Page 317 - Encyclopedia of Nursing Research

284 n MENTAL HEALTH IN PUBLIC SECTOR PRIMARy CARE

symptoms, not only hot flashes, during the Both economic barriers to care and health
menopausal transition and early postmeno- disparities—including inequalities in men-
M pause, warrants more careful examination tal health care related to race and ethnicity—
of both factors related to different symptom are key priorities for research on improving
clusters and differential treatment effects of health services (Institute of Medicine, 2003d;
pharmacological and nonpharmacological Primm et al., 2010; U.S. Department of Health
therapies on clusters of symptoms to enhance and Human Services, 2001). These issues cut
the precision of therapeutic effectiveness. across all areas of public health need, includ-
Involvement of several nurses as investiga- ing mental health services.
tors (Carpenter, Landis, Woods, Newton, and Also in the late 1970s, the primary care
La Croix) for the newly National Institutes setting became formally recognized as
of Health–funded Menopause Symptoms: the de facto mental health services system
Finding lasting Answers for Symptoms and in the United States (Regier, Goldberg, &
Health (MS-FLASH) multisite trials of thera- Taube, 1978). Of the minority of individuals
pies for menopause-related symptoms prom- who receive needed mental health services,
ises to yield opportunity to further these most receive their services in primary care
efforts. instead of the mental health specialty sec-
tor. Many people seen in primary care for
Diana Taylor medical problems have clinically signif-
Nancy Fugate Woods icant comorbid mental health conditions
(Miranda, Hohmann, Attkisson, & Larson,
1994), especially anxiety, depression, and
substance misuse disorders. People with
Mental health in Public severe forms of co-occurring disorders that
include severe mental illness and chronic
sector PriMary care physical illnesses have been found to die
up to 25 years earlier on average compared
with the general population, and this health
Primary care was first comprehensively disparity has increased over time in context
defined by the World Health Assembly in the of inadequate health care service models for
late 1970s following a seminal conference in this population (Morden, Mistler, Weeks, &
Alma-Ata in 1977 (World Health Assembly, Bartels, 2009). The burden of unmet mental
1978). Building upon the key aspects of Alma- health needs remains high for racial and eth-
Ata, the 1978 World Health Organization nic minorities compared with Whites (U.S.
definition of primary care emphasized its Department of Health and Human Services,
defining aspects as essential, first-level health 2001; U.S. Public Health Service Office of
care embedded in the community, avail- the Surgeon General, 1999). Although the
able to all, evidence based, socially accept- past decade has seen some improvements,
able, and affordable. In the United States, there continue to be significant barriers exist
this optimistic vision for high-quality pri- to accessing public sector health services,
mary care has been only partially achieved. including the affordability of care, social
Ongoing challenges to high-quality primary stigma associated with mental illness, and
care services are especially pronounced for fragmented care delivery systems acting as
public sector primary care. Public sector barriers to care when care is sought (U.S.
primary care services serve disproportion- Department of Health and Human Services,
ate of numbers health care users who have 2001; Villena & Chesla, 2010). These issues
limited ability to pay for health services and continue to be most pronounced for popu-
experience significant health disparities. lations which experience the greatest health