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Towards a public health approach for (unmet) needs for mental health care in the province of Antwerp

Book - Dissertation

This doctoral thesis examines mental health in Antwerp using a public health approach. A public mental health approach consists of the promotion of mental wellbeing, and the prevention and adequate treatment of mental health problems in society through informed choices and actions of governments, organizations, communities and individuals. It is based on relevant data, enabling sufficient and adequate mental health services tailored to the needs of the population. An important aim in this regard is reducing inequities in access to care. The thesis starts by explaining why mental health matters. The introduction provides information about the prevalence of (unmet) mental health needs and mental health care use, as well as different methods of mental health needs assessments. The optimal mix of mental health services is discussed. In the next chapter The main studies in this thesis examine mental health more locally and in depth and use different methods and designs to describe the current situation regarding unmet mental health needs in the province of Antwerp, specifically in one rural and one urban primary care zone. First, qualitative focus group discussions and interviews with primary care, mental health and social care professionals explored unmet needs in Antwerp. It was argued that unmet mental health needs are more common in some vulnerable groups. Barriers to mental health care were discussed, which include both demand-side (e.g., lack of insight into the own needs) and supply-side (e.g., fragmentation in health care) barriers. Next, survey research examined clinically assessed and self-perceived mental health problems and mental health care use in the region. It was found that about one in five Antwerp residents has poor mental wellbeing according to validated tests, and about one-tenth has a clinical need for mental health care that causes significant dysfunction in daily life. Of those with a clinical mental health need, only about half seek help. This means that approximately six percent of Antwerp people has an unmet need for mental health care. Another chapter describes the promising concept of iPSYcare, a database linking electronic patient records of the Antwerp psychiatric hospitals and general hospitals with a psychiatric unit. Additional research lines which are discussed in the thesis include waiting times in Flemish mental health care, and the impact of COVID-19 on the mental wellbeing of the Belgian population. Finally, different strategies are described to bridge the treatment gap and make mental health care more accessible and equitable.
Number of pages: 217
Publication year:2023
Keywords:Doctoral thesis