title: Barriers to seeking mental health care after treatment for orofacial injury at a large, urban medical center: concordance of patient and provider perspectives.
abstract: BACKGROUND
  Patients with orofacial injury face significant mental health issues, yet few obtain mental health services. The goals of this study were twofold: (1) compare the perspectives of providers and patients with documented mental health service needs regarding psychosocial aftercare; and (2) identify factors that impede or facilitate aftercare participation.
  
  
  METHODS
  Patients with orofacial injury in a large, urban medical center who met the screening criteria for probable mental health disorder (n = 25) and trauma service providers (n = 35) were queried about their perceptions of psychosocial aftercare and beliefs regarding potential barriers to seeking care. Bivariate analyses and Fisher's exact tests were used to describe and compare patient and provider responses.
  
  
  RESULTS
  Patient participants generally expressed interest in receiving aftercare services for psychological problems. For patients, lack of information about services, financial cost, and availability of transportation emerged as the most salient barriers to care. The providers also rated these barriers as among the most salient; however, important provider- patient discrepancies emerged during barrier ratings. The most potentially challenging area of divergence concerned provider beliefs that patients are disinterested in addressing psychological problems, lack faith in the effectiveness of psychosocial services, and do not regard solving these problems as a priority.
  
  
  CONCLUSIONS
  A substantial proportion of patients have unmet psychosocial needs after facial trauma. Patients desire these services but endorse key barriers to care seeking. Providers are not necessarily aware of either the extent of interest in psychosocial services or the nature of the barriers that would impede care utilization. Implications for improving access to care are discussed.
authors.affiliation: RAND Corporation, Arlington, Virginia, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Chandra
authors.forename: Grant N
authors.initials: GN
authors.lastname: Marshall
authors.forename: Vivek
authors.initials: V
authors.lastname: Shetty
authors.forename: Susan M
authors.initials: SM
authors.lastname: Paddock
authors.forename: Eunice C
authors.initials: EC
authors.lastname: Wong
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.forename: George
authors.initials: G
authors.lastname: Luo
authors.forename: Dennis-Duke R
authors.initials: DD
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000359:Aftercare; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D005151:Facial Injuries / Q000523:psychology* / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D019037:Urban Health Services