Open Collections

Giesbrecht, Allison (Ally)

University of British Columbia

Background: Mental health and/or substance use (MHSU) challenges often reach a point of crisis and result in frequent use of health services with high-costs to the healthcare system. The term “high use of healthcare” (HUH) describes both the frequent and high-cost aspects of this healthcare use. Research in this area has largely been quantitative and has repeatedly identified MHSU challenges and social determinants of health (SDH) as key factors that contribute to HUH. Proposed solutions have frequently been generic and have failed to address MHSU or SDH, rendering them ineffective. This research collaborated directly with people with MHSU HUH to understand lived experiences and perspectives around contexts, challenges, and other factors that relate to MHSU HUH, and identify recommendations for systems change. Methods: This qualitative interview study utilized an interpretive description methodology informed by critical participatory action research values. Three peer-advisors were involved in designing the interview guide. In-depth qualitative semi-structured interviews with adults with MHSU HUH living in British Columbia took place in 2021 and data was analyzed using thematic analysis. Results: Sixteen people participated in the study. Data indicated that people with MHSU HUH often found themselves with no place to go where health needs could be met. Experiences of trauma were also found to be widespread and complex as participants noted personal, intergenerational, and vicarious experiences of trauma all impacted MHSU HUH. Participants also described a strong sense of personal responsibility for maintaining their health within their means. To adequately address MHSU HUH, however, it was noted that a service orientation and upstream reconstructions of health and social systems are needed. Significance: The study provides understanding of MHSU HUH as a symptom of multiple interrelated health and social inequities, and distrust held towards health and institutional systems. It supports greater lived experience leadership and inclusion in system design, implementation and delivery, and reconsideration of the biomedical model as the guiding framework for health, in favour of health equity.

Text

2024-09-30

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/85668

Rehabilitation Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/