Lynn F. Bufka and Nicholas Camp
There are several barriers to the collection of
standardized mental health assessment data in clinical practice settings.
These fall into two major categories: provider
resistance and client
resistance.
The PCP historically has had insufficient
experience and knowledge to identify and treat adequately mental health
conditions that are common to primary care patients.
In addition, practitioners are often uncomfortable talking to patients about
mental health problems, and they believe that patients
are uncomfortable talking about those issues as
well.
The collection of mental heath data in the
primary care
setting is not routinely seen as part of business as
usual. This is complicated by the fact that the
assessment of mental health patients is difficult at best, and results are
complicated by patients’ attitudes (e.g., exaggeration
or minimization of symptoms), risk factors,
socioeconomic factors, and functional levels.
Training primary care to use assessment tools and to understand mental health
disorders may increase the acceptance and
practice of screening. Similarly, clinicians
have been reluctant at times to adopt wide-scale outcomes measurement. Even specialists in mental health have been less
likely to make efforts to measure their
treatments and clinical outcomes, though they are likely to be more familiar and comfortable with standard self-report mental
health assessments.
Clinicians often are concerned that the outcomes
measurement tools are not appropriate for their type of care or focus of
treatment. Clinicians need to consider a range of tools and
identify those most consistent with their practice and treatment aims.
Clinicians also need to be reassured that
outcomes measures are being collected in a confidential, secure fashion for the
betterment of patient care, and not to restrict or
punish clinicians who obtain poorer outcomes. Finally, clinicians are reluctant
to implement new systems if those systems are
not of immediate benefit to themselves and their
patients.
In addition to difficulties in implementing
mental health assessment in primary care settings due to provider
resistance, there has been concern that patients also will resist mental health assessment. A general perception
has been that patients are uncomfortable
addressing mental health issues in the primary care setting (Docherty, 1997). Certainly, at times, this is true. There are clients
who react negatively to questions about mental health functioning in the
general medical setting and would rather focus
on somatic symptoms.
However, when the tools are relatively easy to
complete and the purpose is clear, patients are often comfortable
completing mental health screening tools.
Similarly, outcomes measures with a clear purpose related to care may be most meaningful to patients as well. Efforts to
provide feedback from the outcomes measures
ensures that patients experience the relevance and usefulness of ongoing assessment.
References
Martin
m. Antony & David H. Barlow, 2010, Handbook of assessment and treatment
planning for Psychological disorders,
Second
edition, structured and semi-structured diagnostic interviews, The Guilford
Press
Read Also
Potential considerations in Selection of a diagnostic interviewPrinciples and Practice of assessment in primary care settings
Structured and Semi-Structured Diagnostic Interviews
Psychometrics and tool development considerations
Factors Influencing Assessment
The Current Status of Health Measurement
Evaluating a Health Measurement: The User’s Perspective
Types of Health Measurements
Identifying and Controlling Biases in Subjective Judgments in health measurement
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