Securing Services for Black Adolescents with Mental Health Problems

Lindsey, M.A., Chambers, K., Pohle, C., Beall, P. & Lucksted, A. (2013). Understanding the behavioral determinants of mental health service use by urban, under-resourced black youth: adolescent and caregiver perspectives. Journal of Child and Family Studies 22: 107-121.

This article deals with the topic of the prevalence of black youth experiencing mental health problems  and the related issue of whether they are able to secure mental health services to assess and manage those issues, whether they want to, and what kinds of obstacles get in their way of accessing services.  

According to the research study conducted in this journal article, Black adolescents are less likely than non-Black adolescents with similar mental health problems to receive treatment.  Many adolescents who participated in the study cited non-financial reasons including the negative perceptions they generally have of services and providers, and the self-stigma associated with experiencing mental health problems to begin with.  From a caregiver standpoint, the reasons for not seeking mental health services for their Black adolescent are structural (i.e., having to secure child care, time of day that services are offered) and/or perceptual (i.e., believing that the adolescent does not have mental health problems or believing that mental health services are not helpful).  Some barriers to receiving mental health help in the schools are often logistical (i.e., lack of transportation, scheduling, child care conflicts), but can also be perceptual (i.e., denying the severity of the problem or believing that the mental health problem can be resolved without counseling or other treatment).  There appears to be a general mistrust of mental health service providers among Black adolescents and caregivers, which can be a major deterrent from seeking needed treatment.

There appears to be a need for deeper understanding of behavioral determinants from both the adolescent and caregiver perspective.  During a weeklong meeting at the National Institute of Mental Health (NIMH), Jaccard and colleagues developed a framework now known as the Unified Theory of Behavior (UTB), a comprehensive framework which incorporates both micro- and macro-level constructs from other evidence-based theories of behavior, including Bandura's Social Learning Theory, the Theory of Reasoned Action, versions of the Health Belief Theory of Subjective Culture, and other self-regulations theories.  The primary foundation of the UTB suggests that there are 11 different interrelated classes of constructs that should be taken into account when evaluating the motivation of an individual's behavior, including willingness, abilities, environmental constraints, salience of mental health services, and previous experience utilizing services.  This study used a template analysis based on the UTB in order to empirically determine help-seeking behaviors among Black adolescents and their caregivers. 

This study found that it appears to be the tendency of Black culture for adolescents to want their problems discerned behaviorally (i.e., body posture, hitting people) rather than verbally expressing the problem or stating ways they thought the problem could be resolved.  This mentality is very similar to the culture in which I was raised - to deny that the problem even exists, to sweep the mess under a rug, so to speak, and just forget that it is there.  Don't admit or acknowledge the problem - if the evidence can be hidden, then hide it, and perhaps it will just go away.  On the contrary, I have also been environmentally influenced by our mainstream culture, which tends to promote the importance of verbally expressing emotions and the issues that plague us, in a search for healing and moving forward with life in a healthy, acceptable way.  That said, I find it more important to instead sweep what our family culture tells us to do under that proverbial rug and search for mental and emotional health.  If there is a way to rid the world of these negative stigmas and perceptions, I want to find a way to do that.  Adolescents of today become tomorrow's adults, and we must rely on them to lead us.  Eliminate their struggles, provide support, show them that we are here to help them get through their strife.  Be the therapists that can reach them, help them heal for a brighter and healthier tomorrow, and provide the services that will benefit them the most.  The accessibility is there - now, to establish acceptability...that is the real dilemma.