PAGE 20Dissertation ProspectusFactors Influencing Indiv

Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental
Health in South Texas
Submitted by:
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the
requirements for writing your prospectus. Each section contains
a narrative overview of what should be included in the section
and a table with required criteria for each section. WRITE TO
THE CRITERIA, as they will be used to assess the prospectus
for overall quality and feasibility of your proposed research
study.
2. As you draft each section, delete the narrative instructions
and insert your work related to that section. Use the criterion
table for each section to ensure that you address the
requirements for that particular section. Do not delete/remove
the criterion table as this is used by you and your committee to
evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair
or methodologist, use the criteria table for each section to
complete a realistic self-evaluation, inserting what you believe
is your score for each listed criterion into the Learner Self-
Evaluation column. This is an exercise in self-evaluation and
critical reflection, and to ensure that you completed all sections,
addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined

below. Complete a realistic and thoughtful evaluation of your
work. Your chair and methodologist will also use the criterion
tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when
the tables are deleted.
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are
Required: Not all components are present. Large gaps are
present in the components that leave the reader with significant
questions. All items scored at 1 must be addressed by learner
per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be
Required Now or in the Future. Component is present and
adequate. Small gaps are present that leave the reader with
questions. Any item scored at 2 must be addressed by the
learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component
is addressed clearly and comprehensively. No gaps are present
that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
Southern Texas encompasses different groups of people whose
behavior, gender identity, and gender expression varies
depending on cultural identity and norms. About a quarter of
individuals in United States have a history or are experiencing a

mental disorder with approximately 6% of the population having
critical mental illness. These mental problems typically affect
the general well-being of an individual. For instance, patients
living with severe mental disorders are more likely to die in
average of twenty-six years earlier than the average life
expectancy of the general population. Healthcare cost for
patients with mental disorders increase exponentially, while the
economically disadvantaged people are the most vulnerable to
healthcare problems. The United Nations (UN, 2015) has
identified the issue as one of its Sustainable Development
Goals. These are a collection of goals designed globally that
aim to achieve a sustainable future for all. The UN expressed its
uncertainty regarding the extent to which major social
determinants of mental disorders are being addressed worldwide
(WHO, 2015). Developing a conceptual framework will address
the social determinants and align it with its sustainable
development goals. This way it can systematically review the
pieces of evidence about the social determinants and identify
potential mechanisms and targets for interventions (Lund, et al.
2018). According to the Substance Abuse and Mental Health
Services Administration (SAMHSA), the Centers for Disease
Control and Prevention (CDC) and the U.S. Department of
Justice, millions of people suffer from mental illness in this
country. The high numbers necessitate raising public awareness
and start campaigning for a much better health care system
(Hamilton.et al. 2016). According to the National Alliance on
Mental Health (2019), 47.6 million people in the U.S.
experienced signs of a mental illness in 2018. This amounts to
one in every five adults. Roughly 11.4 million Adults between
the ages of 25 and 35 had an episode of serious mental illness
that same year. In 2016, 7.7 million young people between the
ages of 6 and 17 experienced some sort of mental health
disorder, while 9.2 million people were reported to have
experienced a substance use disorder (National Alliance on
Mental Illness, 2019).
According to Kohn, et al. (2018), there is an emphasis on the

gap in mental health treatment in America when examined
through the prevalence of mental health disorders, the use of
mental health services, and the global burden of disease.
Statistical data from community-based surveys of mental
disorders in the various countries in America including
Argentina, Brazil, Canada, Chile, and the United States, etc.
were utilized in formulating this conclusion. While 42.6% of
children and adolescents in the US suffered mental illness, the
treatment gap in this group was 64%. This issues of addressing
a lack of mental health services has not been given enough
attention, thus resulting in a wide gap in treatment. Mental
disorders in children can be corrected if detected early enough.
Unfortunately, most of the caregivers do not have the skills to
detect these disorders, which allows them to persist to the point
that it is dangerous (Kohn et al. 2018).
According to Bowdoin et al. (2018), a patient-centered medical
home (PCMH) model is designed to improve certain mental
health outcomes, while at the same time proving effective as
cost-containment. This proposed study will examine the links
between care provided that is inconsistent with the PCMH and
healthcare services utilization as well as expenditures for non-
aging citizens who are suffering from mental illness in the
United States. A total 6908 non-aging adults suffering from
mental illness participated in the 2007-2012 Medical
Expenditure Panel Survey. Utilization of healthcare services
was compared with expenditures on care consistent with the
PCMH, other participants include a non-PCMH, usual source of
care (USC), and participants without a USC. The outcome
showed differences in utilization and expenditures between
participants who were provided with care consistent with the
PCMH and those who had a non-PCMH. USC showed no
statistical importance for any healthcare services category. This
research study will examine the factors according to mental
health providers that influence an individuals' decision to utilize
mental health services in South Texas. This research will help

us understand why individuals choose to utilize or regject
mental health services in the state.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair Evaluation Score
(0-3)
Reviewer Score
(0-3)
Introduction
This section briefly overviews the research focus or problem,
why this study is worth conducting, and how this study will be
completed.
The recommended length for this section is two to three
paragraphs.
1. Dissertation topic is introduced along with why the study is
needed.
2. Provides a summary of results from the prior empirical
research on the topic.
3. Using results, societal needs, recommendations for further
study, or needs identified in three to five research studies
(primarily from the last three years), the learner identifies the
stated need, called a gap

4. Section is written in a way that is well structured, has a
logical flow, uses correct paragraph structure, uses correct
sentence structure, uses correct punctuation, and uses correct
APA format.
NOTE: This Introduction section elaborates on the Topic from
the 10 Strategic Points. This Introduction section provides the
foundation for the Introduction section in Chapter 1 of the
Proposal.
Reviewer Comments:
Background of the problem
Individuals with mental health disorders encounter significant
challenges that affect their participation and well-being.
Boardman (2011) researched on social exclusion for people with
MHC in Southern Texas in which he differentiated various
exclusion domains ranging from social interaction,
consumption, and services (healthcare services in particular).
He stated that it is incorrect to generalize social exclusion since
individuals with MHC are not categorized as a homogeneous
population and therefore they encounter unique difficulties i n
accessing mental healthcare services. While the MHC group are
subjected to financial burdens, people with MCH are paid one-
third less than the general population. Overall, these individual
face the highest rated stigma, lower employability, and lower
income in comparison with the non-affected group. Besides
employment rates, this groups are more vulnerable to depression
that is linked to low productivity impacted from rising
absenteeism and reduced capabilities to optimize their skills. As
a result, there has been increasing awareness amongst numerous
groups of companies that they have been losing talent as a result
of mental health disorders that affect workers. This is reflected

in Godman (2013) who highlighted that it is crucial to evaluate
how employers treat people with MHC and how the working
environment in terms of cultural climate or workload affect the
well-being of an employee with mental health issues and the
steps they take to support employees improve their mental
health.
Basing on Interdisciplinary Collaboration model developed by
Brosten, which is used for identification of five central
components of flexibility, investment in common goals,
interdependence, process reflection, and role specialization and
professionalism, Davis (2005) presented another model that
addresses the continuous needs of people suffering from mental
health disorders. The model explains the protocol of integrating
Interdisciplinary Case Review (ICR) into the matrix of
communication between parties involved in the mental
healthcare campaigns. The integral components of ICR include
delineation of roles within the team dynamics and steps
involved for appropriate referral. The stipulation for ICR,
according to the model, is manifested in the way an individual
prefer interaction with one member of ICR team over other
members depending on rapport between them. Additionally, the
intricacy of professionalism between members involved in the
ICR team and the common value brought about by shared
knowledge maximizes the care quality and referral for people
who depend on them. Several community counsellors are
integrated in the ICR team to facilitate communication and
create a rapport with the general population. Erickson (2013)
presented the roles of a community counselor in the
implementation of screening programs for people with
depression. What was not highlighted in the approach is their
role of contacting people in need and how they send screening
results. Interagency cooperation allows the participating
stakeholders to retain autonomy and promote knowledge sharing
which ensures sustainable results are achieved. While the study
established that most of people in Southern Texas were fearful
of speaking about their mental disorders or to share information

about people with mental illness, the study revealed that these
respondents did not have a good understanding of depression
and multiple causes of mental illness.
Grayson (2018) examined the difference in how patients utilize
mental health services with patients that experience a high level
of burden more likely to utilize mental health services.
Similarly, the caregivers that experience serious signs of
depression or anxiety in their child or adolescent tend to use the
services more than the caregivers who experience mild or no
sign of depression or anxiety. The mental health status of the
caregiver is of no significance and does not influence need and
utilization (Grayson, 2016). The Centers for Disease Control
and Prevention (2018) highlight that mental health has become a
significant public health issue in the United States that requires
immediate attention. A mental disorder must be diagnosed at its
early stages to avoid the advance effects of it progressing into
adolescence (Kohn et al. 2018).
Misra et al. (2017) in their article described the concept relating
to the use of complementary and alternative medicine (CAM)
for mental health treatment among children in the Southern
State Region. According to the authors, CAM use among US
children stands at 12%. South Texas has begun to put forth a lot
of effort into improving the health care treatment of children.
The services offered are directly proportional to the allocation
provided. Research showed that some institutions have released
more funding to operate this sector and that this region receives
the second-largest allocation for mental health in the country
(Mista et al. 2017). Despite all these efforts, there still exists a
gap between the treatments of mental health disorders in the
US.
Criteria
(0-3)

Chair or Score
(0-3)
Reviewer Score
(0-3)
Background of the Problem
This section uses the literature to provide the reader with a
definition and statement of the research gap and problem the
study will address. This section further presents a brief
historical perspective of when the problem started and how it
has evolved over time.
The recommended length for this section is two-three
paragraphs.
1. Includes a brief discussion demonstrating how literature has
established the gap and a clear statement informing the reader
of the gap.
2
2. Discusses how the “need” or “defined gap” has evolved
historically into the current problem or opportunity to be
addressed by the proposed study (citing seminal and/or current
research).
2
3. ALIGNMENT: The problem statement for the dissertation
will be developed from and justified by the “need” or “defined
gap” that is described in this section and supported by the
empirical research literature published within the past 3-5 years.
2

APA format.
2
NOTE: This Background of the Problem section uses
information from the Literature Review in the 10 Strategic
Points. This Background of the Problem section becomes the
Background of the Study in Note, this section develops the
foundation for Chapter 1 in the Proposal. It is then expanded to
develop the comprehensive Background to the Problem section
and Identification of the GAP sections in Chapter 2 (Literature
Review) in the Proposal.
Reviewer Comments:
Theoretical Foundations/Conceptual Framework and Review of
the Literature/Themes
Theoretical literature
There is the need to understand the consequences of both
effective utilization and non-utilization of mental health as it
has evolved historically. Mental health services in this southern
state have faced several challenges. Texas (2017) asserts tha t
people suffering from mental illness still face problems despite
the huge costs that are directed towards healthcare. Schwartz
(2017), in support of the Southern State Region, argues that the
increased growth-rate of populations in one specific county
located in a southern state has impacted the health sector at
large. The high population together with economic constrains
has led to a decrease in the number of insurance policies
offering individuals access to health. The access to and
utilization of mental health care for the populations living in
this county has created a gap within the State (Children at Risk,

2013).
Literature Themes
Review of the literature review identified the following themes:
· Lack of proper mental health education and infrastructure has
been the major factor affecting the utilization of mental health.
Goldman et al. (2018) in their research found out that women
who had been exposed to sexual abuse and drug abuse formed
the high numbers of people who utilize mental health services
among the Hispanic and non-white people in the county.
Augsberger et al. (2015) in support of this research argued that
mental health services had been underutilized by Asian women
living in this county, as a result of both cultural needs and
mismatch of the services offered in the health facilities in this
Southern State. What happens to these women as a result of
these lack of services needs to be further extrapolated by further
research. This demonstrates a current gap in existing literature.
· Lack of medical insurance. Research has shown that many
people due to poor economic status have left many people
without health insurance as they cannot afford it. This limits
many average and lower-class families from accessing mental
illness services (Children at Risk, 2013). This is another gap in
existing literature. It is important to ascertain the reality that
living in poverty face and how a lack of services prevents them
from being able to be class mobile in terms of future career
opportunities.
· The poor perception among the community members.
Researchers reveal that many people who live in this county
perceive child mental illness as a mere sign of hunger besides
poor diets. This has left many people neglecting the utilization
of mental healthcare in the community (Children at Risk, 2013).
Again, further research must be conducted to determine how
these attitudes can shift so that socio-economically
disadvantaged families can get their children access to the

critical mental health services that they need.
The theoretical model for this research gap is the Albert
Bandura, Social Cognitive Theory. The Social Cognitive
Theory: Examines the context of health promotion and disease
prevention. It helps to describe how motivations in health and
behaviors are influenced by the interaction of people's beliefs,
environment, and behaviors. It was advocated by famous
psychologists Albert Bandura (Morin, 2019). It is important to
determine the limiting factors behind individuals and families
not currently getting the mental health services that they need.
Many do no seek help due to social stigmatization, while others
simply lack any type of access in the first place. Due to a lack
of promotion in this area, many do not know where to turn and
this is causing the problem to be compounded in society from
one generation to the next.
Major components of the theory concerning individual behavior
change include:
· Self-efficacy: The belief that an individual has control over
and can execute a behavior.
· Behavioral capability: Understanding and having the skill to
perform a behavior.
· Expectations: Determining the outcomes of behavior change.
· Expectancy: Assigning a value to the outcomes of behavior
change.
· Self-control: Regulating and monitoring individual behavior.
· Observational learning: Watching/observing outcomes of
others' performance or modeled behavior.
· Reinforcements: Promoting incentives and rewards that
encourage behavior change (Eslami et al. 2018).

Criteria
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
Theoretical Foundations and/or Conceptual Framework
This section identifies the theory(s) or model(s) that provide the
foundation for the research. This section should present the
theory(s) or models(s) and explain how the problem under
investigation relates to the theory or model. The theory(s) or
models(s) guide the research questions and justify what is being
measured (variables) as well as how those variables are related
(quantitative) or the phenomena being investigated (qualitative).
Review of the Literature/Themes
This section provides a broad, balanced overview of the existing
literature related to the proposed
research topic. It describes the literature in related topic areas
and its relevance to the proposed research topic findings,
providing a short 3-4 sentence description of each theme and
identifies its relevance to the research problem supporting it
with at least two citations from the empirical literature from the
past 3-5 years.
The recommended length for this section is 1 paragraph for
Theoretical Foundations and a bulleted list for Literature
Themes section.
1. Theoretical Foundationssection identifies the theory(s),
model(s) relevant to the variables (quantitative study) or

phenomenon (qualitative study). This section should explain
how the study topic or problem coming out of the “need” or
“defined gap” in the as described in the Background to the
Problem section relates to the theory(s) or model(s) presented in
this section. (One paragraph)
1.5
2. Review of the Literature Themes section: This section is a
bulleted list of the major themes or topics related to the
research topic. Each theme or topic should have a one-two
sentence summary.
1.5
3. ALIGNMENT: The Theoretical Foundations models and
theories need to be related to and support the problem statement
or study topic. The sections in the Review of the Literature are
topical areas needed to understand the various aspects of the
phenomenon (qualitative) or variables/groups (quantitative)
being studied; to select the design needed to address the
Problem Statement; to select surveys or instruments to collect
information on variables/groups; to define the population and
sample for the study; to describe components or factors that
comprise the phenomenon; to describe key topics related to the
study topic, etc.
1.5
APA format.
1.5

NOTE: The two parts of this section use information about the
Literature Review and Theoretical Foundations/Conceptual
Framework from the 10 Strategic Points.
This Theoretical Foundations section is expanded upon to
become the Theoretical Foundations section in Chapter 2
(Literature Review). The Theoretical Foundations and the
Literature Review sections are also used to help create the
Advancing Scientific Knowledge/Review of the Literature
section in Chapter 2 (Literature Review).
Reviewer Comments:
Problem Statement
According to the World Health Organization (2017), the people
of Southern Texas have encountered several barriers in
accessing mental healthcare services. These problems include
insufficient mental healthcare facilities and absence of health
insurance to cover for medical expenses. These have impeded
the possibility of accessing timely screening and treatment of
mental health challenges. The solution for these challenges is to
identify and provide assessment programs and referrals to the
general population to deliver these services close to the citizens
through the Public Health Centers (PHCs). These programs will
be situated at various health centers in Southern Texas to allow
people who may not have access to such care to enjoy a model
of healthcare including behavioral and mental health and
prevention education. Providing the facilities alone is not
enough and does not guarantee effectiveness in serving the
population with mental disorders. It is not known how mental
health providers describe the factors influencing individual
decisions to utilize mental health services. There has to be
integral plans that would bring all stakeholders together to
provide mental healthcare services. The Universal Healthcare
Unit (UHU) recommends the utilization of emotional mental
well-being screening for early identification and referral for
people who need the services.

Criteria
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
Problem Statement
This section includes the problem statement, the population
affected, and how the study will contribute to solving the
problem.
The recommended length for this section is one paragraph.
1. States the specific problem proposed for research with a clear
declarative statement.
1.5
2. Describes the population of interest affected by the problem.
The general population refers to all individuals that could be
affected by the study problem.
1.5
3. Describes the unit of analysis.
For qualitative studies this describes how the phenomenon will
be studied. This can be individuals, group, or organization
under study.
For quantitative studies, the unit of analysis needs to be defined
in terms of the variable structure (conceptual, operational, and

measurement).
1.5
4. Discusses the importance, scope, or opportunity for the
problem and the importance of addressing the problem.
1.5
5. The problem statement is developed based on the need or gap
defined in the Background to the Study section.
2
APA format.
1.5
NOTE: This section elaborates on the Problem Statement from
the 10 Strategic Points. This section becomes the foundation for
the Problem Statement section in Chapter 1 and other Chapters
where appropriate in the Proposal.
Reviewer Comments:
Purpose of the Study
The purpose of this study is to examine how mental health
providers describe the factors influencing individuals' decision
to utilize mental health services in South Texas. The study aims
to come with the factors that either influence or deter the people
in the State from accessing much-needed mental healthcare. The
study will employ a qualitative study that will target mental
health providers within the State who are service providers that
care for the mentally challenged and compare factors impacting

utilization and non-utilization of mental services available in
the State. Additionally, a recommendation on how to improve
the mental health accessibility in the Southern Texas will be
made. Multiple factors that are associated with both the
utilization and under-utilization of specialty mental health
services among the people living in South Texas will be
identified. These include delays in observing and recognizing
the symptoms and how to seek help, the absence of appropriate
mental health providers, and lack of health insurance.
Criteria
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
PURPOSE OF THE STUDY
This section reflects what the study is about, connecting the
problem statement, methodology & research design, target
population, variables/phenomena, and geographic location.
The recommended length for this section is one paragraph.
7. Begins with one sentence that identifies the research
methodology and design, target population, variables
(quantitative) or phenomena (qualitative) to be studied and
geographic location.
1.5

8. : Defines the variables and relationship of variables.
9.
: Describes the nature of the phenomena to be explored.
1.5
APA format.
1.5
NOTE: This section elaborates on information in the Purpose
Statement from the 10 Strategic Points. This section becomes
the foundation for the Purpose of the Study section in Chapter 1
and other Chapters where appropriate in the Proposal.
Reviewer Comments:
Research Questions
The following research questions will help to guide this
qualitative study:
· RQ1: How do mental health providers describe the influence
of self-efficacy on individuals' decisions to utilize mental health
services?
· H1: Self-efficacy influences individuals' decision to utilize
mental health services.
of behavioral capacity on individuals' decision to utilize mental
health services?

· H2: Behavioral capacity influences individuals' decision to
utilize mental health services.
of expectations on individuals' decisions to utilize mental health
services?
· H3: Expectations influence individuals' decisions to utilize
Criteria
(0-3)
Chair Score
(0-3)
Reviewer Score
(0-3)
Research Question(s) and/or Hypotheses
· The recommendation is a minimum of two research questions
along with related hypotheses and variables is required for a
quantitative study.
· Also recommended is a minimum of two research questions
along with the phenomenon description is required for a
qualitative study.
· Put the Research Questions in the appropriate Table in
Appendix B based on whether the study is qualitative or
quantitative.
The recommended length for this …
24

Factors Influencing Individuals' Decision to Utilize Mental
Health in South Texas
Submitted by
A Dissertation Presented in Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy
Grand Canyon University
Phoenix Arizona
March 20, 2020
Contents
Chapter 1: Introduction to the
Study………………………………………………………. 1
Introduction…………………………………………………………
………………………1
Background of the
Study…………………………………………………………………
…2
Problem
Statement……………………………………………………………
…………….3
Purpose of the
Study…………………………………………………………………
……...4
Research Questions and/or
Hypothesis…………………………………………………….5
Advancing scientific Knowledge and Significance of the

Study……………………………5
Rationale for
Methodology…………………………………………………………
……….6
Definition of
Terms…………………………………………………………………
………9
Assumptions, Limitations and
Delimitations………………………………………………10
Summary and Organization of the Remainder of the
Study……………………………….11
Chapter 1: Introduction to the Study
Introduction
Mental health is a major issue around the World. The
United Nations (UN, 2015), has identified the issue as one of its
Sustainable Development Goals. These are a collection of goals
designed globally that aim to achieve a sustainable future for
all. The UN expressed its uncertainty regarding the extent to
which major social determinants of mental disorders are being
addressed worldwide (WHO, 2017). Developing a conceptual
framework will address the social determinants and align it with
its sustainable development goals. This way it can
systematically review the pieces of evidence about the social
determinants and identify potential mechanisms and targets for
interventions (Lund, et.al., 2018).
According to the Substance Abuse and Mental Health
Services Administration (SAMHSA), the Centers for Disease
Control and Prevention (CDC) and the U.S. Department of
Justice, millions of people suffer from mental illness in this
country. The high numbers necessitate raising public awareness
and start campaigning for a much better health care system
(Hamilton.et.al, 2016). According to the National Alliance on
Mental Health (2019), in 2018, 47.6 million people in the U.S.
experienced mental illness which means 1 in every 5 adults.

11.4 million Adults between ages 25 and 35 had an episode of
serious mental illness in the same year. In 2016, 7.7 million
youths aged 6-17 experienced some sort of mental health
disorder, while 9.2 million people were reported to have
experienced substance use disorder (National Alliance on
Mental Illness, 2019).
According to Kohn, et al. (2018), there is an emphasis on
the gap in mental health treatment in America when examined
through the prevalence of mental health disorders, the use of
mental health services, and the global burden of disease.
Statistical data from community-based surveys of mental
disorders in the various countries in America including
Argentina, Brazil, Canada, Chile, and the United States, etc.
were utilized. While 42.6% of children and adolescents in the
US suffered mental illness, the treatment gap in this group was
64%. The need to address the issue of mental health has not
been given enough attention resulting in the wide gap in
treatment. Mental disorders in children can be corrected if
detected early enough. Unfortunately, most of the caregivers do
not have the skills to detect these disorders causing them to
advance (Kohn et al., 2018).
According to Bowdoin et al. (2018), a patient-centered
medical home (PCMH) is a model meant for improving health
outcomes while at the same time meant to contain the cost of
care. This study examines the links between care provided
inconsistent with the PCMH and healthcare services utilizati on
as well as expenditures for non-aging citizens who are suffering
from mental illness in the United States. 6908 non-aging adults
suffering from mental illness participated in the 2007-2012
Medical Expenditure Panel Survey. Utilization of healthcare
services was compared with expenditures on care consistent
with the PCMH, other participants include a non-PCMH, usual
source of care (USC), and participants without a USC. The
outcome showed differences in utilization and expenditures
between participants who were provided with care consistent
with the PCMH and those who had a non-PCMH. USC showed

no statistical importance for any healthcare services category.
This research study will examine the factors according to
mental health providers that influence an individuals' decision
to utilize mental health services in South Texas. This research
will help us understand why individuals choose to or not to
utilize mental health services in the state.
Background of the Study
Mental health is one of the leading health issues affecting
Americans (Centers for Disease Control and Prevention, 2018).
While numerous treatment options have been developed for the
treatment of people with mental disorders, statistics show that
the number of people suffering from these conditions continues
to increase. Multiple studies suggest that people go through
various stages before seeking appropriate treatment. However,
there are barriers that prevent people to access mental health
treatment at the right time. These barriers are broadly divided
into system-level structural factors and individual attitudinal
factors. Existing research shows that people fail to seek mental
health treatment as a result of attitudinal barriers.
While the fear of stigmatization has been considered to be
one of the causes of poor utilization, of mental health treatment,
available research has shown that it is not one of the reported
barriers to seeking treatment for psychological issues.
According to Mental Health America (2020), psychologically
distressed Americans were more likely to report that they are
unable to access medical attention as a result of financial
barriers as compared to respondents in New Zealand. Data
collected from Netherlands, United States and Canada shows
that the income level of respondents does not affect the ability
of people suffering from psychological conditions from
accessing mental health services (Mental Health America,
2020).
A mental disorder must be diagnosed at its early stages to
avoid the advance effects of it progressing into adolescence
(Kohn et al., 2018). According to Grayson (2018), there has
been a notable difference in how patients utilize mental health

services with patients that experience a high level of burden
more likely to utilize mental health services. Similarly, the
caregivers that experience serious signs of depression or anxiety
in their child or adolescent will tend to use the services more
than the caregivers who experience mild or no sign of
depression or anxiety. The mental health status of the caregiver
is of no significance and does not influence need and utilization
(Gulliver et al., 2019).
Misra et al. (2017) in their article describe the concept
relating to the use of complementary and alternative medicine
(CAM) for mental health treatment among children in the
Southern State Region. According to the authors, CAM use
among US children stands at 12%. The Southern State Region
has placed a lot of effort into improving the health care
treatment of children. The services offered are directly
proportional to the allocation provided. Research showed that
some institutions have released a lot of funds to run this sector
and that the Sothern State Region receives the second-largest
allocation for mental health (Mista et al., 2017). Despite all
these efforts, there still exists a gap between the treatments of
mental health disorders in the US.
Mays et al., (2018), suggests that ethnicity and nativity
differences impact utilization of mental health services for
people suffering from mental disorders in the United States. The
rate of mental health disorder among black men is higher
compared to the African American men. Studies show that most
black men in the United States fail to seek medical services for
treatment. According to Mays et al., (2018), Obamacare
provides opportunities to reduce the nativity and ethnicity
variation in the utilization of mental health. Mays et al.,
(2018), suggest that Significant investment in primary care and
expansion of healthcare insurance is likely to increase the
utilization of mental health for Caribbean black men.
According to Davis et al., (2017), the United States is
facing an epidemic of morbidity and mortality as a result of
opioid prescription. According to the study, the use of opioids

has quintupled over the past fifteen years yet disability and pain
among Americans has not improved. Accordingly, the Centers
for Disease Control and Prevention, (2018), emphasizes that
more than 235, 000 people have lost their lives from 2000 to
2018 as a result of overdose from opioid prescriptions. Davis et
al., (2017), points out that the identification of particular
populations that rely heavily on these medications can help in
the development of effective preventive measures.
According to Gulliver et al., (2019), mental health needs
for university students in the United States have not been met.
About 17% of students who attend a university or college suffer
from mental disorders. Only one third of students suffering
from mental conditions receive treatment despite having
insurances that cover services and access to campus health
providers. Mental illnesses are likely to persist for students who
do not receive early treatment. This leads to grater social
impairment, higher rates of substance abuse and ultimately
lower graduation rates. Gulliver et al., (2019), argues that there
is need to meet these needs that have not been met for a long
time now.
The factors affecting the utilization of mental health
among students in higher institutions of learning are evolving
rapidly (Gulliver et al., 2019). Emerging research shows there
are lower rates of treatment among heterosexual students,
younger students, racial minority groups, and men. However,
campus size, number of providers in an institution, mental
health beliefs by students and student characteristics shows a
small portion of difference in services among institutions of
higher learning. The study suggests that improved awareness on
the importance of seeking mental health treatment among
students suffering from mental disorders could help improve
mental health services utilization.
Problem Statement
It is not known what influences an individual's decision to
or not to utilize mental health services in the United States. It is
not known how mental health providers describe the factors

influencing individuals' decision to utilize mental health
services. There are increasing mental health cases among the
children in the country. In, addition, there is limited research on
the factors that influence individual decisions to seek tr eatment
for mental illnesses. This research seeks to identify the key
issues that prevent the people of this country from utilizing the
mental health services and facilities.
According to Gulliver et al., (2019), there is a pressing
need to determine the factors that influence the utilization of
healthcare services among students in institutions of higher
learning. The study points out that the studies that were carried
out on the topic have not yielded substantial results (Gulliver et
al., 2019). Existing literature has associated poor utilization of
mental health services to lack of awareness, social status,
ethnicity and nativity. This research will help to establish how
these factors affect the utilization of mental health services.
Chang & Biegel, (2018), stated that more studies need to
be conducted to establish how policies can be used to address
the financial barriers to the utilization of mental health services
in the United States. The study found out that most Latino
Americans understand the need for mental health services but
are unable to access treatment due to lack of financial
resources. Nam et al., 2018, recommends for additional research
to determine attitudes and perceptions on seeking treatment
among people suffering from psychological conditions as
mental health services are still widely underutilized in the
United States.
In addition, Gordon (2018) reported that most people in
the US particularly those from minority groups prefer seeking
support from their families and friends rather than seeking
mental health services. The study suggested that more research
need to be conducted to establish the factors that may have
influenced them to avoid professional help. In another meta-
analysis study, the researcher recommended more studies to be
conducted in the field to gain a deeper understanding as to why
individual fail to utilize mental health services despite the

concerted efforts by the government and other non-
governmental agencies to create awareness and increase access
to mental healthcare (Schnyder et al., 2017).
Purpose of the Study
The purpose of this qualitative descriptive study was to
examine how mental health providers describe the factors
influencing individuals' decision to utilize mental health
services in South Texas. The study aimed to come with the
factors that either influence or deter the people in the State
from accessing much-needed mental healthcare. Furthermore,
the study employed a qualitative study that targeted mental
health providers within the State who were service providers
that care for the mentally challenged and compare factors
impacting utilization and non-utilization of mental services
available in the State.
The study made a recommendation on how to improve the
mental health accessibility in the State. It identified multiple
factors that are associated with both the utilization and under -
utilization of specialty mental health services among the people
living in the State such as delays in observing and recognizing
the symptoms and how to seek help, the absence of appropriate
mental health providers, and lack of health insurance. The study
will also play a significant role in bridging the gap that has
existed in literature concerning the utilization of mental health
in the US. This was achieved by suggesti ng new approaches in
which the rate of metal health utilization can be increased.
This study aimed to provide theoretical framework that
could be used for future studies focusing on the topic of mental
health utilization in the United States. The evidence presented
in the study bridges the psychological gap that has for a long
time been unexploited by researchers. The study also examines
factors that influence the utilization of mental health service
among students in higher learning institutions and this will help
college and universities to develop better strategies for helping
students to seek mental health services. This will help student
avid defiant behaviors such as missing classes and engaging in

drug abuse.
Research Questions and/or Hypothesis
Research questions and the hypothesis for this study comes
from the problem statement. The increasing rates of people
suffering from mental health conditions in the United States
shows that the interventions measures being implemented now
are ineffective, understanding the factors that cause these cases
to increase could help develop effective strategies for dealing
with mental disorders in the United States. Similarly, the study
sought to fill this gap in existing literature by reviewing the
factors that influence the utilization of mental health among
people living in South Texas.
The following research questions will help to guide this
qualitative study:
RQ1: How do mental health providers describe the influence of
self-efficacy on individuals' decisions to utilize mental health
services?
H1: Self-efficacy influences individuals' decision to utilize
behavioral capacity on individuals' decision to utilize mental
health services?
H2: Behavioral capacity influences individuals' decision to
utilize mental health services.
expectations on individuals' decisions to utilize mental health
services?
H3: Expectations influence individuals' decisions to utilize
Conceptual Framework
The conceptual framework shown in figure one presents
the major factors that influence health seeking behaviors among
individual’s with mental illnesses. The framework is inspired by
existing research and ideas of other researchers as well as the
theoretical framework of this study. Two major themes where
identified, environmental and personal factors and relationships

between service providers and service users. Each of these
themes has subthemes that represent the factors influencing
individual’s decisions to utilize mental health. Evidence
suggests that environmental factors influencing utilization of
mental health include gender, stigma, cultural identity and level
of income (Chang, & Biegel, 2018).
Multiple studies have indicated that factors influencing the
relationship between mental health providers and service users
include discrimination, power and authority, communication and
service awareness (Lancaster, 2017). According to Kohn et al.,
(2018), poor communication and the perception that mental
health professionals have power and authority over their
patients has led the poor utilization of mental health services in
the United States.
Figure 1: Conceptual Framework
Advancing Scientific Knowledge and Significance of the Study
The results of this research will add considerably to the
results of other studies as it provides means by which
prevention and intervention efforts will help to raise mental
health awareness and the importance of utilizing mental health
services among Americans as well as offer culturally sensitive
services. The result would direct efforts and focus on reducing
the stigma that is associated with mental health problems in the
minds of most people (Morin and Cherry, 2019). Besides, the
results will help, and be of value to practitioners in determining
the necessary strategies to be used to allow more individuals to
receive the necessary health care services that they require. It
will also help in eliminating the individualized beliefs that tie
people from getting the public services they ought to and thus
help them be more responsive to the services which are
available to them.
This study will also provide new knowledge to the existing
literature on the approaches to the treatment of people suffering
from psychological conditions, Practitioners can use the
findings of this study to increase improve their practice in

dealing with patients with mental illnesses. This study would
also be of great importance to researchers in the field of
counseling and psychology. Scholars in this field are interested
on understanding the factors that influence the utilization of
mental health services by those suffering from psychological
conditions. Historically, socioeconomic factors have been
considered as the primary reason why people avoid seeking
mental health services. This has made it difficult for researchers
to explore other factors that could have significant impacts on
how people perceive mental health services.
Lack of enough knowledge on how various factors
influence the utilization of mental health services has led
practitioners to use ineffective treatment approaches that
endangers the lives of people suffering from the condition. By
evaluating the factors that influence utilization of mental health
services, this study will help providers to avoid making errors
in the healthcare setting that could have adverse effects on their
patients. With increased knowledge on the factors leading to
poor utilization of mental health the providers will be in a
position to use the appropriate techniques in dealing with
patient suffering from mental health conditions.
Similarly, the result will enhance knowledge of social
learning theory through observation and modeling as they both
play significant and primary roles in this process, which moves
far and beyond Albert Bandura's behavioral theory, which
suggests that all behaviors can or are learned through
conditioning, and cognitive theories. Bandura's social lear ning
theory also proposed that learning also exist or develop simply
by observing the actions of others (Morin and Cherry, 2019).
Therefore, a learning condition like this may be used in
explaining different behaviors, including those factors
influencing individuals' decision to either utilize or not utilize
mental health.
This study will also enhance knowledge of the Health
Behavioral Model (HBM). According to Nobiling & Maykrantz
(2017) HBM is very effective in exploring perceptions about

mental health. However, most previous studies that aimed to
determine factors influencing mental health utilization did not
make use of this theory. Unlike those researches, the present
study will expand knowledge on how the HBM can be used
effectively to evaluate health seeking behaviors in a certain
region or population. The researcher believes that future studies
will utilize the theory in evaluating the factors influencing
decisions to utilize mental health among people with mental
disorders.
The Theory of Planned behavior on the other hand has also
been used in this study to predict health intentions. Unlike the
HBM, this theory has been utilized by a wide range of studies to
wide range of health intentions and behaviors including
substance use health service utilization, drinking and smoking
among other (Graham & Rosén, (2019). The theory assumes that
people behaviors are influenced by social climate. The findings
of this study will help expand the knowledge of the theory and
how people can change their behaviors towards utilizing mental
health services.
Rationale for Methodology
The most appropriate methodology that was used in
answering the research questions and which also helped to
address the problem statement is a qualitative methodology
(Colorafi and Evans, 2016). The qualitative approach is very
effective when a phenomenon that is being queried is properly
and effectively defined, and this study has distinctly defined the
phenomena of factors influencing the behavior and choices of
people in a natural environment to utilize or not utilize Mental
Health. The methodology is preferred as it is flexible when
researching health science topics to support various medical
theories.
In addition, this methodology provides a broad picture on
why people in South Texas avoid seeking mental health
services. Since this study aims to expand knowledge in the field
of mental health utilization, qualitative approach is the best
approach as it creates openness to explore new topic areas. It

also helps to stimulate personal experiences for people living in
South Texas concerning the utilization n of mental health. It
also helps the researcher to avoid prejudgments which could
compromise the outcome of the study. Prejudgments are recipes
for biases, and these affects studies significantly. This approach
explains particular responses from the focus group.
The methodology supports the research in finding and
filling the gap in the study. It was adopted because it would
help to provide real-life pieces of evidence from the interview
with participants. The literature has determined the causes of
the low utilization of mental health in the South to include
limitations to accessing health care. It also identified other
barriers to specialty mental health care utilization (Augsberger
et al., 2015). Interviews and Questionnaires were used to gather
correct information. Data was obtained to determine the health-
seeking behavior and mental health patients/services in the
State.
Quantitative methodology would not have been the best
method to be used in this study. According to Queirós, Faria, &
Almeida, (2017), qualitative methodology is best used in studies
focus on comparing variables. In this study, the researcher is
focusing on the behaviors of individuals and their perceptions
towards the utilization of mental health. As a result, this
methodology would be ineffective. Additionally, the results
obtained from a qualitative methodology do not provide a
detailed narrative of the phenomenon being studied but focuses
on numerical descriptions which may not help to determine the
health-seeking behaviors in the focus group (Queirós, Faria, &
Almeida, 2017).
Furthermore, numerous studies on factors’ influencing
individual’s decisions to utilize mental health services have
been conducted using quantitative methodology. As a result,
using quantitative approach for this study would yield results
that have already been presented by other researchers. The
results would be presented in a statistical manner and this
would make it difficult for the researcher to explore themes and

relationships that influence help seeking behaviors among
individuals with mental illnesses in South Texas. It was
therefore important to use a different approach in analyzing
these factors to gain new knowledge in the field.
Nature of the Research Design for the Study
The design for this piece of research work was a
qualitative descriptive study that involved collecting
information from service providers in the State, which aimed at
identifying the specific issues that are deterring the utilization
of mental healthcare facilities in this South. Qualitative
descriptive is the most appropriate design selected because it
helps to describe how mental health providers and mental health
professionals the factors influencing individuals' decision to
utilize mental health services. (Kim et al., 2017) This method is
also justified as it applies the description of the factors in play
and how they affect the outcome. According to Kim et al.
(2017), qualitative-descriptive research is descriptive and helps
in describing a natural phenomenon.
This method is suitable in research as it helps to describe
factors limiting the utilization of mental healthcare in the
county. Literature also supports the fact that issues of
underutilized mental health resources and non-institutionalized
adults are a behavioral risk factor in the South (Hamilton et al.,
2016). This approach was also the most appropriate for this
study as it gives a holistic understanding of health-seeking
behaviors among people in South Texas. In this approach,
respondents are in a comfortable environment and therefore the
behaviors observed are not biased. This design also ensures the
researchers own interpretations of the results they get are
transparent.
After analysis of the population group, 12 Mental Health
Providers were determined to suffice as a sample group. The
respondents were chosen among the mental health providers
with a membership of the Mental Health Association in South
Texas, which included focus groups of service providers' that
formed the sample population. The study area for the research

incorporated caregivers, psychiatrists, and therapists' offices,
and counseling facilities within the State. A structured system
of interviews with a minimum of 120 questionnaires and 40
mental health providers was used as the primary source of data.
The data was collected in three weeks with each
respondent given 30 minutes for the interview and filing the
questionnaire. Data was collected for the study using interviews
and questionnaires. Notes were taken; interviews were tape-
recorded and documented properly. Mental health providers
with membership in Mental Health Associations were the main
participants in the study based on 5 years' experience and the
willingness to be interviewed. Providers were selected to
complete questionnaire forms that included basic demographic
questionnaire, which was used based on their experience’s life
(Keenan et al., 2017).
A consent form was sent and obtained with signatures. The
selected participants submitted the consent forms and complete
the interview using …

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