title: Balancing accessibility and selectivity in 21st century public mental health services: implications for hard to engage clients.
abstract: This research highlights the importance of expanding examinations of service accessibility for hard to engage client populations to include assessments of individuals' ability to gain entrance to services and the system's ability to meet the service needs of particular client populations. The results of this research provide a framework to support these examinations. The increasing levels of selectivity and targeting of mental health services to particular client populations found in this study raise fundamental questions about the goals of service accessibility in 21st century public mental health services generally, and for hard-to-engage clients particularly. These findings also point to the need for examinations of the eligibility criteria and gatekeeping mechanism that are used to target services to particular client populations to determine if they are working as intended and to assess what impact these mechanisms have on hard to engage clients' ability to gain entrance to needed services.
authors.affiliation: Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-7164, USA. abw38@case.edu
authors.forename: Amy Blank
authors.initials: AB
authors.lastname: Wilson
authors.forename: Stacey
authors.initials: S
authors.lastname: Barrenger
authors.forename: Casey
authors.initials: C
authors.lastname: Bohrman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Draine
mesh_terms: D017144:Focus Groups; D020793:Gatekeeping; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data; D015143:Philadelphia; D017150:Public Sector; D036301:Qualitative Research; D016312:Treatment Refusal