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Background

A study was conducted to explore issues relating to the accessibility of the Mental Health Support Worker ( MHSW) service in Wester Hailes. The MHSW service is a single-worker service providing support for people in the locality who experience co-morbid mental health and substance use problems. The service was established in 2002 with funding from the Health Improvement Fund ( HIF).

The aim of the study was:

To explore the issues of accessibility to the Mental Health Support Worker ( MHSW) service in Wester Hailes in order to facilitate the development of the service to meet the needs of the community.

The specific objectives were:

• To ascertain levels of referrers' knowledge of the service
• To gain insight into clients' issues regarding the MHSW service, reasons for referring individuals, and experiences of clients accessing the MHSW services.
• To identify areas for development in order to maximise the accessibility of the MHSW service within the resources of the project.

Method

The views of clients and those who make referrals to the service were sought. Two methods of data collection were used: postal questionnaires and interviews.

Gathering clients' views

A self-completion postal questionnaire was distributed to a sample of 86 clients of the MHSW. Participants were asked to indicate whether they would consent to an interview to explore the themes from the questionnaires in greater depth. Those consenting to interview were interviewed either face-to-face or by telephone.

Gathering referrers' views

A self-completion postal questionnaire was distributed to a sample of 83 professionals who had, or could by virtue of working with clients in the locality, make referrals to the MHSW service.

Analysis

A return rate of 52% of referrers' questionnaires, and 16% of client questionnaires was achieved. Interviews were undertaken with an additional 7 clients. Descriptive statistics were generated using SPSS to explore relationships between the variables in the questionnaire data.

Summary of main findings

Referrers' knowledge about the MHSW service, reasons for referring individuals, and experiences of referral.

Knowledge of the MHSW service was variable and dependent on personal contact with the MHSW.

The range of differing perceptions of what is provided by the MHSW service is indicative of a lack of consistent and accessible information about the service.

Decisions relating to referral of clients are therefore based on limited and inconsistent information. This leads to clients being referred for a variety of reasons.

Levels of satisfaction varied across the occupational groups, with the only factor consistently rated highly being locality base and flexibility of the MHSW service.

Clients' issues regarding accessing the MHSW services

There are clear gender differences relating to individuals' help-seeking behaviour and the experience of the MHSW service.

Information received by clients was mostly verbal and therefore influenced by the referrer's own knowledge and perception of the service. Information was perceived as most important by men when considering factors which facilitated their use of the MHSW service.

Both men and women in the sample stated that they had delayed seeking help until they felt that they could no longer manage by themselves. This may be due to a number of factors including stigma and lack of information regarding available services. Cultural factors may also play a part as men delayed seeking help for a longer time than women.

Some client respondents experienced increased vulnerability when the MHSW was unavailable, either due to holidays or lack of 24-hour cover.

High levels of satisfaction were expressed with the MHSW service. However, these findings may be influenced by a number of factors relating to the relationship of the respondents with the MHSW and the self-selecting nature of the sample.

Facilitating Accessibility of MHSW service

The findings of this study reflect current policy which emphasises the need for services to work jointly in order to support clients.

The location of services within the local community was highlighted, by both clients and professionals who took part in the study, as one of the most important factors in making the service accessible.

Other factors which strongly support the accessibility of the service were the option of home visits and the ability to get appointments quickly.

Factors such as the provision of 24 hour support, written information about the service for both referrers and clients and the continuity of cover for clients when the MHSW is on annual leave were perceived as additional factors which would facilitate the client's ability to access and engage with the MHSW service.

Suggestions for service development and further research

1. The development of an information leaflet for distribution to potential referrers.

2. Further investigation of the factors affecting referrers' decision making processes when considering referral to mental health services.

3. This research endorses the importance of focusing on gender sensitivity in mental health services.

4. Development of written information and alternative information sources such as video for clients.

5. Development of an organisational structure that supports service accessibility, cohesion and flexibility such as 24 hour cover and annual leave cover.

6. The promotion of community educational initiatives to promote awareness of mental health problems, decrease stigma and promote inclusion in areas of need.

7. Further research may be required into the specific factors that facilitate and inhibit access to mental health services in Scotland with particular focus on marginalised groups.

Further details from:

Dr Anne Robertson

anne.robertson@ed.ac.uk

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