Author: Eleanor Watson
Watson, Eleanor, 2024 Exploring mental health support for people with communication access needs: Learnings from lived experience., Flinders University, College of Nursing and Health Sciences
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People with communication access needs are known to face elevated risk factors for poor mental health. Existing research and reports from the Australian Disability Royal Commission identify that this group are frequently exposed to events that negatively impact mental health and wellbeing. Consequently there are social and legislative imperatives to improve the communication accessibility of mental health supports.
Research Question. This study explored mental health support for people with communication access needs with the objective of identifying potential improvements to promote inclusion in mental health care. The researcher sought the perspectives of three populations: people with communication access needs, their everyday communication partners (ECPs), and mental health workers (MHWs) to respond to the following research questions:
1. What strategies and resources for promoting the inclusion of people with communication access needs in psychoeducational support have previously been tried? Refer to the published scoping review (E. Watson et al., 2022).
2. What do people with communication access needs and their ECPs know, or want to know, about mental health and related supports and services?
3. What are the barriers and facilitators to mental health help-seeking for people with communication access needs?
4. What are the experiences, perceptions, and skills of MHWs relating to the provision of mental health care to people with communication access needs?
5. How can mental health care be adapted to improve access to systemic resources that promote the mental health of people with communication access needs?
Method. A participatory-social justice mixed methods design, underpinned by a transformative paradigm and the Human Rights Model (Degener, 2016; Mertens, 2007), was utilised to promote the inclusion of stakeholders throughout the research process. Online surveys and interviews were designed in collaboration with lived-experience research advisors and delivered to stakeholder groups: people with communication access needs (n=9 survey, n=6 interview), their ECPs (n=9 survey, n=6 interview), and MHWs (n=24 survey, n=9 interview). Framework Analysis (Ritchie et al., 2014) was used to analyse the interviews and survey data was analysed using descriptive statistics. Quantitative and qualitative data were integrated using the Framework approach. Levesque et al.’s (2013) Conceptual Model of Access to Health Care was applied to contextualise the findings among the empirical research, legislation, and contemporary social policy.
Findings. The scoping review revealed a range of communication access strategies (for example, using communication partner skills, providing accessible written information, and incorporating AAC) that have been utilised in research and practice to promote participation in psychoeducational interventions. Additionally, analysis of interview and survey data from the three groups yielded two key themes:
1. Experiences: Informing mental health knowledge and practice.
2. Factors that influence access to mental health care: Barriers and facilitators.
Within key theme one, data revealed that experiences informed the mental health awareness of people with communication access needs and ECPs, rather than proactive education. People with lived experience and ECPs desired more information about mental health and support pathways. MHWs’ accounts revealed a lack of pre-service education to prepare them to provide communication access, they had learned on the job to accommodate communication diversity. Data yielded insights into positive and negative influences on mental health in people with communication access needs. Social connectedness had substantial positive impacts, while loss of autonomy presented negative impacts for lived-experience participants. In key theme two, barriers and facilitators occurred across five sub-themes: Communication Access Factors, Systems Factors, ECP Supporter Factors, MHW Practitioner Factors, and Environmental Factors.
Conclusions. Mental health support can benefit people with communication access needs, and a range of strategies are available to enhance communication access. Research that prioritises the perspectives of lived-experience stakeholders provides rich information about the barriers to engaging with mental healthcare. Applying the Conceptual Model of Access to Health Care (Levesque et al., 2013) clarified the pinch-points encountered by people with communication access needs across the mental health system. Recommendations for ECPs, MHWs, and disability and mental health service providers have been developed to improve inclusivity in mental healthcare for people with communication access needs.
Keywords: Communication, Access, Mental Health, Disability, Human Rights, Mixed Methods
Subject: Public Health thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Parimala Raghavendra