Identifying Barriers to Mental Health Services: Thematic Analysis of Student Reflections

BACKGROUND: Mental health struggles are common in the student population, as is the stigma around mental illness. Stigma & biases are known barriers for students as they seek mental health services.
OBJECTIVES: Identify predominant themes surrounding mental illness & mental health services that exist amongst medical students & identify barriers that deter students from seeking help if they need care.
METHODS: This study was approved by the USU IRB as exempt. We analyzed 50 de-identified reflective practice papers, written by USUHS medical students. Probe questions for these papers elicited discussions of biases & stigma surrounding mental illness & treatment in the US military population. The investigators sent
emails to the classes of 2022 & 2023, asking permission to use each student’s essay in this analysis. Analysis used a thematic qualitative analysis approach.
RESULTS: The following themes emerged: Caring for the Caregivers; Defining Bias and Stigma; Health is Health; The Mission and Mental Health; & Students and Their Diverse Experiences. These themes supported a primary theme: Each student’s barriers, bias, and stigma are unique.
DISCUSSION: Every year at USUHS, more than 150 first-year medical students reflect on mental health & recall their experiences surrounding mental healthcare using the vehicle of reflective practice essays. The investigators assumed that biases & stigma would be discussed, & students would reflect upon these, even
suggesting ways to overcome them. Though this did occur, it was not the focal point of most students’ reflections. Broader, deeper ideas surfaced. How do we balance our responsibility of serving in the US Military while also being responsible for the mental wellbeing of our service members? How can we care for our patients effectively when we’re hesitant to care for ourselves? Is there truly an agreed upon definition for ‘bias’ and ‘stigma’ or are these concepts different depending on who’s reflecting on them? Are we properly caring for our patients when we can’t integrate mental & physical health into an all encompassing approach to patient care? The above themes emerged along with the realization that, indeed, barriers to mental health care exist. However, they can only be identified by the person for whom they exist. And the only way to begin breaking
down these barriers is to engage students, providing information, continuing the conversation, & deliberately moving forward to change our healthcare culture.