Skip to main content

Advertisement

Log in

Balancing Accessibility and Selectivity in 21st Century Public Mental Health Services: Implications for Hard to Engage Clients

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

This research highlights the importance of expanding examinations of service accessibility for hard to engage client populations to include assessments of individuals’ ability to gain entrance to services and the system’s ability to meet the service needs of particular client populations. The results of this research provide a framework to support these examinations. The increasing levels of selectivity and targeting of mental health services to particular client populations found in this study raise fundamental questions about the goals of service accessibility in 21st century public mental health services generally, and for hard-to-engage clients particularly. These findings also point to the need for examinations of the eligibility criteria and gatekeeping mechanism that are used to target services to particular client populations to determine if they are working as intended and to assess what impact these mechanisms have on hard to engage clients’ ability to gain entrance to needed services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Pandini JA, Banks SM, Bramley J, et al. Measuring access to mental health care: a multi-indicator approach to program evaluation. Evaluation and Program Planning. 2002; 25:271–285.

    Article  Google Scholar 

  2. Glied S, Frank R. Better but not best: Recent trends in the wellbeing of the mentally ill. Health Affairs. 2009; 28(3):637–648.

    Article  PubMed  Google Scholar 

  3. Osher, FC, Levine IS. Navigating the Mental Health Maze: A Guide for Court Practitioners. 2005. Council of State Governments.

  4. Stiles PG, Boothroyd, RA, Snyder, K, et al. Service penetration by persons with serious mental illness: how should it be measured? The Journal of Behavioral Health Services & Research. 2002;29(2):198–207.

    Google Scholar 

  5. Abram KM, Teplin, L. Co-occurring disorders among mentally ill jail detainees: implications for public policy. American Psychologist. 1991;46:1036–1045.

    Article  PubMed  CAS  Google Scholar 

  6. Lovell D, Gagliardi G, Peterson P. Recidivism and use of services among persons with mental illness after release from prison. Psychiatric Services. 2002;53:1290–1296.

    Article  PubMed  Google Scholar 

  7. Padgett D, Struening EL, Andrews, H. Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Medical Care. 1990;28:805–821.

    Article  PubMed  CAS  Google Scholar 

  8. Ridgely M, Goldman H, Willenbring M. Barriers to the care of persons with dual diagnoses: organizational and financing issues. Schizophrenia Bulletin. 1990;16(1):123–132.

    Article  PubMed  CAS  Google Scholar 

  9. Whitmer GE. From hospitals to jails: the fate of California's deinstitutionalized mentally ill. American Journal of Orthopsychiatry. 1980;50:65–75.

    Article  PubMed  CAS  Google Scholar 

  10. Draine J. Wilson AB. Pogorzelski W. Limitations and potential in current research on services for people with mental illness in the criminal justice system. Journal of Offender Rehabilitation. 2007;45:159–177.

    Article  Google Scholar 

  11. Wilson AB, Draine J. Collaborations between criminal justice and mental health system’s in prisoner reentry. Psychiatric Services. 2006;57:875–878.

    Article  PubMed  Google Scholar 

  12. Smith, BD, Marsh JC. Client-service matching in substance abuse treatment for women with children. Journal of Substance Abuse Treatment. 2002;22(3):161–168.

    Article  PubMed  Google Scholar 

  13. Department of Behavioral Health and Intellectual disability Services. Offices of Mental Health. Available online at http://www.dbhids.org/office-of-mental-health-omh. Accessed on 3/22/12.

  14. Padgett D. Qualitative Methods in Social Work Research: Challenges and Rewards. Thousand Oaks, CA: Sage, 2008

  15. Morgan DL. Focus Groups as Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage, 1997.

    Google Scholar 

  16. Emerson RM, Fretz RI, Shaw LL. Writing Ethnographic Field Notes. Chicago, IL: University of Chicago Press, 1995.

    Book  Google Scholar 

  17. Strauss AL, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage, 1998.

  18. Grob G. From Asylum to Community: Mental Health Policy in Modern America. Princeton, NJ: Princeton University Press, 1991.

  19. Cutler DH, Bevilacqua J, McFarland BH. Four decades of community mental health: a symphony in four movements. Community Mental Health Journal. 2003;39:381–398.

    Article  PubMed  Google Scholar 

  20. Mowbray CT, Grazeir KL, Holter M. Managed behavioral health care in the public sector: will it become the third shame of the states? Psychiatric Services. 2002;53(2):157–171.

    Article  PubMed  Google Scholar 

  21. Mechanic D. From Advocacy to Allocation: The Evolving American Health Care System. New York, NY: The Free Press, 1986

    Google Scholar 

  22. Hogan MF. The president’s new freedom commission: recommendations to transform mental health care in America. Psychiatric Services. 2003;54:1467–1474.

    Article  PubMed  Google Scholar 

  23. Power AK. A public health model of mental health for the 21st century. Psychiatric Services. 2009;60:580–584.

    Article  PubMed  Google Scholar 

  24. Goldman HH, Glied SA, Alegria M. Conclusion: mental health in the mainstream of public policy. American Journal of Psychiatry. 2009;166:1215–1216.

    Article  PubMed  Google Scholar 

  25. Morrissey JP, Fagan JA, Coczza JJ. New models of collaboration between criminal justice and mental health systems. American Journal of Psychiatry. 2009;166:211–1214.

    Article  Google Scholar 

Download references

Acknowledgments

This research was funded in part by a grant from the Leonard Davis Institute of Health Economics, University of Pennsylvania.

Conflicts of interest

The authors report no competing financial interests or commercial relationships

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amy Blank Wilson PhD, LSW.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilson, A.B., Barrenger, S., Bohrman, C. et al. Balancing Accessibility and Selectivity in 21st Century Public Mental Health Services: Implications for Hard to Engage Clients. J Behav Health Serv Res 40, 191–206 (2013). https://doi.org/10.1007/s11414-012-9307-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-012-9307-x

Keywords

Navigation