Access to mental health services for people living with heart failure: a qualitative study.

Abstract

Amidst low recognition and treatment for mental health conditions among people living with heart failure (PLWHF), this study aimed to identify factors affecting access to mental health services for PLWHF. Semi-structured phone interviews were conducted with PLWHF (n=13) and clinicians and researchers (n=9). Heart failure remote management programme at a large urban academic hospital in Ontario, Canada. Using inductive reflexive thematic analysis, 14 themes were created and mapped to Levesque's patient-centred access to care framework, revealing barriers at the system and patient levels. System-level barriers included service approachability (ie, difficulties detecting mental health concerns; unpreparedness for referral conversations), availability and accommodation (ie, limited mental health services; poorly timed services; inconsistent care pathways) and affordability (ie, limited human resources; lack of options for choice or finding fit; insufficiency of generic mental health services). Patient-level barriers included limitations in the ability to perceive mental health needs (ie, low mental health literacy), as well as seek (ie, stigma), reach (ie, inconvenience of in-person delivery) and pay (ie, lack of full insurance coverage and high cost of psychological services) for mental healthcare. The findings suggest enhancing the approachability, availability and appropriateness of mental health services and promoting the ability of PLWHF to recognise their mental health needs as potential interventional targets.