Factors Influencing Individuals’ Decision to Utilize Mental Health in South Texas

Dissertation Prospectus

Factors Influencing Individuals’ Decision to Utilize Mental Health in South Texas






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.


Score Assessment
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 Comment by Dr June Maul: SUMMARY FEEDBACKJames- Good work this week! You made a lot of progress during residency week. And this prospectus reflects that work and the progress. I have made specific recommendations in the various sections. It will be important to continue to revise and improve this prospectus prior to your prospectus and dissertation classes. As you do work on it use the readings to become an expert in your topic, your methodology and design, and your data analysis. You have a good start. However significant work in needed to finalize this prospectus and meet all of the criteria. Remember to continue with this focus. Thank you for your hard work during this class and your contribution to making it a success.

Mental health is a major issue around the World. The United Nations has identified the issue as one of its Sustainable Development Goals. The UN expressed its uncertainty regarding the extent at which major social determinants of mental disorders is being addressed Worldwide. Therefore, it is developing a conceptual framework that will address the social determinants and aligns it with its sustainable development goals so that it can systematically review the evidences about the social determinants and identify potential mechanisms and targets for interventions (Lund, et.al, 2018). Accordingly, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice, every year in this country, millions of people suffer from mental illness. The high numbers necessitate raising public awareness and start campaigning for a much better health care system (Hamilton.et.al, 2016). 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 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). Comment by Dr June Maul: Add a citation as evidence.


The U.S. Mental Health Care & Policy: Mental Health America (MHA), was developed in 1909. First studies on the effects of not using mental health services was identified in the mid-1950s It found that institutional inpatient and outpatient care models are required, which facilitated the development of a variety of antipsychotic drugs Augsberger, Yeung, Dougher, & Hahm (2015). Analyzed the hidden barriers to accessing care and utilization of mental health for Asian American Women in Southern Texas Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016). Reviewed and analyzed how the likelihood of lower hospitalization was associated with the race of African Americans while increasing age was a key predisposing factor in increased likelihood of hospitalization in South Texas.

First studies on the effects of using mental health services was identified in the mid-1950s. The studies identified the needs as:

· Deficiencies in Care

· Proper Treatment of People with Mental illnesses

· Cruel and Inhumane Treatment of People with Mental illnesses

· The need for Institutional Inpatient and Outpatient Care Models

· Need to Facilitate the Development of a Variety of Antipsychotic Drugs

Raval, G. R., & Doupnik, S. K. (2017), and Moore, J. & Krehbiel, C. (2016). identified the GAPS in mental health as

· Inadequate access to care

· Lack of adequate funding for the mental health sector

· Cost/Lower income earnings makes it had to get mental health services

Median treatment gap for schizophrenia & psychosis: 32.2%.; Depression: 56.3%; Dysthymia: 56.0%; Bipolar disorder: 50.2%; Panic disorder: 55.9%; GAD: 57.5%; OCD: 57.3%.; Alcohol abuse and dependence treatment gap at 78.1%.

Solutions were identified as:

· Reducing stigma

· Improving mental health literacy

· Creating Awareness

Moore, J. & Krehbiel, C. (2016). Raval, G. R., & Doupnik, S. K. (2017). Unite for Site (2020).

According to Kohn, et. al, (2018), there are emphasis on the gap in mental health treatment in the American Region when examined through the prevalence of mental health disorders, 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. The World Mental Health Survey published data were used in estimating professional the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas (Kohn, Ali, Puac-Polanco, Figueroa, López-Soto, Morgan, & Vicente, 2018).

Individuals’ decision to utilize mental health is increasingly becoming a concern because of health insurance coverage and the extent to which it narrow-network plans, this include the few 25 percent of providers in the health insurance market, effects of individuals’ choice of chosen and accessing specialty providers-particularly in mental health care. According to the research conducted in 2016 with 531 provider participant networks in the Affordable Care Act Marketplaces, in which the networks were evaluated based on their size and the percentage of providers in any network as they differ between mental health care providers and a control group of primary care providers. In comparison to the primary care networks, providers’ participation in the mental health networks was found to be low, with less than 43% of psychiatrists and less 20% of nonphysician mental health care providers participating in any network. Averagely, less than 25% of all primary care providers and just about 11.3 percent of all mental health care providers practice in a given state-level market. As a result of these findings, important questions have risen about provider barriers of not meeting the goal of mental health parity regulations. Meeting the demand and increasing network participation among mental health care providers including greater attention to regulations of network size and composition, could improve consumer choice and complement efforts at influencing individuals’ decision to utilize mental health (Zhu, Zhang, & Polsky, 2017).

Bowdoin, Rodriguez-Monguio, Puleo, Keller, & Roche, (2018) emphasized that 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. Yet, the evidence is inconclusive. This study aims at studying and examining the links between care provided in consistent with the PCMH and healthcare services utilization as well as expenditures for non-aging citizens who are suffering mental illness in the United States. A survey that was conducted which used self-reported data of 6908 non-aging adults suffering mental illness participated in the 2007-2012 Medical Expenditure Panel Survey. Participants involved in the study on utilization of healthcare services were compared with expenditures on care consistent with the PCMH, other participants include 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 the volunteers who had a non-PCMH USC showed non statistical importance for any healthcare services category. The conclusion demonstrated that there are consistencies in care received with the PCMH was not significantly linked with differences in healthcare services utilization or expenditures when compared to having a non-PCMH USC.

The health sector in the Southern State has been applauded for the good work in health allocations and expenditures. However, despite all the expenditures and better services offered to the people living in the State, mental health sector still faces challenges, especially among many Asian and African American people who have little to no access of utilizing of the services within the region (Texas, 2017). The Texas 2017 mental health national outcome measures (NOMS), attributed a number of factors that hinder most people from accessing mental health services to include inadequate access to care, costs, and lower income earnings. In addition, the results of the studies conducted on mental health care in the State have shown that the issue of mental health services has a big gap among the different cultures, but mostly affecting the minority groups in the nation. The most difficult challenge that was established was the improvement of mental health especially among the minority groups such as the Asian Americans and the African Americans. In most reported cases, many people are dying and committing suicide as a result of not properly utilizing mental illness health services and lack of insurance coverage.

One Southern State has been recognized as one of the States where the utilization of mental health facilities is below the expected standards. Although it is one of the areas with the highest and the best health facilities, yet, this Southern State still faces a lot of challenges on the number of children with mental health challenges.

The study will be conducted on all ethnic communities including African Americans, Asian Americans Hispanics and the Caucasian citizens of the Southern State, that were affected by lack of mental health services. The high mental health cases in this Southern State are blamed on various factors. One of the factors is the lack of enough and well-trained mental health professionals within the county. Such has resulted to lack of utilization of the mental health facilities, hence the rising number of mentally challenged children. Poverty levels in the Southern State have also been blamed for the increased number of mentally challenged children. Most of the people in the Southern State have low income and cannot afford insurance hence lacking the access to mental healthcare.

Providers in the mental healthcare clinics in the State, agreed that many people laced knowledge about the mental healthcare because of their low social status. Also, they acknowledged that they lacked enough knowledge about the importance of mental healthcare.

This is a research study will examine how mental health providers describe the factors influencing individuals’ decision to utilize mental health services in South Texas. The study is important in understanding the major reasons for utilizing and reasons that limit utilization of mental health services in the State and recommending ways through which the issues can be resolved. Comment by Dr June Maul: This section is too long and has a lot of information not specific to the criteria in the rubric table. Please revise it with one paragraph focusing on each of the main criteria. Comment by Dr June Maul: It is important to more directly identify your proposed topic in the first paragraph. It sets the focus for the reader throughout this section and the rest of the document. You have identified some good citations to define the need for the study. Make the arguments more direct and specific. They need to clearly lead to the gap and problem statement.


Criteria Learner Self-Evaluation Score


Chair Evaluation Score


Reviewer Score



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

The objective of this prospectus is to examine the factors influencing individuals’ decision to utilize mental health in the South of United State of America. Previous research works have explored the field of health accessibility not only in Texas but throughout the country. When narrowing down to the State, research has shown a gap alignment of medical services and needs of the people living in the State. Children at Risk (2017) deliberate on various increasing children with mental disorders’ needs in the society. Most of them develop mental illness from birth. Though the State has been applauded for having the best health services, the region still faces a number of challenges which are a threat to the child-health. Access to mental health is a gap yet to be filled in Texas (Beatty, Wilson, Ciecior, & Stringer, 2015). This has been fueled by few mental health professionals in the State, which has led to poor infrastructure in the mental health sector. The sectors greatly affected are the juvenile systems and emergency facilities. Many people in the region are uninsured and also have lower income which makes it had for them to get mental health services. In addition, poor parenting was a great contributor of health illness. This calls for further research into the field to understand more factors which affects the utilization of mental-health services in the areas not only in children but all people of this Southern State County.

According to the Centers for Disease Control and Prevention, mental health has become a significant public health issue in the United States that requires immediate attention and must be diagnosed at its early stages. Without an early diagnosis and treatment, children and adolescents may experience problems in the home, at school and among friends including issues with forming friendships. Accordingly, researchers have explored some barriers relating to the utilization of mental health service, notwithstanding, there were other factors that may also influence individuals’ decision to not utilize mental health. Comment by Dr June Maul: This paragraph needs citations to support your arguments

Providers are primarily the means by which most people including children and adolescents as well as adults enter treatment. They are responsible for taking care of their patients/clients physical and emotional well-being. The objective here is to specifically explore any relationship existing in utilizing mental health services and the influences of providers, including burden, provider mental health status and caregiver type. The study is a cross-sectional and utilizes secondary analysis of the 2003 National Survey of Children’s Health of 3,986 children and adolescents ages 6-17 with mental health needs. To understand provider influences and their characteristics as it relates to the relationship between need and utilization of mental health services, a bivariate and multivariate analyses were conducted (Grayson, 2016).

Results indicates that experienced providers who encounter some level of burden may likely utilize mental services than others who do not experience any burden. Providers that experience high level of burden will likely 15 times or more utilize mental health services (OR =13.70; 95% CI 10.58-17.74, p<0.001). Similarly, the caregivers that experience serious signs of depression or anxiety in their child or adolescent (OR=1.55; 95% CI 1.21-1.98; p<0.05) 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 has no influence on need and utilization (Grayson, 2016).

Teenagers in the age range of 14 to 17 are significant and are found to utilize mental health services more than the younger ones (OR=1.48; 95% CI1.16-1.89; p<0.05). African American children use mental health services more than the Caucasian Hispanic or other children (OR=0.59; 95% CI 0.38-0.91; p<0.05). The income and the caregivers have no influence on utilization. Furthermore, individuals with insurance coverage tend to use mental health services more than those without coverage (OR=1.88; 95% CI 1.22-2.64; p<0.05). The findings of this research indicate that providers are important for people to get mental health treatment for their loved ones; in addition, to how providers may be barriers to people with need. Furthermore, this study is promoting the need for more studies to include qualitative research to fully understand extra issues and challenges that providers and people face while trying to get mental health treatment (Grayson, 2016).

Similarly, in their 2015 research analysis, Augsberger, Yeung, Dougher, & Hahm (2015), analyzed the hidden barriers to accessing care and utilization of mental health for Asian American Women in the county. It showed that 299 women representing 43% of the participants have suffered from symptoms of depression or have had suicidal attempts. It examined the mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of Asian family to the stigma of mental health.

Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016), did research on the factors that affect mental healthcare access among African Americans. They identified one of the reasons to be low income and lack of awareness about the existing institutions that offer mental healthcare. Augsberger, Yeung, Dougher, & Hahm (2015), identified further issues that affect the accessibility of mental healthcare among Asian American women in the county. Accordingly, the authors concluded in their research that the Asian American women are suffering from depression and often were faced with the thoughts of suicide. According to the authors, Asian American women were stigmatized because of the mental health issues, and most of them do not want to come out and seek treatment.

Misra, S. M., Guffey, D., Roth, I., & Giardino, A. P. (2017) in their article “Complementary and Alternative Medicine use in Uninsured Children in Texas”, the authors describe the concept relating to the use of complementary and alternative medicine (CAM) for mental health treatment among children in this Southern State County. According to the authors, CAM use among US children stands at 12%. According to the 2012 National Health Interview Study. The research suggests that there are a number of uninsured population due to their limited access to care, which resulted in higher CAM use. A survey of 250 uninsured patients at various pediatric facilities in a free mobile clinic program showed a very high use by Hispanic population, their rate of CAM use in the last 12 months was close to 50% among children and 60% among parents. One Southern State has placed a lot of effort into improving the health care treatment of children; according to that 2012 research report conducted a study National Health Interview Study. Research study suggests that facilities that the services offered are inversely proportional to the allocation provided. Misra and the rest have concluded that this issue has raised a lot of concern since the mental health of the people remain to be very low despite the efforts implanted. Research showed that some institutions have released a lot of funds to run this sector. This research also showed that this Sothern State receive the second largest allocation for mental health.

Based on the data collected, a gap was identified regarding the factors that affect the utilization of Mental health facilities within the county. Various people within the mental healthcare profession have done research on some factors that may deter people from receiving mental healthcare. The literature on the mental health gap in the county has revealed major reasons as to why the gap exists. Stigmatization and low income are some reasons as to why the gap exists in the county. Comment by Dr June Maul: This section should be no more than three paragraphs. And it needs to focus more directly on the criteria. Revise this section to first present the societal issue which is well done. The second paragraph then defines how the research evolved from when it began. The third paragraph then presents the arguments that lead to the need/gap and ultimately the problem statement.


Criteria Learner Self-Evaluation Score


Chair or Score


Reviewer Score


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    
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. 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 evolved historically. Mental health services in this Southern State has faced several challenges. Texas (2017) asserts that people suffering from mental illness still faces problems despite the huge costs that are directed towards the healthcare. Schwartz, (2017) in support of this Southern State argue 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 few medical insurances which limits 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). Comment by Dr June Maul: You need to more specifically identify the model(s)/theories which will provide the theoretical foundation. The theoretical foundation is an important focal point for your research. It needs to align with the problem statement and provide the guidance for the data collection. Continue to identify and consider various models as you finalize your prospectus. You can find them from similar studies

Review of the Literature

Empirical Approach: Emphasized the issues of underutilized mental health resources and non-institutionalized adults as behavioral risk factors in Southern Texas. Augsberger, Yeung, Dougher, & Hahm (2015) identified various issues such as the history of suicide thoughts and depression among the Asian American women, different cultural needs in this specific Southern State county. Comment by Dr June Maul: Comment by Dr June Maul: This section should be about one page long. In it identify 4-6 major topics that are relevant to your study on a broad context. You can find these potential topics by looking at the Review of Literature section in dissertations related to your topic.

There are identifying facts suggesting the factors that influence either utilization or under-utilization of mental health services among Asian American women with a history of depression and suicide in this county of research. There is also a mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of families to the stigma of mental health. It concluded and recommended that mental health utilization should not be low among all the cultures, but rather extremely encouraged especially among women in the county (Augsberger, Yeung, Dougher, & Hahm, 2015).

Similarly, Wang, & Xie, (2019) emphasizes the need to eliminate the prevalence of mental health service utilization among many adults in the United States. The authors examined the links between mental health service utilization, health insurance coverage, mental health problems and drug abuse, and the health disparities among communities. In 2013. the authors in conjunction with the National Survey on Drug Use and Health performed a research with 37,424 adults’ respondents, with the outcome that only 5