Choice, coercion, and/or muddling through: An exploration of older Manitobans’ experiences seeking psychological care
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Date
2018-10
Authors
Berard, Lindsay
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Abstract
In any given year, approximately 20% of Canadians suffer from mental health problems, and treatment-seeking has been shown to be least likely in older adults. Although decades of research have been devoted to help-seeking behaviors, barriers to accessing treatment, and service utilization models, reasons why many older adults with mental health problems do not seek professional help are not fully understood. Theoretical models can be helpful in improving our understanding of why people do or do not seek help, and the Network Episode Model (NEM) (Pescosolido et al., 1998) suggests that there are three unique pathways into treatment: choice (willingness), coercion (force or pressure) or muddling through (either ‘drifting around’ between services, or having someone other than the client take over the help-seeking journey). This study aimed to capture the dynamic process of older Manitobans’ help-seeking pathways, in order to better understand the experiences of clients from their initial mental health concerns, through to a clinical psychologist’s office. The current study examined two objectives: 1) classifying participants' pathways into treatment according to the NEM, and 2) exploring whether the pathways should represent distinct treatment journeys (i.e., choice, coercion, or muddling through), or if they are best conceptualized as co-occurring processes (i.e., choice, coercion, and muddling through). Utilizing secondary qualitative data from three previous studies (N = 35), objective one was examined using directed content analysis, to classify older Manitobans’ pathways into treatment using the NEM. Participants’ sought help for a variety of reasons, including anxiety and mood disorders, coping with life stressors and physical illness, and caregiver stress. Findings highlight that the majority (n=21, 60%) of the sample entered care choicefully (willingly accessing treatment), with 42.9% of that group involving ‘others’ in their treatment-seeking, by way of referrals, advise, or support. The remaining participants (n =14, 40%) entered care through the muddling pathway. No participants’ pathways were primarily categorized as coercive. For the second objective, conventional content analysis was used to explore how best to categorize pathway journeys. Findings demonstrated that few participants (n = 10, 28.6%) had a help-seeking journey that represented only one type of pathway. A period of muddling through was included in all but two participants’ journeys to care, and muddling often preceded choice. These findings highlight that the process of help-seeking is not always unitary or a direct pathway to treatment. For clinicians, having an effective way to capture and describe pathways to treatment as a dynamic process with choice, coercion, and muddling through could prove to be more beneficial for understanding clients and developing personalized conceptualizations to treatment. Additionally, this may serve to inform health researchers and policy makers in understanding the often-complex route to accessing care, which may aid in removing barriers and systematic delays to accessing treatment, supporting the growing numbers of older adults with mental health problems who will need treatment in the coming decades.
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Keywords
Mental health, Help-seeking, Older adults, Network Episode Model, Service utilization