The Complexities of Help-Seeking: Exploring Challenges Through a Social Network Perspective

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

Research in the area of social networks and health has demonstrated that lay social network members play a critical role in the early stages of the illness career, influencing key decisions and pathways to formal care. Here, we revisit and extend this body of work, examining how the lay social network context can moderate the influence of treatment experiences on recovery outcomes as the illness career unfolds. To achieve this goal, we address two research questions, drawing on a longitudinal sample of people making their initial contact with the mental health treatment system: First, we explore how treatment experiences, lay social network characteristics, and recovery outcomes change over 2 years, beginning with the point of entry into treatment. Second, we examine whether the relationship between perceived treatment experiences and recovery outcomes is contingent on characteristics of the lay network context in which clients are socially embedded, focusing on the network's cultural orientation toward medical professionals. We find that positive treatment interactions facilitate improved self-esteem, mastery, role functioning, recovery optimism, and global functioning when the lay network culture is pro-medical, but largely have null effects on the recovery process when the lay network is more hostile to medical professionals.

At the intersection of lay and professional social networks: how community ties shape perceptions of mental health treatment providers

BACKGROUND

The therapeutic alliance is a critical determinant of individuals' persistence and outcomes in mental health treatment. Simultaneously, individuals' community networks shape decisions about whether, when, and what kind of treatment are used. Despite the similar focus on social relationship influence for individuals with serious mental illness, each line of research has maintained an almost exclusive focus on either 'inside' (i.e. treatment) networks or 'outside' (i.e. community) networks, respectively.

METHOD

For this study, we integrate these important insights by employing a network-embedded approach to understand the therapeutic alliance. Using data from the Indianapolis Network Mental Health Study (INMHS, n = 169, obs = 2206), we target patients experiencing their first major contact with the mental health treatment system. We compare patients' perceptions of support resources available through treatment providers and lay people, and ask whether evaluations of interpersonal dimensions of the therapeutic alliance are contingent on characteristics of community networks.

RESULTS

Analyses reveal that providers make up only 9% of the whole social network, but are generally perceived positively. However, when community networks are characterized by close relationships and frequent contact, patients are significantly more likely to report that treatment providers offer useful advice and information. Conversely, when community networks are in conflict, perceptions of treatment providers are more negative.

CONCLUSION

Community-based social networks are critical for understanding facilitators of and barriers to effective networks inside treatment, including the therapeutic alliance. Implications for community-based systems of care are discussed in the context of the USA and global patterns of deinstitutionalization and community reintegration.

Successful linkage between formal and informal care systems: the mobilization of outside help by caregivers of persons with Alzheimer's disease

Health interventions are currently being revamped to address the specific needs of chronic illness and population aging. In this context, focus has increasingly turned to Alzheimer-type dementia, an illness that is considered to mobilize a large number of social actors into long-term involvement of varying intensity. Linkage problems between families and professional systems have been well documented, yet the reasons for this remain relatively unexplored. In this article, we outline how we used social network data and narrative methods to better understand the linkage processes between formal and informal care systems. We present the trajectories of four caregivers of people suffering from Alzheimer's disease who were able to establish relationships with resources outside the family. In each of the cases, the dimensions of trust and recognition were central to establishing and maintaining supportive relationships, and must therefore be understood in light of social network dynamics and the broader environment. Although preliminary, this study contributes to the state of knowledge on linkage problems by proposing "bottom-up" solutions that are client centered.