Mental health gained momentum only several decades ago when people identified the link between individuals’ mental wellbeing and their functioning in the community, as well as the overall performance of the society as a whole (Richter et al., 2019; Silva et al., 2016). It has been acknowledged that the provision of mental health services to underprivileged people is seen as an important ground for addressing social disparities, especially those related to the life in rural areas (Fernández-Niño et al., 2019). People’s perspectives regarding their mental health and their access to the corresponding services have undergone considerable changes, as people of color acknowledge the existing disparity and some of the potential outcomes of such a situation (Holley et al., 2016; Villatoro et al., 2018; Wilson et al., 2018). The most recent research on the factors causing inequity in access to mental health care and its outcomes is mainly associated with social aspects (Creedon & Cook, 2016; Derr , 2016; Stepanikova & Oates, 2017).
The primary elements of people’s social life that have the strongest impact on their access to health care are seen as income and education (Assari, 2017; Barr, 2019). Income is regarded as the central factor restricting people’s access to mental health services although this type of care has been included in diverse insurance packages available to the underprivileged population (Creedon & Cook, 2016). Low-income families still have limited knowledge regarding the services available to them, as well as access to training regarding the relevance of their mental health (Memon et al., 2016). Education is closely related to the financial aspect as people with a low level of education tend to have a low income and insufficient understanding of the ways mental health affects their lives (Hall, 2018). Considerably less attention has been paid to such social factors as ethnicity and age. Researchers tend to consider these components in conjunction with the factors mentioned above, income or education, as well as a combination of these two factors. Moreover, age-related research is often confined to the child and adolescent development (Cuijpers et al., 2019; Hodgkinson et al., 2017; Platell et al., 2017).
Since the focus has been mainly on social aspects contributing to the existing disparities, the corresponding theoretical frameworks have been used (Detels et al., 2017; Barr, 2019). The social class theory has been utilized to explore the nature and consequences of the existing inequity in Americans’ access to mental health care (Detels et al., 2017; Barr, 2019). This approach is natural and has enabled researchers to identify the exact relationship between people’s income and education and access to healthcare services (Barr, 2019). Nevertheless, other factors may be influential as well since people’s age or ethnicity are important aspects to consider when analyzing individuals’ behavior (Assari, 2017; Hodgkinson et al., 2017; Platell et al., 2017). These four aspects can be seen as major social factors influencing people’s choices and perspectives, including their perceived barriers to mental healthcare services (Hodgkinson et al., 2017; Platell et al., 2017). Age is a factor that can expand the scope of social class research due to the developmental peculiarities of people at different stages of their lives, which is associated with different worldviews, access to resources, and health conditions. The social class theory may be further developed to encompass these relevant elements.
By examining the relation between socioeconomic status and access to mental health services, the researcher may be able to understand how, in certain communities, the need to access mental health care can be promoted, which can help reduce the number of severe mental illnesses or adverse effects associated with mental illnesses that remain untreated for extensive periods. Hence, empirically, the exploration of this topic for a Ph.D. study can help determine the actual relationship between ethnicity, age, and decision to obtain mental health care. From a practical perspective, this study will help develop programs that target increasing the awareness about mental health problems. Theoretically, this study will extend the boundaries of the existing social class framework to include ethnicity and age as important factors.
Statement of the Problem
While the need to address mental health issues has been recognized as a public health concern, there remain significant gaps between the need for and treatment of mental disorders. Given the number of individuals who need mental health services but do not receive them, it is vital to identify the factors that contribute to mental health services’ underutilization. The study seeks to address the underutilization of mental services by low-income individuals focusing on age, ethnicity, income, and education as contributing factors. These low socioeconomic status (SES) groups include diverse racial and ethnic minorities, unemployed persons, and new immigrants (Villatoro et al., 2018). Globally, 50% of people with mental disorders receive no treatment. In developed countries, the percentage varies from 35 to 50% and 76 to 85% in low or middle-income countries. This trend is a clear indication that mental-related disorders are on the rise, and it is time that the concerned authorities spring into action to tame these numbers. According to Maura et al. (2017), factors indicated as the major contributors to the underutilization of mental services have become part of many people’s lives. The unemployment rate is high, people are afraid to speak about their mental conditions, and discrimination based on ethnicity and race has become widespread in the society and little is being done to address it.
There is little or no data on how SES has significantly affected people’s use of mental health services. The available statistics indicate the same, and if left unchecked, it may lead to mental health and socioeconomic deterioration of vulnerable groups. As such, the study will seek to explore how SES contributes to the underutilization of mental health services.
Purpose of the Study
The study purposes to logically and expliciltly identify how SES contributes to the underutilization of mental health services. It will incorporate a survey to determine the participants’ SES and their perceived access to psychological care. The data obtained will then be processed and analyzed to obtain the relationship between the variables.
The key independent variables to the study are income and education. Additional independent variables that may not be crucial to the study but will also be considered are race, ethnicity, and age. They will be discussed in relation to the dependent variables, which will be the perceived need for mental health assistance and access to such, using statistical software. A prospective study will be conducted among individuals of age 18 and over with mental disorders will be monitored for over 1.5 years. The study will be conducted in six towns scattered across the country. Participants will be recruited through sampling shortly after the report to MindCare has been approved. They will be asked to complete a fully structured questionnaire certified by the World Health Organization and the World Mental Health Survey Initiative.
Theoretical or Conceptual Framework
One of the key ways to understand the barriers that people face in accessing mental health services and why many opt to leave the treatment is to use Karl Marx’s social-class theory. The theory originates from a series of individual personal interests that relate to human struggle and social alienation. The study will apply the theory to analyze the relationship between SES and access to mental health services. Individual SES characteristics play a significant part in determining individual access to mental health services (Detels et al., 2017). Those with substantial income will receive the services regularly since they can afford it. Those with low income, on the other hand, may choose not to access quality care. These individuals will disregard the illness at its early stages due to a lack of funds and ignorance due to a lack of education. They recognize the seriousness of the illness when it has become dangerous. The disparity is further exacerbated by the need to earn money to treat the disorder that might be getting worse. As such, the primary factors that determine one’s SES status are their income and education, which govern one’s ability to recognize their problems and access care when necessary.
However, other factors can also contribute to one’s ability to address their issues via the healthcare system. One’s ethnicity can affect the effectiveness of their care upon accessing ethnic and racial communities being served to different extents through the medical system. The ethnicity of an individual may also affect an individual’s ability to access quality mental health services. Lack of support from governments by providing infrastructure and resources to the marginalized and minority communities serves to increase underutilization. These people may become ignorant of such services, and in some communities, they may even regard the mentally ill people as cursed or an outcast. Age also serves as a contributor to the rising number of underutilization of mental health services. The problem’s prevalence increases with age, and as such, this impedes an individual’s ability to earn income through work. As such, these four causes can affect one’s health through the differences in ways healthcare facilities treat them or their willingness to seek care. However, their effects are likely to be less significant than those based on cultural factors. Race can also be a factor in care access, with various SES because of efforts undertaken to serve these particular population segments.
This belief is reflected in the conceptual framework, which considers the relationship between SES, care access, and health outcomes. It is similar to the one proposed by Barr (2019), where one’s socioeconomic conditions directly influence their health outcomes, with access contributing to this relationship as a mediating variable through being affected by the former and being correlated with the latter. With that said, the study will also consider health a determinant of perceived access to reflect the effects of an increased need to access care and the associated costs lowering access. As the study focuses on the relationship between SES and access, it will not consider the indirect effects of access on health, as such a consideration would be out of the research scope.
The author believes the three additional independent variables to act as moderators, influencing the relationship between SES and access to care. People with the same socioeconomic conditions, but differences in these variables may exhibit different access levels. However, the author expects a majority of the differences to be relegated to the primary variables, which leads to the belief that people with low SES may be underserved in terms of access. The possibility warrants investigation, and, therefore, the author has decided to make it central to this study and obtain information that confirms or denies the idea. Quantitative research would help gain a preliminary picture of the situation, which can then be explored with a supplementary qualitative study if necessary. The research questions and hypotheses were formulated to clarify the matter and investigate different aspects of the relationship.
The social class theory provides understanding of the problem which is assessing how SES contributes to the underutilization of mental health services. The social class theory is appropriate for addressing the problem based on the fact that it incorporates all the factors that have been pointed to one deciding not to receive the mental health services. Low income, age, lack of eduction, and ethnic and racial discrimination define an individual’s SES and this is echoed by the social class theory. The theory extends to the study’s statement problem whereby it acknowledges that the problem is there, and thus, there is the need for the concerned authorities to strategize on ways that they can solve the problem. Thus, by doing so, the theory will help the study achieve its purposes of making sure that every individual with mental disorder has access to mental health services. The social class theory provides a lens by which to answer the research questions which ask what effects do SES have on perceived access to psychological care? The social class theory will support a response to the research questions by providing concrete pieces of evidence that will be helpful in the study.
Nature of the Study
Studies usually incorporate different forms of study methods to accomplish various objectives. Among these methods, there are the cross-sectional design, an observational study design method (Refiee et al., 2018). In this study design, the outcome and exposures in the study participants at measured by the investigator concurrently. The criteria of exclusion and inclusion are used in selecting participants in the study, after which assessing the outcomes and exposure is carried out. The study is largely used for population-based surveys and in assessing disease prevalence in clinic-based samples. The study is inexpensive and is usually conducted relatively faster since it can be done before planning a cohort study or a baseline in a cohort study. Quantitative study design, on the other hand, aims to establish the relationship between the dependent and independent variables in a population (Bloomfield & Fisher, 2019). The designs are either descriptive or experimental. Using a sample of hundreds or even thousands usually guarantees an accurate estimate of the relationship between variables in a descriptive study, and it is less likely to be biased.
The qualitative method offers the researcher an avenue to conduct a study based on quantities. It focuses on understanding human behavior from an informant’s perspective, whereby it does assume a dynamic and negotiated reality. It allows the researcher to collect data through participant observation easily and interviews, and the data is analyzed based on the themes from descriptions by informants. The quantitative method, on the other hand, offers the researchers facts about social phenomena. The method assumes a fixed and measurable reality on the concept being investigated since the data collection is done through measuring things. The statistical and numerical analysis of data offers the researcher an accurate outcome. Based on this study, a quantitative study design will be the best-suited design due to its accuracy, and it uses deductive reasoning that allows an individual to form a hypothesis, collect data, and use the collected data after the analysis is made and the conclusion shared.
There are four main types of quantitative research; quasi-experimental, correlational, experimental, and descriptive research. Correlational research attempts to establish the existing relationship between two or more variables using statistical data (Cox, 2019). The distributions of variables and data relationships are studied only and cannot be manipulated. Quasi-experimental research focuses on establishing cause-effect relationships among variables. In this research, an independent variable can be identified but cannot be manipulated by the experimenter. The effects of the independent variable on the dependent variable are usually measured. Descriptive research establishes an association between variables while experimental establishes causality, and it is usually regarded as true experimentation since it uses scientific methods to establish the cause-effect of a relationship among group variables(Cox, 2019). Of the four types of qualitative research, correlational research will be the best fit for my study since it allows one to determine between two or more variables using statistical data.
The present study seeks to gain insights from the selected demographic cohort at a specific point in time; hence, it is cross-sectional. Besides, it is fair to consider it observational as the author intends to measure the effect of a risk factor (socioeconomic status) without administering any intervention. There is no control or deliberation regarding who is and who is not exposed to the selected risk factor. The study’s scope is limited to communities residing in California (potentially, to only one town) and varying their socioeconomic status. The scope’s narrowness is explained by ensuring that participants discuss the same psychological facilities in their replies for further comparison.
Preferably, the sample will display sufficient diversity and include individuals from different socioeconomic classes and communities. The chosen inquiry method is a survey that determines participants’ socioeconomic status (SES) and their perceived access to mental health care. Administering this procedure will provide the author with quantitative data. That will help to understand the nature of the relationship between three variables – income and education (independent) and access to mental health care (dependent).
The type of statistical methodology used in the present study hinges upon key assumptions and limitations of the data. Indeed, its quality largely determines the validity and reliability of results. Tentatively, the research objectives may be achieved by using multiple linear regression due to the presence of two independent variables. However, the proposed statistical model might prove to be inapplicable. It may happen if the author will detect multicollinearity between independent variables, which is possible since income and education do correlate (Hall, 2018). Lastly, biases in data such as missing data points should not be overlooked. If the missingness appears systematic, particular care will need to be taken to improve the robustness of the analysis.