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Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-03-2016 | Original Article

Barriers to the Treatment of Mental Illness in Primary Care Clinics in Israel

Authors: Liat Ayalon, Khaled Karkabi, Igor Bleichman, Silvia Fleischmann, Margalit Goldfracht

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 2/2016

Abstract

The present study examined physicians’ perceived barriers to the management of mental illness in primary care settings in Israel. Seven focus groups that included a total of 52 primary care Israeli physicians were conducted. Open coding analysis was employed, consisting of constant comparisons within and across interviews. Three major themes emerged: (a) barriers to the management of mental illness at the individual-level, (b) barriers to the management of mental illness at the system-level, and (c) the emotional ramifications that these barriers have on physicians. The findings highlight the parallelism between the experiences of primary care physicians and their patients. The findings also stress the need to attend to physicians’ emotional reactions when working with patients who suffer from mental illness and to better structure mental health treatment in primary care.

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al-Krenawi, A., & Graham, J. R. (1999). Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev. Culture, Medicine, Psychiatry, 23(2), 219–243.CrossRef

Ayalon, L., Arean, P. A., Linkins, K., Lynch, M., & Estes, C. L. (2007). Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. American Journal of Geriatric Psychiatry, 15(10), 906–912. doi:10.1097/JGP.0b013e318135113e.CrossRefPubMed

Ayalon, L., Gross, R., Yaari, A., Feldhamer, E., Balicer, R., & Goldfracht, M. (2011). Characteristics associated with purchasing antidepressant or antianxiety medications through primary care in Israel. Psychiatric Services, 62(9), 1041–1046. doi:10.1176/appi.ps.62.9.1041.

Ayalon, L., Karkabi, K., Bleichman, I., Fleischmann, S., & Goldfracht, M. (2014). Between modern and traditional values: Informal mental health help seeking attitudes according to Israeli Arab women, primary care patients and their providers. International Journal of Social Psychiatry. doi:10.1177/0020764014549082.

Bell, R. A., Franks, P., Duberstein, P. R., Epstein, R. M., Feldman, M. D., Garcia, E Fy, & Kravitz, R. L. (2011). Suffering in silence: Reasons for not disclosing depression in primary care. The Annals of Family Medicine, 9(5), 439–446. doi:10.1370/afm.1277.CrossRefPubMed

Bener, A., & Ghuloum, S. (2011). Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. International Journal of Social Psychiatry, 57(5), 480–486. doi:10.1177/0020764010374415.CrossRefPubMed

Benzer, J. K., Beehler, S., Miller, C., Burgess, J. F., Sullivan, J. L., Mohr, D. C., … Cramer, I. E. (2012). Grounded theory of barriers and facilitators to mandated implementation of mental health care in the primary care setting. Depression Research and Treatment, 2012, 11. doi:10.1155/2012/597157.CrossRef

Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006). Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging, 21(1), 140–151. doi:10.1037/0882-7974.21.1.140.

Central Bureau of Statistics. (2006). Immigrants from the former Soviet Union: Demographic trends 1990–2001 (in Hebrew). Jerusalem: Central Bureau of Statistics.

Central Bureau of Statistics. (2014). Population by population group (in Hebrew). Jerusalem: Central Bureau of Statistics.

Chomienne, M. H., Grenier, J., Gaboury, I., Hogg, W., Ritchie, P., & Farmanova-Haynes, E. (2011). Family doctors and psychologists working together: Doctors’ and patients’ perspectives. Journal of Evaluation in Clinical Practice, 17(2), 282–287. doi:10.1111/j.1365-2753.2010.01437.x.CrossRefPubMed

Chong, W., Aslani, P., & Chen, T. (2013). Health care providers’ perspectives of medication adherence in the treatment of depression: A qualitative study. Social Psychiatry and Psychiatric Epidemiology, 48(10), 1657–1666. doi:10.1007/s00127-012-0625-3.CrossRefPubMed

Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13(1), 3–21. doi:10.1007/bf00988593.CrossRef

Coventry, P., Hays, R., Dickens, C., Bundy, C., Garrett, C., Cherrington, A., & Chew-Graham, C. (2011). Talking about depression: A qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Family Practice, 12(1), 10.PubMedCentralCrossRefPubMed

Coyne, J. C., Schwenk, T. L., & Fechner-Bates, S. (1995). Nondetection of depression by primary care physicians reconsidered. General Hospital Psychiatry, 17(1), 3–12. doi:10.1016/0163-8343(94)00056-J.

Dinos, S., Stevens, S., Serfaty, M., Weich, S., & King, M. (2004). Stigma: The feelings and experiences of 46 people with mental illness: Qualitative study. The British Journal of Psychiatry, 184(2), 176–181. doi:10.1192/bjp.184.2.176.CrossRefPubMed

Dolberg, P., Goldfracht, M., Karkabi, K., Bleichman, I., Fleischmann, S., & Ayalon, L. (under review). Beliefs and attitudes regarding the nature of depression and anxiety among older primary care immigrant patients from the former Soviet Union and their physicians.

Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. B. (2000). Treatment preferences among depressed primary care patients. Journal of General Internal Medicine, 15(8), 527–534. doi:10.1046/j.1525-1497.2000.08035.x.PubMedCentralCrossRefPubMed

Elwy, A. R., Yeh, J., Worcester, J., & Eisen, S. V. (2011). An illness perception model of primary care patients’ help seeking for depression. Qualitative Health Research, 21(11), 1495–1507. doi:10.1177/1049732311413781.CrossRefPubMed

Fournier, J. C., DeRubeis, R. J., Hollon, S. D., et al. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. Journal of the American Medical Association, 303(1), 47–53. doi:10.1001/jama.2009.1943.PubMedCentralCrossRefPubMed

Jiménez, X., Thorkelson, G., & Alfonso, C. A. (2012). Countertransference in the general hospital setting: Implications for clinical supervision. Psychodynamic Psychiatry, 40(3), 435–449. doi:10.1521/pdps.2012.40.3.435.CrossRefPubMed

Kadam, U. T., Croft, P., McLeod, J., & Hutchinson, M. (2001). A qualitative study of patients’ views on anxiety and depression. British Journal of General Practice, 51(466), 375–380.PubMedCentralPubMed

Kaplan, G., Glasser, S., Murad, H., Atamna, A., Alpert, G., Goldbourt, U., & Kalter-Leibovici, O. (2010). Depression among Arabs and Jews in Israel: A population-based study. Social Psychiatry and Psychiatric Epidemiology, 45(10), 931–939. doi:10.1007/s00127-009-0142-1.CrossRefPubMed

Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., … McCulloch, D. (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine, 363(27), 2611–2620. doi:10.1056/NEJMoa1003955.PubMedCentralCrossRefPubMed

Kernberg, O. F. (1987). Projection and projective identification: Developmental and clinical aspects. Journal of the American Psychoanalytic Association, 35(4), 795–819. doi:10.1177/000306518703500401.CrossRefPubMed

Kessler, R. (2012). Mental health care treatment initiation when mental health services are incorporated into primary care practice. The Journal of the American Board of Family Medicine, 25(2), 255–259. doi:10.3122/jabfm.2012.02.100125.CrossRefPubMed

Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the food and drug administration. PLoS Medicine, 5(2), e45. doi:10.1371/journal.pmed.0050045.PubMedCentralCrossRefPubMed

Kljenak, D., & Parikh, S. (2012). P-867—Mental health education for primary care providers. European Psychiatry, 27, Supplement 1(0), 1. doi:10.1016/S0924-9338(12)75034-4.

Kravitz, R. L., Paterniti, D. A., Epstein, R. M., Rochlen, A. B., Bell, R. A., Cipri, C., … Duberstein, P. (2011). Relational barriers to depression help-seeking in primary care. Patient Education and Counseling, 82(2), 207–213. doi:10.1016/j.pec.2010.05.007.

Levav, I., Al-Krenawi, A., Ifrah, A., Geraisy, N., Grinshpoon, A., Khwaled, R., & Levinson, D. (2007). Common mental disorders among Arab-Israelis: Findings from the Israel National Health Survey. Israel Journal of Psychiatry and Related Sciences, 44(2), 104–113.PubMed

Mendelsohn, R. (2012). Parallel process and projective identification in psychoanalytic supervision. The Psychoanalytic Review, 99(3), 297–314. doi:10.1521/prev.2012.99.3.297.CrossRefPubMed

Miles, M. B., Huberman, A. M., & Saldana, J. (2014). Qualitative data analysis: A methods sourcebook (3rd ed.). Thousand Oaks, CA: Sage.

Morgan, D. L. (1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, CA: Sage.

Murray, C. J. L., & Lopez, A. (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Geneva, Switzerland: World Health Organization.

Muskin, P. R., & Epstein, L. A. (2009). Clinical guide to counter transference: Help medical colleagues deal with ‘difficult’ patients. Current Psychiatry, 8(4), 25–32.

Ross, C., & Mirowsky, J. (2013). The sense of personal control: Social structural causes and emotional consequences. In C. Aneshensel, J. Phelan, & A. Bierman (Eds.), Handbook of the sociology of mental health (pp. 379–402). Dordrecht: Springer.

Rost, K., Nutting, P., Smith, J., Coyne, J. C., Cooper-Patrick, L., & Rubenstein, L. (2000). The role of competing demands in the treatment provided primary care patients with major depression. Archives of Family Medicine, 9(2), 150–154.CrossRefPubMed

Roy-Byrne, P., Craske, M. G., Sullivan, G., et al. (2010). Delivery of evidence-based treatment for multiple anxiety disorders in primary care: A randomized controlled trial. JAMA, 303(19), 1921–1928.PubMedCentralCrossRefPubMed

Schumann, I., Schneider, A., Kantert, C., Löwe, B., & Linde, K. (2012). Physicians’ attitudes, diagnostic process and barriers regarding depression diagnosis in primary care: A systematic review of qualitative studies. Family Practice, 29(3), 255–263. doi:10.1093/fampra/cmr092.CrossRefPubMed

Serrano-Blanco, A., Palao, D., Luciano, J., Pinto-Meza, A., Luján, L., Fernández, A., … Haro, J. (2010). Prevalence of mental disorders in primary care: Results from the diagnosis and treatment of mental disorders in primary care study (DASMAP). Social Psychiatry and Psychiatric Epidemiology, 45(2), 201–210. doi:10.1007/s00127-009-0056-y.CrossRefPubMed

Shirom, A., & Gross, R. (2002). World health systems: Israel. In B. J. Fried & L. M. Gaydos (Eds.), World health systems: Challenges and perspectives. Ann Arbor: Health Administration Press.

Smith, R. C. (1984). Teaching interviewing skills to medical students: The issue of ‘countertransference’. Academic Medicine, 59(7), 582–588.CrossRef

Smith, R. C., Laird-Fick, H., D’Mello, D., Dwamena, F. C., Romain, A., Olson, J., … Frankel, R. (2014). Addressing mental health issues in primary care: An initial curriculum for medical residents. Patient Education and Counseling, 94(1), 33–42. doi:10.1016/j.pec.2013.09.010.

Thombs, B. D., Coyne, J. C., Cuijpers, P., de Jonge, P., Gilbody, S., Ioannidis, J. P. A., … Ziegelstein, R. C. (2012). Rethinking recommendations for screening for depression in primary care. Canadian Medical Association Journal, 184(4), 413–418. doi:10.1503/cmaj.111035.PubMedCentralCrossRefPubMed

Tracey, T. J. G., Bludworth, J., & Glidden-Tracey, C. E. (2012). Are there parallel processes in psychotherapy supervision? An empirical examination. Psychotherapy, 49(3), 330–343. doi:10.1037/a0026246.CrossRefPubMed

Tvivian Mizrachi, M. (2007). The reform in mental health: Selected issues for discussion (in Hebrew). Jerusalem: Haknesset: The Center for Research and Science.

Unutzer, J., Katon, W., Callahan, C. M., Williams, J. W, Jr, Hunkeler, E., Harpole, L., … Langston, C. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288(22), 2836–2845.CrossRefPubMed

Vickers, K. S., Ridgeway, J. L., Hathaway, J. C., Egginton, J. S., Kaderlik, A. B., & Katzelnick, D. J. (2013). Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access. General Hospital Psychiatry, 35(5), 461–467. doi:10.1016/j.genhosppsych.2013.06.011.CrossRefPubMed

Von Korff, M., Katon, W., Unützer, J., Wells, K., & Wagner, E. H. (2001). Improving depression care: Barriers, solutions, and research needs [Press release].

Wallace, J. E. (2012). Mental health and stigma in the medical profession. Health, 16(1), 3–18. doi:10.1177/1363459310371080.PubMed

Whitebird, R. R., Solberg, L. I., Margolis, K. L., Asche, S. E., Trangle, M. A., & Wineman, A. P. (2013). Barriers to improving primary care of depression: Perspectives of medical group leaders. Qualitative Health Research, 23(6), 805–814. doi:10.1177/1049732313482399.CrossRefPubMed

Title: Barriers to the Treatment of Mental Illness in Primary Care Clinics in Israel
Authors: Liat Ayalon
Khaled Karkabi
Igor Bleichman
Silvia Fleischmann
Margalit Goldfracht
Publication date: 01-03-2016
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 2/2016
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-015-0634-0

Keynote webinar | Spotlight on medication adherence

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Barriers to the Treatment of Mental Illness in Primary Care Clinics in Israel

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Keynote webinar | Spotlight on medication adherence

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