The treatment gap in mental health care in a rural German region: from a concept of social milieu to a group-specific intervention. An interdisciplinary model study using epidemiological data

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More than half of all people with mental illness in Germany have never availed themselves of professional psychiatric support. Besides structural factors, the causes for this treatment gap can be found in the level of knowledge and in the attitudes of the persons affected. The interdependencies between value orientations and lifestyles in relation to psychiatric health care provision at the intersection of sociology and medicine are an under-researched determinant of this treatment gap.The possibility to understand the social process of seeking psychiatric care while taking values and individually dominating lifestyles into consideration makes constructs like ‘the social milieu’ a promising instrument for health services research that has to date only rarely been drawn on. The first-time explication of relevant values, principles and lifestyles should help with the formulation of new and direly needed alternative hypotheses for explaining the treatment gap, and to develop valid instruments that facilely measure milieu factors relevant for psychiatric undersupply, with a view to expanding existing theories on the matter.The aim is to identify social milieus that bear a particularly high risk of a treatment gap in a three-staged preliminary study. Stage 1 is devoted to distinguishing the sociodemographic determinants of psychiatric undersupply in the rural and structurally weak model region Western Pomerania on the basis of present data from an ongoing epidemiological survey. Stage 2 envisages that 2 x 20 subjects with depressive symptoms (risk group that has not sought help N = 20; control group that has sought help N = 20) undergo follow-up with a special focus on the help-seeking context. A guided interview (“Grounded Theory”) will be used to measure relevant implicit and explicit values and lifestyles in relation to professional mental health support in order to improve understanding of this high-risk population. In stage 3 the outcomes of stages 1 and 2 will be synthesized to social milieu concepts for a rural population with a high risk of a treatment gap.After an item-based evaluation of the construct relevance in ongoing surveys, a complex intervention to reduce the treatment gap among the affected risk-population will be developed. In light of social inequality and public polarization, improving our understanding of the impact of social milieus is of pivotal importance, as social milieus that are already disadvantaged could be at risk of being excluded from provision even further. Patient-oriented psychiatric health care provision as an element of an open society should be sufficiently attractive and as easily accessible as possible for persons from all social backgrounds.