Barriers to Effective Mental Health Services for African Americans

“More importantly, the ECA and the NCS revealed that the level of unmet need for mental health care was substantially higher for African-Americans and Hispanics/Latinos than it was for white Americans (Snowden, 2001).”

“In this sense, they come to believe and act as if the stigma is a real and legitimate phenomenon (Corrigan, 2004b; Corrigan et al., 2003; Link et al., 2001; Miller & Kaiser, 2001; Okazaki, 2000; Snowden, 2001; Snowden & Cheung, 1990; Stevens & Hall, 1988).”

“Some cross-sectional studies find few or no racial differences in attitudes toward mental health treatment (19-21) while others suggest that compared to their White peers, African American adults hold more negative attitudes towards seeking mental health treatment(22).”

“Several American studies suggest that African Americans receive mental health care about half as often as white people (Diala et al, 2000; Snowden, 2001; Snowden, 2003), even though they have higher rates of some mental disorders (Thornicroft et al, 1999; Davis & Ford, 2004).”

“Some factors cited for the underutilization of mental health services by African Americans have included economic constraints (Snowden, 2001), service access barriers (e.”

“Past research also emphasized the need to address the cultural background of families when attempting to identify the influence of parent attitudes on service use [84,85].”

“Differential access to services based on income may be less striking in this sample because of working people having health insurance and poor people having Medicaid.(17) Placing income and education in the same model may account for some of the same variance, and the effects of income may be mediated through educatio…”

“…levels of disability, higher rates of inpatient service use, lower rates of outpatient mental health service use, and more barriers in seeking mental health treatment (Snowden, 2001; U.S. Department of Health and Human Services [DHHS], 2001; Ward, Clark, & Heidrich, 2009; Williams et al., 2007).”

“Relatedly, results from the Schizophrenia Patient Outcomes Research Team (PORT) indicated that in a sample of 719 adults with schizophrenia sampled from inpatient and outpatient programs in the Southern and Midwestern United States, rates of conformance to the PORT Treatment Recommendations (see Lehman and Steinwachs,…”

“…problems (Chatters, Taylor, & Neighbors, 1989; Snowden, 2001), their stigma of mental health service use (McKay, Nudelman, McCadam, & Gonzales, 1996; Snowden, 2001), and fear of being perceived negatively by friends and family (Hines-Martin, Brown-Piper, Kim, & Malone, 2003).”

“For example, we know that burnout and compassion fatigue are negatively related to tenure and age (Boyas et al., 2013), likely to be higher for women (McLean et al., 2011), and likely to be under-reported for people of color (Snowden, 1999, 2001).”

“This mistrust of the mental health providers is associated with perceived mistreatment, racism, stereotyping, and bias by mental health providers and institutions (28-31, 7).”

“, 1994a), disparities exist in mental health service utilization (Snowden, 2001), with African Americans typically having lower rates of treatment seeking than whites, higher drop-out rates from treatment, and greater use of emergency care.”

“Reasons for racial differences in access to mental health care may be related to the informal and social contacts preferred by people of color (McMiller & Weisz, 1996; Snowden, 2001; Snowden, 1998).”

“First, the elements incorporated into Nia are crucial for intervening with low-SES African American women because these women are reluctant to seek formal mental health services, particularly from the dominant system, and thus are more likely to participate in an Afrocentric intervention (Snowden, 2001).”

“Familial and community disapproval of treatment seeking is often rooted in the African American view of faith and the church community as essential for coping with life’s problems, even mental health difficulties (Snowden, 2001; Taylor & Chatters, 1986).”

“…there are some indications that the influence of such factors as financial concerns is greater for persons with alcohol use disorders who are female (Weisner, 1993), minority, or of relatively low socioeconomic status (e.g., Allen, 1995, Beckman & Amaro, 1986, Brown et al., 2000, Snowden, 2001).”

“A 1998 study showed that African Americans, much like other ethnic groups, are more likely than Whites to live in deep poverty, which includes about 14% of Black families and only 3.5% of White families (Snowden, 2001).”

“Last, historical mistrust of the healthcare system by AAs may explain the discrepancy (Snowden, 2001).”

“Cultural issues related to factors that predict termination also play a role in understanding these processes (McCabe et al., 1999; Snowden, 2001; Richardson, 2001).”

“Within the past three decades, the psychological experiences and mental health concerns of African Americans have drawn increased attention from the psychological community (Snowden, 2001; Whaley, 2001).”

“…1985; Cooper–Patrick et al., 1997), exhibit mistrust of the mental health system (Thompson, Neighbors, Munday et al., 1996; Vega & Lopez, 2001; Whaley, 2001a, 2001b), and prefer to utilize self–reliant (Snowden, 2001) and spiritual practices (Broman, 1996; Snowden & Cheung, 1990; Snowden, 2001).”

“…geographical shortages of behavioral health professionals in certain African American communities (Merwin 2003), particularly for those who prefer counseling and psychotherapeutic interventions or voluntary support networks (Snowden 2001), not necessarily available in community health clinics.”

“These results highlight the importance of efforts to reduce structural barriers to treatment for Blacks, particularly those who may lack available resources and encounter substantial challenges when navigating the healthcare system (Snowden 2001).”

“, 2006; Mills, 2000) and that African Americans are likely to not seek traditional mental health services (Diala et al., 2000; Miranda & Cooper, 2004; Snowden, 2001; USDHHS, 2001) and are more likely to utilize informal sources of care (Davis, 1998; Mills, 2000; Mills & Edwards, 2002; Warren, 1995).”

“Self-reliance is also associated with active coping dispositions, such as John Henryism, which is particularly salient for African-American men (James, 1994; Snowden, 2001).”

“Snowden (2001) reviewed barriers to mental health services among Af-cope with problems by relying on themselves, calling on friends, and seeking spiri- rican Americans and cited cultural issues, including mistrust of mental health profession-tual support (Chapman & Mullis, 2000).”

“This response may be due to the participants’ skewed understanding of mental health terminology and the stigma associated with mental health and illness in the Black community (Snowden, 2001).”

“The finding that African Americans perceive more barriers to mental health service utilization has been found consistently in the adult literature (Snowden, 2001).”

“This finding is consistent with previous research indicating that African Americans were less likely than were Whites to seek help from family, friends, or religious helpers (Hines-Martin, 1998; Snowden, 2001).”

“…likely than members of other racial and ethnic groups to access or use formal mental health services including psychologists and psychiatrists (Alvidrez, 1999; Barrio, Yamada, Hough, Hawthorne, Garcia, & Jeste, 2003; DHHS, 2001; Padgett, Patrick, & Burns, 1994; Snowden, 2001; Wang et al., 2005).”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“Psychological literature has long used a deficit approach (Guthrie, 1998) by examining individual level outcomes by comparing Whites and African Americans without considering the social location of African Americans and how these identities intersect within a larger social context.”

“Essentially, Snowden demonstrated that African Americans with symptoms similar to those of White Americans were 1.8 times more likely to be diagnosed with schizophrenia and about half as likely to be diagnosed with an affective disorder (Snowden, 2001, 2003).”

“In general, African Americans tend to deny the threat of mental illness and strive to overcome mental health problems through selfreliance and determination (Snowden, 2001).”

“Some studies in the psychotherapy literature have also reported that matching is associated with decreased dropout in African-Americans (Sue, 1998).”

“Snowden [11] hypothesized that help-seeking behaviors of African Americans may reflect specific coping styles, the influence of stigma, and a lack of resources and treatment opportunities.”

“The idea that Black people do not have mental health problems because they are ‘stronger’ than individuals of other races also emerged from this study and is present in the mental health stigma literature [26,27].”

“When compared with White women, Blacks are less likely to report or discuss the abuse with staff (Snowden, 2001).”

“Older African Americans with mental disorders are more likely than White Americans to seek care from a general practitioner (6, 8, 11, 14).”

“[8] Snowden LR.”

“…worry As a result of the underrepresentation of African American and Asian American individuals in research samples (Neal & Turner, 1991; Snowden, 2001; Wells, Klap, Koike, & Sherbourne, 1999), much of our knowledge about depression, social anxiety, and worry in African American and…”

“Cultural barriers, such as mistrust and fear of treatment, may prove equally as obstructive, placing rural African Americans at risk of experiencing significant levels of functional impairment resulting from unmet psychiatric need (19,21,22).”

“…mental health services may account for the high dropout rates among Asian American populations; similar high dropout rates are observed for African American populations (Snowden, 2001), Hispanic American populations (Vega & Lopez, 2001), and American Indian populations (Johnson & Cameron, 2001).”

“Specifically, empirical research has shown that African Americans are less likely to seek help from mental health professionals and agencies compared to Caucasians (Barksdale et al., 2010; Bussing, Gary, Mills, & Garvan, 2003; Dobalian & Rivers, 2008; Snowden, 2001).”

“mental health system (Blank, Mahmood, Fox, & Guterbock, 2002; Chatters, Taylor, & Neighbors, 1989; Lindsey et al., 2006; Snowden, 2001).”

“) have shown that when compared with EuropeanAmericans, racial/ethnic minorities (REM) and other cultural minorities are often less likely to utilize mental health services [1–5], more likely to terminate treatment prematurely [6], and less likely to receive the highest quality of care [7].”

“Considering inner-city African American children represent an especially vulnerable group due to their increased likelihood of having unmet mental health need(s), both national reports and prior findings have emphasized a need to expand research efforts to identify help-seeking variables which may account for lower ra…”

“Such studies have also found that African Americans have less favorable mental health outcomes after treatment (Sue, Fujino, Hu, Takeuchi, & Zane, 1991; Williams et al., 2007), which may be due to differences in the quality of (Virnig et al., 2004) or access to services (Snowden, 2001).”

“In particular, stigma around mental health issues has been found to influence help seeking among African Americans (Alvidrez, 1999; Snowden, 2001).”

“Despite the benefits of formal mental health services, African Americans are less likely to seek assistance from formal mental health providers, like social workers, to manage psychological problems (Barrio et al., 2003; Snowden, 2001; Wang et al., 2005).”

“In low income minority communitieswhere access and quality are limited, theremay be greater reliance on repeated emergency room treatment over ongoing routine outpatient care (Snowden, 2001).”

“Although previous findings among African American adults suggest that some social network processes deter or delay entrée into services, [23,24] our findings provide significant data (albeit with small to moderate effect sizes) regarding the potential effects of the social support system on adolescents who are experie…”

“African Americans may also be hesitant to seek mental health treatment because of a wealth of personal and cultural coping resources; these resources may serve as substitutes for professional mental health assistance and may proliferate social norms about the irrelevance of such service (Snowden, 2001).”

“Previous studies have shown that, as compared to their non-Hispanic white peers, African American older adults may hold somewhat more negative attitudes toward mental illness because they have a stronger tendency to view a mental illness such as depression as a personal weakness and are more likely to report somatic r…”

“…that variables likely to contribute to parents seeking help for their child include previous experience with mental health services, attitudes toward mental health professionals, stigma, or situational variables (e.g., Dubow et al. 1990; Harrison et al. 2004; McMiller and Weisz 1999; Snowden 2001).”

“African Americans, for example, are less likely than Whites to use outpatient mental health services (Barrio et al., 2003; Padgett, Patrick, & Burns, 1994; Snowden, 2001; Wang et al., 2005).”

“If anything, most research suggests that racial differences emerge with respect to the interpretation of symptoms, rather than with respect to their detection (Angel and Thoits 1987; Snowden 2001).”

“System barriers (medical and mental health settings) may include: a culturally insensitive and/or stigmatizing environment, lack of minority health care providers and consumers; [15] few strategies for maintaining evidencebased practices; lack of electronic technology; failure to align system and financial incentives…”

“In examining factors that may affect shared decision–making preferences, we found that white participants were more likely to rely on their providers’ knowledge for information about their mental illness, which may be related to different patterns of help seeking or greater mistrust of the mental health system among A…”

“Despite the sizeable volume of scholarship about mental health service use for Black American adults (Barksdale & Molock, 2009; Snowden, 2001; R. Thompson, Dancy, Wiley, Perry, & Najdowski, 2011) and children (Alegria et al.”

“…felt that evidence about mental health techniques that effectively meet the needs of multi-cultural groups is still lacking (Brach & Fraser, 2000; Phillips, Mayer, & Aday, 2000; Saha, Taggart, Komaromy, & Bindman, 2000; Vega & Lopez, 2001; Leong & Lau, 2000; Snowden, 2001; Johnson & Cameron, 2001).”

“They are also often underserved by the larger mental health system (Dixon & Vaz, 2005; Snowden, 2001).”