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Objectives The objective of this study was to examine mental health services utilization of older African Americans using data from the National Survey of American Life (NSAL). Methods A sub-sample of African American respondents aged 55 years or older (n=837) was used for this study. Thirteen mental disorders, including mood, anxiety, and substance disorders, were assessed using the Diagnostic Statistical Manual-IV World Mental Health Composite International Diagnostic Interview. Seventy-four respondents (9.6%) met criteria for a disorder. Self-reported service use included psychiatric and non-psychiatric mental health services, general medical care, and non-health care (e.g., human services and complementary-alternative medicine). Results Overall, 46.5% (n=30) of older African Americans with any one 12-month disorder used some form of services in the last year; 47.2% (n=12) with two or more disorders used any services. Those reporting any mood disorder had higher service use in every sector compared to those with any anxiety or any substance disorder. Age was significantly related with each service sector except for non-health care. There were no significant gender or work status differences, and marital status was only significant in non-health care use. Those aged 55–64, married, and not residing in the south were more likely to report any service use than their respective counterparts. Conclusions These findings reveal that a significant proportion of African American older adults with mental health disorders do not receive professional help. Future research on system, provider, and patient factors is needed to clarify and explain underutilization of mental health services.

Objective-We investigated the influence of race/ethnicity in diagnostic and disposition decisionmaking for children and adolescents presenting to an urban psychiatric emergency service (PES).Method-Medical records were reviewed for 2991 child and adolescent African American, Hispanic/Latino, and White patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were employed to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions.Results-Binomial logistic regression analyses reveal that African American (OR=2.28, p<.001), and Hispanic/Latino (OR=2.35, p<.05) patients are more likely to receive a psychotic disorder and behavioral disorders diagnoses (African American:OR=1.66, p<.001; Hispanic/Latino:OR=1.36, p<. 05) than White children/adolescents presenting to PES. African American youth compared to White youth are also less likely to receive depressive disorder (OR=0.78, p<.05), bipolar disorder (OR=. 44, p<.001), and alcohol/substance abuse disorder (OR=.18, p<.01) diagnoses. African American pediatric PES patients are also more likely to be hospitalized (OR=1.50, p<.05), controlling for other socio-demographic and clinical factors (e.g., GAF). Conclusions-The results highlight that non-clinical factors such as race/ethnicity are associated with clinical diagnostic decisions as early as childhood suggesting the pervasiveness of such disparities.

Social work interventions that emphasize culturally relevant services from a strengths-based perspective may be more appropriate than traditional mental health services for African American women who suffer from depression. An examination of the literature on epidemiology, etiology, and use of services for this population highlights the paucity of empirical studies, and an exploration of the treatment literature reveals insufficient application of culturally relevant approaches to African American women. Psychosocial competence, a strengths-based approach, and the Black feminist perspective offer the opportunity to gain a clearer understanding of the intersection and influence of oppression among depressed African American women and provide a useful framework for mental health practice with this population. A case vignette is provided, and future directions for research, practice, and policy are discussed.