Comparing Racial/Ethnic Differences in Mental Health Service Use Among High-Need Subpopulations Across Clinical and School-Based Settings

While short, this article presented several findings with the potential for exciting discussion. The first is the major finding that the lack of racial/ethnic differences in school-based service use contrasted with significant racial/ethnic differences in clinical settings among the high-need populations (Hispanic, Black, Asian American and Pacific Islander (AAPI). Upon reading this, my first thought was "surprise, surprise." It was a finding that I clearly expected to see in this article. However, it did not stop me from thinking a little more critically about why that was the case. My initial reasoning obviously focused on socioeconomic status. Racial/ethnic minorities have less financial resources, thus they are not able to afford mental health treatment at pay-for-service clinical facilities. Again, there was nothing novel about that idea. But I do find it rather presumptuous. Not nearly enough detail was given about the socioeconomic status of the groups that were being tested, so to blindly assume that minority groups' infrequent use of clinical facilities is mostly due to being of a low-SES borders on racist ideology. Not all Whites have a lot of money and not all minorities are poor. So without more information, I would be rather ignorant and quite frankly, rather lazy to assume based upon stereotypes.

After setting SES to the side, I chose to focus more closely on another implication of these findings: culture must play a role. I was so quick to immediately equate race with financial status that I overlooked the differences that exist between cultures. For example, family trust and discretionary disclosure are highly valued in many Hispanic communities, so going to a clinical facility could be considered taboo in many of those households. Without finding a way to control for that, I cannot rule it out as a possible confounding variable in this study. And quite frankly, that inability highlights a major weakness of this study, its lack of stability between groups. Unfortunately, that is an issue with performing a cross sectional study, as there are so many variables to account for that inevitably you miss a few that could truly play a major role in whatever research is being conducted.

As disappointed as I was with the lack of controls in this study and the inability to strongly suggest causation, what troubled me the most was the implications for schools that this study seemed to uncover. According to the findings, schools are the places where we see a lack of significant differences between groups in terms of mental health service usage. The author frames this in such a positive way that it almost makes it seem believable that school services are the answer. Well, that honestly is not the case. In the case that SES plays a factor, how many public schools in low SES neighborhoods can afford to pay someone to provide service in the school setting? If they can afford it, what is the quality of care? While it is great to know that students of many races/ethnicities get help at school, what type of help is being provided? Is any of it evidence-based? At least in a clinical setting the quality of care can reasonably be assumed to be relatively high. But at a middle/high school where going to see a counselor is taboo, what can we honestly say about the services? I can imagine that many students go to see their "guidance counselor" under the guise that they need some academic guidance, when really they want to discuss a mental health disorder they are experiencing. How equipped are those school counselors to provide effective mental health treatment? I know my line of questioning sounds rather cynical, but I believe that my questions are the ones that need to be asked. Yes, students of all races/ethnicities seem to be using the school resources more evenly than what is found in clinical settings. But is that due to voluntary usage for mental health purposes? And are the services doing what they are supposed to do?