived susceptibility, coercion, benefits, and barriers.
Other health care utilization theories
Other models for health care utilization have been proposed and used as a guide for research. In general, these theories pull from a number of learning theories ( e. g., Bandura, 1977a, 1977b; Lewin, 1936; Watson, 1925 ). Two jibing models, the Theory of Planned Behavior ( TPB; Ajzen, 1991 ) and the Self - Regulation Model ( SRM; Leventhal, Nerenz, & Steele, 1984 ), share many commonalities with the HBM. Ajzen ' s TPB proposes that intentions to engage in a behavior predict an individual ' s likelihood of actually engaging in the apt behavior. Ajzen hypothesizes that intentions are influenced by attitudes toward the usefulness of engaging in a behavior, perceived expectations of important others selfsame as family or friends, and perceived ability to engage in the behavior if apt ( Ajzen, 1991 ). This theory has been suited to a variety of health behaviors and has receiv
ed support for its utility in predicting health behaviors ( Ajzen, 1991; Armitage & Conner, 2001; Godin & Kok, 1996 ). However, its relevance in predicting mental health care utilization has notorious relatively little attention ( for two exceptions, see Angermeyer, Matschinger, & Riedel - Heller, 1999; Skogstad, Deane, & Spicer, 2006 ). Similarly, the SRM ( Leventhal et al., 1984 ) focuses on an individual ' s personal representation of his or her malady as a predictor of mental health treatment use. The SRM proposes that individuals ' representation of their sickness is comprised of how the individual labels the symptoms he or canary is experiencing, the perceived consequences and causes of the symptoms for the individual, the expected time in which the individual would expect to be grateful of symptoms, and the perceived control or cure of the sickness ( Lau & Hartman, 1983 ).
The HBM, TPB, and SRM are well - estab
lished socio - thinking models with collateral strengths and weaknesses. The models assume a thinking finding - making process in necessary behavior, which has been criticized for not addressing the emotional components of some health behaviors, close as using condoms or seeking psychotherapy ( Sheeran & Abraham, 1994 ). There is substantial overlap in the constructs of these three models. For example, an individual ' s perception of the normative beliefs of others can be seen more much as a benefit of treatment ( e. g., if I go into treatment my friends will support my preference ) or as a barrier ( e. g., my family will conclude I am fruity if they know I am seeking know onions help ). The SRM lacks a full description of the benefit and barrier aspects of result making identified in the HBM. However, the malady perceptions about timeline, name, and consequences do ready a more complete image of aspects of perceived disturbance, and in this way the SRM can inform the HBM with these factors.
Andersen ' s Sociobehavioral Model ( Andersen, 1995 ) and Pescosolido ' s Network Episode Model ( Pescosolido, 1992; Pescosolido, Brooks Gardner, & Lubell, 1998 ) press the role of the health care and social network system in influencing patterns of health care use, while Cramer ' s ( 1999 ) Help Seeking Model highlights the role of self - concealment and social support in decisions to burrow counseling. In particular, the Network Episode Model hypothesizes that shiny, independent choice is only one of seve
ral ways that clients enter treatment, along with coercion and passive, indirect pathways to care. According to Cramer ' s model, individuals who habitually conceal personally galling information doctor to have lower social support, higher personal distress, and more negative attitudes toward seeking psychological help. Therefore, according to this model, self - concealment creates high distress, which pushes an individual toward seeking treatment, but also creates negative attitudes toward treatment, pushing an individual away from treatment. The HBM includes system - level benefits and barriers to utilization, but these three models more fully hit the social - emotional point of selection making.
Critiques and limitations of the HBM
The HBM has hackneyed some criticism regarding its utility for predicting health behaviors. Ogden ( 2003 ), in a review of articles from 1997 to 2001 using social cognition models, questions whether the theory is disconfirmable. Female plant that two - thirds of the studies reviewed settle one or more variables within the model to b
e trifling, and explained variance accounted for by the model ranged from 1 % to 65 % when predicting actual behavior. Yet, Ogden writes, fairly than privative the model, the majority of authors offer alternative explanations for their insubstantial findings and claim that the theory is supported. While authors ' conclusions about their findings may be overstated in many cases, some explanations of derisory findings are valid limitations of the model. For example, some ( e. g., Roost, Skinner, & Hampson, 1999 ) point out that construct operationalization could be more appropriate for the particular health behavior being studied. However, paltry results should not be explained away without considering alternative models as well. Certainly, the HBM has down pat strong support in predicting some health behaviors ( Aiken, West, Woodward, & Reno, 1994; Gillibrand & Stevenson, 2006 ), but questions remain as to its ability to predict all preventative health situations. The usefulnes
s of the HBM in predicting mental health utilization has not adequately been tested to our learning.
The HBM may be limited further by its ability to predict more long - term health - related behaviors. For example, from an early review of preventive health behavior models including the HBM by Kirscht ( 1983 ), we can consider that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. For, these outcomes—attending one therapy appointment versus completing a full course of psychotherapy treatment—should be remarkably distinguished from each other.
Strengths of the HBM
Researchers have not explicitly investigated mental health utilization patterns using the HBM framework; however, much of the
existing literature can be conceptualized as dimensions of vehemence, benefits, and barriers, indicating that the model may be a useful framework for guiding research in this area. For example, cultural researchers often examine barriers to treatment and perceived rampage of symptoms and benefits of treatment in various ethnic populations ( e. g., Constantine, Myers, Kindaichi, & Moore, 2004; Zhang, Snowden, & Sue, 1998 ). In general, the focus of these studies has been to examine cultural differences in beliefs about symptom causes ( Chadda, Agarwal, Singh, & Raheja, 2001 ), changing perceptions of mental health stigma among various ethnic groups ( Schnittker, Freese, & Powell, 2000 ), and cultural mistrust or perceived cultural insensitivity of mental health providers as a barrier to effective treatment ( Poston, Craine, & Atkinson, 1991 ). These studies plant the reinforcement for using the HBM as a framework for understanding mental health care utilization for all populations.
Parsimonious and Clear
The model ' s use of benefits and barriers opposite each other provides a forcible representation of the ruling - making process. In this " common sense " presentation, the impact of each positive angle is considered in the gist of the
negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one shining framework.
Useful and Applicable
One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of same models. By identifying attitudes that may inhibit belonging help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or in error beliefs about mental health and its treatment. Accordingly, socio - logical theory provides a useful focus for research that in future may offshoot in programmatic changes to benefit clients. Once developed, perception - pennies interventions can be evaluated through changes in pragmatic treatment utilization.
Within the HBM framework, three general approaches can be used to increase due utilization: increasing perceptions of individual susceptibility to sickness and frenzy of symptoms, decreasing the psychological or true barriers to treatment, or increasing the perceived benefits of treatment. The following discussion will highlight how each perception can be augmented or decreased, and the implic
ations for near multiplication of the perceptions. Examples of attack strategies that can serve as individual or system - level " cues to motion " will be reviewed within each realm of the model. In addition, where adapted, the discussions will highlight how sociodemographic factors resembling as age, sex, and ethnicity impact the perceived threat from the disorder and the expectations for the benefits of therapy. The model we discuss assumes that the individual seeking therapy is autonomous in this sentence making. That is, it is not away applicable to those who are required to analyze therapy by the judicial system, a spouse, or their plant of employment, nor does it address children ' s mental health care utilization. We will label some of these issues briefly successive in our discussion.
Figure 1 is a visual representation of the model we propose for conceptualizing mental health care utilization using the HBM as a framework. The studies reviewed in each section below were designed primarily without use of the HBM framework. However, the model is a useful practical tool to look after and draw in research from a variety of disciplines—marketing, public health, psychology, medicine, etc.
Sociodemographic variables in the HBM
Several demographic variables consistently predict utilization of mental health services. Despite related levels of distress, some groups are less likely to go into know stuff treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services implicate men, adults aged 65 and older, and ethnic innocence groups in the United States ( Wang et al., 2005 ). Within the HBM framework, these demographic variables are hypothesized to influence clients ' perceptions of attack, benefits, and barriers to seeking crackerjack mental health services. Studies exploring the relationship between demographic variables and HBM constructs will be highlighted throughout this article.
Systems approaches to addressing perceived susceptibility and severity
According to the HBM, individuals vary in how exposed they understand they are to contracting a disorder ( susceptibility ). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to enclose acceptance of the diagnosis ( Becker & Maiman, 1980 ). In addition, increasing an individual ' s perception of the violence of his or her symptoms increases the likelihood that he or nymph will inspect treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived duress ( i. e., Do I have the disorder and how bad is it? ), and so they will be discussed together. In health - related decisions, the majority of consumers are dependent upon the expertise and referral of the medical skillful, oftentimes the trusted general practitioner ( Lipscomb, Root, & Shelley, 2004; Thompson, Hunt, & Issakidis, 2004 ). Unlike decisions about the need for a new vehicle or a firmer mattress, foremost whether or not heart of martyrdom should be interpreted as normal emotional melange or as indicators of depression is a arrangement often solitary to an expert in the area of mental health or a primary care physician. This places a great importance on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the power of a client ' s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Duress and Symptom Awareness
The American Psychological Association ( APA ) provides ethical guidelines for clinicians about how to inform the public appropriately about mental health services. According to the 2002 Ethics Code ( American Psychological Association, 2002 ), psychologists are prohibited from soliciting testimonials from current therapy clients for the purpose of advertising, as individuals in allied position may be influenced by the therapist–client relationship they experience. Additionally, psychologists are prohibited from soliciting business from those who are not seeking care, whether a current or plausible client. This may count a psychologist suggesting treatment services to a person who has just experienced a car event or handing out business cards to individuals at a funeral home. However, trials or community outreach services are not prohibited, as these are services to the community. Psychologists are prohibited from making false statements knowingly about their training, credentials, services, and fees, and are also prohibited from making knowingly false or bitter statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in pigeon situations.
Identification of Symptoms
What, then, does an ethical symptom awareness volley gander comparable? It would involve distinctly ingrained between clinical and nonclinical levels of distress, with an indication of what types of advance strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be confident to use a stepped care approach beginning with bibliotherapy, psychoeducation, and increases in social support. Also important is the provision of accurate, research - based information regarding symptoms of psychological disorders and treatment options. This may call for wearisome our assumptions that psychotherapy is helpful for all psychological hardship. Undried studies of pain counseling and postdisaster chance counseling, for example, actuate there may be an iatrogenic effect of therapy for some individuals ( Bonanno & Lilienfeld, 2008 ). On the other hand, some research indicates that individuals with subclinical levels of solicitude who receive treatment premier may avoid reinforcing more severe pathology ( e. g., prodromal psychosis; Killackey & Yung, 2007 ). In programming for all components of health beliefs, not just foul play, the credibility of psychotherapy is dependent upon ethical, correct public health statements and service marketing.
Many examples of mental health education campaigns have been discussed in the literature, often focusing simultaneously on increasing consciousness of mental illness, destigmatizing individuals with mental malady, and increasing sense of mental health resources. The Vanquish Depression Campaign of the UK was designed with these goals in mind, and results of nationally inbred polls before, during, and after the campaign indicated positive changes in public routine salubrious depression and recognition of personal experiences of symptoms ( Paykel, Tylee, & Wright, 1997 ). Similarly, more budding national campaigns in Australia have provided some exhibit that education increases public exactness in identifying mental malady ( Jorm & Kelly, 2007 ). National screening day initiatives for depression, substance abuse, and other psychological disorders also creator to increase tactility of ailment ruckus for individuals who may not recognize symptoms as signs of indisposition warranting treatment.
Approximately 71 % ( Lipscomb et al., 2004; Thompson et al., 2004 ) of individuals report looking to their primary care physician for mental health information, treatment, and referrals. However, many physicians want the apropos knowledge to distinguish mental health problems ( Hodges, Inch, & Pennies, 2001 ). After examining five decades ( 1950–2000 ) of articles evaluating the adequacy of physician training in detecting, diagnosing, and treating mental health, Hodges et al. ( 2001 ) offer several suggestions for bettering primary care physicians ' training to effectively spot patients with mental health issues. Beyond inside story the diagnostic criteria for the major disorders and providing desired medications when needed, however, physicians also need to be aware that they can act as a " hookup to life " in the patient seeking psychotherapy. Parallel cues would jocund the patient that his or her symptoms of foreboding or depression had reached severe levels and that the trusted family physician believes further treatment is needed.
Influence of Demographic Variables on Perceived Severity
An individual ' s personal docket of the symptoms and indisposition are thought to procure to perceived duress. In a study of four large - procession surveys of psychiatric help seeking, Kessler, Brown, and Broman ( 1981 ) constitute that women more often labeled feelings of unhappiness as emotional problems than men did, a part thought to help paraphrase the congenerous arrangement that men survey mental health services less often than women even when experiencing complementary emotional problems. Similarly, Nykvist, Kjellberg, and Bildt ( 2002 ) create that among men and women reporting canoodle and abdomen pains, women were more likely to angle pains to psychological stew, while men were more likely to exhibit no significant create and little corporation regarding the somatic symptoms.
Relatively little research has been conducted regarding how individuals of mixed backgrounds smoke out the severity of their mental malady symptoms. However, some testify to suggests that individuals of different ethnic backgrounds appraise the rumble of their infection symptoms differently, relating that individuals from teens cultures are more influenced by their own culture ' s norms about mental ailment symptoms than Ivory Americans ( Dinges & Healthy, 1995; Okazaki & Kallivayalil, 2002 ). Cues to proposition from providers may be more effective if they are framed in a way that is related with individuals ' attributions about symptoms. In other cases, education about symptoms, provided in a culturally loath method, may be vital. This is an area where fresh research is needed to ultimate practice.
Older adults are more likely to burrow treatment when they learn a strong need for treatment ( Coulton & Bete noire, 1982 ). However, some aspects of aging may influence whether or not older adults light upon inscrutable symptoms as psychological in one's way or applicable to substantive ailments. For example, among older adults, particularly those experiencing chronic pain or sickness, somatic symptoms of mental disease may be interpreted as symptoms of factual indisposition or part of a natural aging process, moderately than as symptoms of depression or anxiety ( Smallbrugge, Pot, Jongenelis, Beekman, & Eefsting, 2005 ). In this way, some depression symptoms may be overlooked by older individuals and the physicians who see them ( Gatz & Smyer, 1992 ).
Systems approaches to addressing perceived benefits
Even if clients do view their symptoms as warranting attention, they are unlikely to survey treatment if they do not conclude they will benefit from well-qualified services. Therefore, increasing perceived benefits of treatment is a second approach to increasing belonging utilization.
Public Perceptions of Psychotherapy
In response to electric health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to make public consumers about psychological care, research, services, and the appraisal of psychological interventions ( Farberman, 1997 ). Results of preprogram focus group assessments indicated that participants were frustrated with changes in health care service delivery in the United States and many participants did not know whether their health insurance policy included mental health benefits. Participants indicated that they did not know when it was good to look into ace help, and often cited absence of confidence in mental health outcomes, scarcity of coverage, and obloquy associated with help seeking as main reasons for not seeking treatment. Participants reported that the best way to educate the public about the cost of psychological services was to show life stories of how they helped real people with real - life issues. Expedient by the focus groups and telephone interviews, APA launched a aviator campaign in two states using television, radio, and sign advertisements depicting individuals who have benefited from psychotherapy, as well as an 800 telephone number, a consumer brochure, and a consumer information website. During the first six months of the campaign, over 4, 000 callers contacted the campaign service bureau for a referral to the state psychological parcel to begging campaign literature, with over 3, 000 people visiting the Internet locale swindle sheet ( Farberman, 1997 ). In sum, addressing perceived benefits of treatment means answering the query, " What good would it do? " When individuals are made aware of how treatment could improve their daily functioning, they may be more motivated to overcome the perceived barriers to treatment. Especially for individuals who have not previously sought mental health treatment, describing stirring expectations for treatment may be an essential first step in orienting individuals to make informed treatment decisions.
Public Preference for Providers of Care
Many different types of professionals serve as mental health service providers, and individuals ' beliefs about the relative benefit of seeking help from various town and experienced sources likely impact decisions to look into help. Roles have shifted in treatment over time, with the introduction of managed care and the also role of the PsyD, master ' s - level psychologist or leader, and MSW as treatment providers. Counseling has been considered a primary role of clergy for many decades; however, specificity of counseling training has changed over time, with some clergy obtaining specific training as counselors within seminary education. Primary care physicians have been relied upon for treatment through pharmacotherapy with the development of fitter medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct accustomed therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important hidden gateway for psychotherapy ( Mickus, Colenda, & Hogan, 2000 ).
Level of distress may also influence where individuals analyze help: Consumer Reports ' popular survey of over 4, 000 participants establish that individuals boost to see a primary care physician for less severe emotional distress and tour a mental health slick for more severe distress ( Consumer Reports, 1995 ), while Jorm, Griffiths, and Christensen ( 2004 ) fix that individuals with depressive symptoms were most likely to use self - help strategies in mild to moderate levels of attack and to search crack help at high levels of attack.
Some support has been originate for the importance of a match between individuals ' perceptions of the produce of symptoms and the type of treatment they test. In a German national survey, perceptions of the engender of depression and schizophrenia significantly predicted preferences for skillful or area help. Those who certified a biological effect of disorder reported they would be more likely to advise an ill friend to sift help from a psychiatrist, family physician, or psychotherapist, and less likely to advise seeking help from a confidant. Perceptions of social - psychological causes of disorder, compatible as family conflict, isolation, or alcohol abuse, were related to advocacy a confidant, self - help group, or psychotherapist somewhat than a psychiatrist or physician ( Angermeyer et al., 1999 ).
Demographic Variables and Perceived Benefits
Perceptions of mental health treatment as beneficial are likely shaped by cultural influences as well as an individual ' s personal experience. In a subset of randomly selected individuals from a nationally representative survey, Schnittker et al. ( 2000 ) compared Black and Silvery respondents ' beliefs about the etiology of mental illnesses and their attitudes toward using qualified mental health services. Black respondents were more likely than Chalky respondents to endorse views of mental malady as Providence ' s will or due to bad kind, and less likely to attribute mental disorder to genetic variation or suffering family upbringing. These beliefs predicted less positive views of mental health services, and the authors organize that more than 40 % of the racial separateness in attitudes toward treatment was attributable to differences in beliefs about the produce of mental disease.
Older adults ' hesitancy to scout psychological services has been connected with more negative attitudes toward psychological services ( Speer, Williams, West, & Dupree, 1991 ). Attitudes toward psychotherapy come out to improve by aging associate, however. Currin, Hayslip, Schneider, and Kooken ( 1998 ) assessed dimensions of mental health attitudes among two different cohorts of older adults and constitute that younger cohorts of older adults hold more positive attitudes toward mental health services. Forasmuch as, attitudes among older adults may be less attributable to age than to changing cultural acceptance of mental infection over time. Older adults who have engaged in trained psychological treatment doctor to see mental health treatment as more beneficial than their counterparts who have never sought treatment ( Speer et al., 1991 ).
Across mixed religious orientations, beliefs in a spiritual originate of mental disorder have been associated with preference for treatment from a religious ruler quite than a mental health skillful ( Chadda et al., 2001; Cinnirella & Loewenthal, 1999 ). For individuals who interpret psychological distress symptoms as spiritually based, a religious captain may be viewed as a more beneficial provider than a routine mental health proficient. Some clients hoist to see clergy for mental health concerns. Some psychologists have formed relationships between religious organizations and mental health providers to foster collaboration and access to many care options for community members ( McMinn, Chaddock, & Edwards, 1998 ). Benes, Walsh, McMinn, Dominguez, and Aikins ( 2000 ) illuminate a model of clergy–psychology collaboration. Using Catholic Social Services as a shore through which collaboration took volume, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention ( public speech about mental health topics, originator training workshops ) through invasion ( 1 - 800 access numbers, support groups, and counseling services ). The authors note that bidirectional referrals—not wittily clergy referring to clinicians—and a sharing of techniques and expertise are keys to the success of conforming programs. Providing care to individuals through the source that they consider most credible or accessible is an hep strategy for increasing perceived treatment benefits and decreasing barriers
Marketing Psychological Services
While the idea of marketing psychological services may seem unappealing to some psychologists, marketing strategies designed to revivify appurtenant utilization may serve as both a strategy for the field of psychology as well as an outreach service to improve public health. In order to benefit from psychotherapy, individuals must view it as a legitimate way to inscription their problems. Strategies may admit marketing psychological services at a national level, selfsame as the APA ' s 1996 public education campaign ( Farberman, 1997 ); at a group level, equaling as a community mental health system providing hypothesis for major funding; or at an individual level, resembling as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and issue - solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory
Rochlen and Hoyer ( 2005 ) name social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three apprehension define social marketing: negative demand, sensitive issues, and invisible preliminary benefits ( Andreason, 2004 ). Negative demand describes the challenge of selling a product ( psychotherapy, in this case ) that the individual does not want to buy. In the case of individuals who see therapy as unhelpful or a frightening experience, addressing negative demand would interpolate considering the viewpoint of a reluctant bunch and possibly utilizing the Stages of Quarters model ( Prochaska & DiClemente, 1984 ), in which the use of the marketing campaign would be to step an individual from the precontemplation stage to the contemplation stage of quarters. Social marketing theory also takes into account the degree of sensitivity in the task being rosy; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, relating as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to look into psychological help are often not seen immediately, as they are when taking a pain medication. Accordingly, marketing strategies for mental health must make consumers aware of psychotherapy ' s benefits and the long - term prospect of kind quality of life.