Trust and Health Service Use

The emergence of managed care into the health care system was intended to change the behaviors of both providers and patients to contain rising health care costs. These management strategies raise concerns about interference with professional trust relationships and its impact on access to care and quality of care, especially for disabled individuals with severe mental illness. Due to their vulnerability, they are less likely to advocate for themselves in receiving proper quality health care. In addition, distrust of health care systems is a prominent feature of this population because of their past experiences with systems of care and providers who have restricted their choices regarding treatment options. Many individuals with mental illness have experienced coercion in regard to treatment, resulting in mistrust in health care providers and an increased reluctance to use services (Regier, Narrow, Rae, & et al., 1993). With these preexisting negative, disadvantaged conditions, changes in the health care system could further limit utilization of health/mental health services among this vulnerable population and result in undesirable outcomes. Consequently, more expensive treatment modalities may be needed and may result in higher health care expenditures among this population