Student-run free clinics are uniquely positioned to understand the barriers to accessing mental health resources. We abstracted patient demographics and clinical characteristics from 355 patient charts and examined referral patterns for a subset of patients. Seventy-three (21%) of patients were found to have a psychiatric diagnosis and were more likely to have more medical comorbidities (10 versus 6, p < 0.001), total medications (8 versus 6, p < 0.001, and to be English-speaking (odds ratio: 1.97, p < 0.05). Of patients who received a referral, 37 (60%) were referred to specialty treatment, the majority to a single outside agency provider. 15 (25%) of patients were interviewed. Barriers to successful referral included transportation and medical symptoms. A facilitator of successful referral was concern for individual’s health. Language, social stigma, and cost were not cited as barriers. This study describes mental health needs at a SRFC and suggests opportunities for improvement.
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Alegría M, Mulvaney-Day N, Woo M, Torres M, Gao S, Oddo V (2007) Correlates of past-year mental health service use among Latinos: Results from the National Latino and Asian American Study. American Journal of Public Health. https://doi.org/10.2105/AJPH.2006.087197
Barnes RD, Ivezaj V (2015) A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity Reviews. https://doi.org/10.1111/obr.12264
Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G (2012) Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. https://doi.org/10.1186/1471-244X-12-36
Cunningham PJ (2009) Beyond parity: Primary care physicians’ perspectives on access to mental health care. Health Affairs. https://doi.org/10.1377/hlthaff.28.3.w490
Garfield RL, Zuvekas SH, Lave JR, Donohue JM (2011) The impact of national health care reform on adults with severe mental disorders. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2010.10060792
Gorrindo P, Peltz A, Ladner TR, Reddy I, Miller BM, Miller RF, Fowler MJ (2014) Medical students as health educators at a student-run free clinic: Improving the clinical outcomes of diabetic patients. Academic Medicine 89(4):625–631. https://doi.org/10.1097/ACM.0000000000000164
Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24(2):105–112. https://doi.org/10.1016/j.nedt.2003.10.001
Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC (2011) Quality of mental health care at a student-run clinic: Care for the uninsured exceeds that of publicly and privately insured populations. Journal of Community Health. https://doi.org/10.1007/s10900-011-9367-5
Linden A, Butterworth SW, Prochaska JO (2010) Motivational interviewing-based health coaching as a chronic care intervention. Journal of Evaluation in Clinical Practice. https://doi.org/10.1111/j.1365-2753.2009.01300.x
McQueenie R, Ellis DA, McConnachie A, Wilson P, Williamson AE (2019) Morbidity, mortality and missed appointments in healthcare: A national retrospective data linkage study. BMC Medicine 17(1):2. https://doi.org/10.1186/s12916-018-1234-0
Merz EL, Malcarne VL, Roesch SC, Riley N, Sadler GR (2011) A multigroup confirmatory factor analysis of the Patient Health Questionnaire-9 among English- and Spanish-speaking Latinas. Cultural Diversity & Ethnic Minority Psychology 17(3):309–316. https://doi.org/10.1037/a0023883
Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, Kessler RC (2011) Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine 41(8):1751–1761. https://doi.org/10.1017/S0033291710002291
Packness A, Halling A, Simonsen E, Waldorff FB, Hastrup LH (2019) Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study. British Medical Journal Open 9(3):e023844. https://doi.org/10.1136/bmjopen-2018-023844
Piette JD, Wagner TH, Potter MB, Schillinger D (2004) Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Medical Care. https://doi.org/10.1097/01.mlr.0000108742.26446.17
Preventive Services Task Force US. (2009). Screening for depression in adults: U.S. preventive services task force recommendation statement. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-151-11-200912010-00006
Rowan K, McAlpine DD, Blewett LA (2013) Access and cost barriers to mental health care, by insurance status, 1999–2010. Health Affairs. https://doi.org/10.1377/hlthaff.2013.0133
Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TPGM, Richir MC (2015) Learning in student-run clinics: A systematic review. Medical Education 49(3):249–263. https://doi.org/10.1111/medu.12625
Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, Von Korff M (2007) Depression–anxiety relationships with chronic physical conditions: Results from the World Mental Health surveys. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2007.01.015
Soltani M, Smith S, Beck E, Johnson M (2015) Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic. Academic Psychiatry. https://doi.org/10.1007/s40596-014-0257-x
Syed ST, Gerber BS, Sharp LK (2013) Traveling towards disease: Transportation barriers to health care access. Journal of Community Health. https://doi.org/10.1007/s10900-013-9681-1
The WHO World Mental Health Survey Consortium (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys. JAMA. https://doi.org/10.1001/jama.291.21.2581
Wahle B, Meyer K, Faller M, Kochhar K, Sevilla J (2017) Assessment of hypertension management and outcomes at an indianapolis student-run free clinic. Journal of Health Care for the Poor and Underserved 28(2):694–706. https://doi.org/10.1353/hpu.2017.0068
Zucker J, Gillen J, Ackrivo J, Schroeder R, Keller S (2011) Hypertension management in a student-run free clinic: Meeting national standards? Academic Medicine. https://doi.org/10.1097/ACM.0b013e31820465e0
Faculty time dedicated to this initiative was supported by the Vanderbilt University School of Medicine and The Shade Tree Clinic. We would like to acknowledge Dr. Bonnie Miller and Dr. Jeffery Balser for their support of the Shade Tree Clinic and to Thao Le and Daniel Sack for their critical review of this manuscript. The clinical operations of Shade Tree Clinic were supported by the Baptist Healing Trust. Thank you to the student and physician volunteers for dedicating their time and effort to the clinic. Thank you to the patients of Shade Tree Clinic without whom this work would not be possible.
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Knoll, O., Chakravarthy, R., Cockroft, J.D. et al. Addressing Patients’ Mental Health Needs at a Student-Run Free Clinic. Community Ment Health J 57, 196–202 (2021). https://doi.org/10.1007/s10597-020-00634-3
- Student-run free clinic
- Mental health
- Primary care
- Vulnerable populations
- Medical education