Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Abstract

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.

Connecting students to mental health care: pilot findings from an engagement program for school nurses

“…Previous research points to several barriers to engaging adolescents in MHS, including fear of stigma regarding mental health, as well as uncertainty around what to expect from MHS and if such services would be helpful (e.g., Lindsey et al, 2013; Thompson, 2013). Consistent with these findings, during the focus group, school nurses who participated in the current study reported these to be challenges that they faced when discussing mental health issues with youths.…”

“…This rate is comparable to adolescents’ service utilization in specialty mental health settings, where one would expect rates to be lower due to geographic, transportation, and scheduling barriers. In studies of adolescents’ help-seeking behaviors and attitudes toward MHS, adolescents identified stigma of mental health and privacy concerns (e.g., fear of being teased or gossiped about by peers) as major barriers to seeking MHS (Lindsey, Chambers, Pohle, Beall, & Lucksted, 2013; Thompson et al, 2013). Adolescents also expressed some hesitation about whether MHS would be useful and were generally uncertain of what to expect from services (Thompson et al, 2013).…”

“…Adolescents also expressed some hesitation about whether MHS would be useful and were generally uncertain of what to expect from services (Thompson et al, 2013). Additionally, adolescents noted difficulty verbalizing emotions and a reliance on others (e.g., caregivers, school personnel) to identify mental health issues (Lindsey et al, 2013). These challenges highlight the need for strategies to effectively engage adolescents in MHS.…”

Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers

“…Evidence suggests service users of Black ethnicities underuse mental health services (Doyle et al, 2012;Lindsey et al, 2013;Nadeem et al, 2007) and are more likely to experience adverse pathways to mental healthcare (Ayalon and Alvidrez, 2007;Commander et al, 1999;Morgan et al, 2005). Future research would benefit from focusing on mental healthcare perceptions within caregivers of Black ethnicities.…”

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

“…Fear of stigmatization regarding mental health, as well as uncertainty about what to expect from mental health services have also been identified as barriers to mental health treatment engagement (Lindsey, Chambers, Pohle, Beall, & Lucksted, 2013; Thompson et al 2013). How these factors specifically affect treatment engagement is not well understood.…”