The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness

Abstract

We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16–24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015–2018 was used to summarize service use among 13,363 transition age youth age 16–24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤ .05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P < .001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P < .05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes.

Clients’ Perspectives Regarding Peer Support Providers’ Roles and Support for Client Access to and Use of Publicly Funded Mental Health Programs Serving Transition-Age Youth in Two Southern California Counties

“…48 This finding is consistent with our previous quantitative findings showing that the availability of Latino peer providers was associated with greater engagement in outpatient mental health services among Latino TAY. 27 Other recent studies have highlighted the role of cultural and family stigma as important barriers to mental health services among Latinos, the benefits of provider concordance among Latinos in terms of patient satisfaction and engagement in care, and the potential role of peer navigators to better support Latinos with SMI accessing both mental and physical health services. [49][50][51]…”

“…This finding is consistent with our quantitative findings of increased service use among clients in programs where peers were engaged in diverse service roles. 26 , 27 Clients recognized that peer providers helped them to navigate mental health services by reducing barriers to access, collaborating with other mental health team members to address client needs, and imparting specific informational support to help clients navigate mental health services. Other studies have similarly placed peers in the role of case service navigator.…”

“…Purposeful sampling was used to identify the six programs in which peers provided a range of services to a diverse population of TAY. 27 Programs were provided with a recruitment flyer and suggested messaging to recruit TAY clients to join focus groups. Focus groups were conducted between September and November 2019.…”

“…Quantitative analyses based on administrative data first found that peer support was associated with increased use of outpatient mental health services and greater use of services in programs. 26 , 27 This qualitative investigation thus sought to expand upon quantitative findings and it examines TAY client perceptions of peer providers as it relates to support provided to facilitate their recovery and well-being.…”

Peer Support as a Tool for Community Care: “Nothing About Us, Without Us”

“…Because peers often "speak the same language" (both literally and socioculturally), trusted companionship of empathetic peers more effectively validates experiences of structural oppression, marginalization, and exclusion (Repper, 2013, p. 6;Faulkner & Basset, 2012). Peer support services are proven to provide culturally and developmentally appropriate care for young people (ages 16-24) with serious mental illness (Ojeda et al, 2020). Additionally, a U.S. clinical trial surveyed adults with mental illness who had been hospitalized three or more times in 18 months and were at risk for recurrent psychiatric hospitalizations.…”