Graduate Thesis Or Dissertation
 

Access and Utilization of Mental Healthcare Services Among Children and Adolescents in India – A mixed-methods study

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  • Background: According to the National Mental Health Survey (NMHS), the treatment gap of any mental disorder in India among the general population was reported to be as high as 83% (R. S. Murthy, 2017). There is insufficient evidence currently describing the treatment gap among the child and adolescent population. Given the large population of young people in India, and mental health and healthcare being a major concern among young people, this dissertation attempts to contribute to the literature on global mental health equity by focusing on barriers and facilitators that influence mental healthcare access and utilization among children and adolescents. Methods: The objective of this dissertation is to examine equity in access and utilization of mental healthcare services among children and adolescents in India. It employs a sequential explanatory mixed-methods approach consisting of three distinct phases: quantitative followed by qualitative, and their integration in the concluding remarks. In Phase 1 of the study, I analyzed the NMHS (2015-16) to determine the odds of utilizing private compared to public mental healthcare treatment based on predisposing, need-based and enabling characteristics (i.e., Anderson’s Behavioral Model) among adolescents 18-24 years-old. In Phase 2, I collected and analyzed perspectives of mental healthcare providers offering services to children and adolescents in the public and private mental healthcare landscape in India. The dissertation documents, from the provider perspective, barriers and facilitators in children and adolescents attempting to access mental healthcare in major metropolitan cities in India using the Health Stigma Discrimination Framework and the Levesque’s Framework. In Phase 3, I integrated findings from the above phases by drawing patterns, themes, commonalities, and differences to shape implications for current and future work in the area. Findings: Integration of findings from Phases 1 and 2 indicate that majority of the public mental healthcare users were primary and secondary school children (i.e., 5th-10th graders) and majority of the private mental healthcare users were adolescents with pre-university (i.e., 11th and 12th grade) and undergrad education. There was a high usage of both public and private mental healthcare services among those living with mental and behavioral conditions related to substance and tobacco use. There exists inequity in the quality of mental healthcare services currently available evidenced in the finding that only a small portion of the study sample utilized mental healthcare services at Community Healthcare Centers, Primary Health Centers, and Government urban health centers as compared to the majority utilizing services at private clinics. Additionally, the study found that stigma towards mental health and healthcare operates at several different levels, including stigma towards pharmacological interventions (i.e., interpersonal, and intrapersonal stigma), parental perceptions regarding care seeking (i.e., interpersonal) and lack of resource allocation for schools to design a mental health support system for students (i.e., structural). Conclusion: Findings suggest a need to invest resources and create interventions that specifically address the above factors. Such strategies could have a longer-lasting impact on promoting an environment of mental health equity for children and adolescents in India.
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