Mental Health and Addiction State of Ethnocultural/Racial Communities

Migration has become a common trend and an expected fact of life among the majority of underdeveloped and developing nations. Immigration exposes newcomers to a new experience, an acculturation. Acculturation is not always a successful process and may become stressful. Acculturative stress can manifest itself in different ways. Many researchers have suggested a connection between immigration and increased risk of developing mental health/addiction problems. Studies have shown that ethnocultural/racial groups have experienced difficulties in gaining access to mental health and addiction care services. This background paper is prepared to 1) discuss the mental health & addiction state of Ethnocultural/racial communities, and 2) offer working recommendations.     

Service Utilization among Ethnic Minority Children with ADHD: A Model of Help-Seeking Behavior

Despite a significant increase in the number of children and adolescents who receive clinical services for attention deficit hyperactivity disorder (ADHD), there is still a considerable level of unmet need. Children of ethnic minority status continue to lag well behind their non-minority counterparts in the rate of diagnosis and treatment for the disorder. Racial/ethnic disparities in service use are the result of a combination of access barriers and individual, cultural, and societal factors. The ADHD Help-Seeking Behavior Model is proposed as a framework for understanding factors that may be predictive of service use. Variables specific to ADHD and ethnic-minority populations are integrated within the framework of a four-stage pathway model encompassing problem recognition, decision to seek help, service selection, and service use. The authors argue that by systematically addressing factors related to service use for each ethnic minority group, more effective intervention initiatives can be developed to improve identification and treatment for ADHD among underserved children.     

Factors Associated with Mental Health Service Need and Utilization among Unaccompanied Refugee Adolescents

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.     

Mental Health and Substance Abuse Services to Parents of Children Involved with Child Welfare: A Study of Racial and Ethnic Differences for American Indian Parents

American Indian (AI) parents of children involved with child welfare were compared to White, Black and Hispanic parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0–14 years involved with child welfare. Weighted statistics provided population estimates, and multivariate logistic regression was used to predict the likelihood of caregivers receiving mental health or substance abuse services. There were significant disparities in the likelihood of receiving mental health, but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in this study. AI parents fared the worst in obtaining mental health treatment. Parents of children at home and of older children were less likely to access mental health or substance abuse treatment.     

Racial/Ethnic Differences in Parental Endorsement of Barriers to Mental Health Services for Youth

The present study investigated parental endorsement of barriers to care in a racially/ethnically diverse, at-risk sample of youth with mental health needs by testing the following hypotheses: (1) African American, Asian/Pacific Islander American, and Latino youth would have higher levels of unmet need compared to Non-Hispanic Whites (NHWs); (2) Parents of ethnic minority youth would report a greater number of barriers to mental health services for their children than would parents of NHWs; (3) The pattern of greater barrier endorsement by parents of ethnic minorities compared to parents of NHWs would persist across different barrier types; (4) Barrier endorsement would be related to unmet need for mental health services. As hypothesized, ethnic minority youth had higher levels of unmet need as compared to NHWs. However, despite this finding, parents of ethnic minority youth reported fewer barriers than did parents of NHWs, and this pattern generally persisted across barrier types. Furthermore, barrier endorsement was unrelated to unmet need. Post hoc analyses suggest the influence of cultural factors upon barrier endorsement, indicating the importance of taking such influences into account in future research on barriers to care.     

How Parents Seek Help for Children with Mental Health Problems

Parents seeking help for their child's mental health problem face a complicated system of services. We examined how parents navigate the various services available. Sixty parents contacting a children's mental health center were interviewed regarding their efforts and rationale in seeking help for their child. On average, in the year prior to the interview parents sought help for two different child problems, contacted five different agencies or professionals for help, and parents and/or children received two different treatments. One fifth of the time parents said they accepted treatments that they did not want. Almost all parents (87%) were simultaneously in contact with more than one agency at some point within the previous year. Future help-seeking models need to capture the iterative referral process that many parents experience.     

Parent/Caregiver Satisfaction with Their Child's Medicaid Plan and Behavioral Health Providers

The experiences of children in FFS and MC managed care plans (n = 715) were examined through satisfaction ratings by their parents/caregivers about their behavioral health provider and their Medicaid behavioral health plan. Multivariate regression analyses compared satisfaction ratings among children enrolled in FFS versus MC while controlling for other known predictors of satisfaction including child and parent/caregiver demographic characteristics, behavioral health status, and child history of behavioral health service use. Caregiver satisfaction with their children's behavioral health provider did not differ significantly between those children in managed care plans and those in fee-for-service plans. However, satisfaction ratings for Medicaid FFS plans were significantly more positive than those for Medicaid MC plans.     

Perceived Need for Treatment and Engagement in Mental Health Services Among Community-Referred Racial/Ethnic Minority Adolescents

This study examines clinical and family predictors of perceived need for treatment and engagement in mental health treatment services among community-referred racial/ethnic minority adolescents and their primary caregivers. Findings indicated that the majority of families perceived a need for treatment, but that perceived need was not associated with treatment engagement. Family factors (i.e., low cohesion and high conflict within the family) predicted perceived need for treatment among adolescents, whereas clinical factors (i.e., adolescent internalizing and externalizing symptomatology) predicted caregiver perceived need for adolescent treatment. Neither clinical nor family factors predicted treatment engagement.     

Capitation and Racial and Ethnic Differences in Use and Cost of Public Mental Health Services

This study investigated racial and ethnic differences in the probability of mental health service use and costs of treatment before and after the implementation of capitated financing. Models were created to test effects on utilization and costs of African American, Latinos, and white mental health consumers. As service use and costs declined under capitation, Latino, and white levels of use and cost tended to converge. African American utilization patterns in the capitated areas tended to parallel their white counterparts. Differential rejection by, or exclusion of, African American and Latino consumers did not appear to occur in response to capitation. This project is supported by the National Institute of Mental Health, Grant R01 MH 54136. Preliminary analyses were presented at the Association for Health Services Research Annual Meeting, Los Angeles, 2000.     

Gender and Racial/Ethnic Differences in Use of Outpatient Mental Health and Substance Use Services by Depressed Adults

This study examines depressed adults’ use of mental health services, focusing on Latinos and African Americans. Self-report data for adults meeting CIDI criteria for major depression or dysthymia from the 1997–98 HealthCare for Communities Survey were analyzed. Gender stratified logistic regression models examined the relationship between race/ethnicity and outpatient mental health service use, controlling for sociodemographic, health status, insurance, and geographic characteristics. Latinas and African American women and men exhibited low use of outpatient mental health services. Similar results were observed in an insured subsample. Service use by minorities was more affected by financial and social barriers (e.g., stigma). No gender differences were observed in self-reported barriers to care. Concerted and continued efforts to promote access to mental health services are critical for minority men and women affected by depression; adults may have unmet mental health needs. Other vulnerable populations include older adults especially, men, and men in poor health.     

Unmet Needs for Mental Health Services for Latino Older Adults: Perspectives from Consumers, Family Members, Advocates, and Service Providers

This study qualitatively assessed the need for mental health services among Latino older adults in San Diego, California. The primary mental health issue was depression. Primary organizational barriers to accessing services were language and cultural barriers secondary to a lack of translators, dearth of information on available services, and scarcity of providers representative of the Latino community. Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status. Age- and culturally-appropriate services are needed to overcome these barriers.     

Racial/Ethnic Disparities in Parent Perception of Child Need for Mental Health Care Following School Disciplinary Events

Disciplinary problems at school potentially affect parent perception of child need for mental health care. This article explores effects of a child's first school suspension or expulsion on parent perception of child need for services in three racial-ethnic subgroups. Subjects were mothers participating in a national longitudinal study and their children. First-time school suspension or expulsion positively affected service use and parent-reported service need among white non-Hispanic children, but had little or no effect for African American and Hispanic children. These results suggest that information on child behavior provided to parents by teachers and school administrators can influence parent perception of child service need, but that racial-ethnic differences may exist in parent interpretation of and response to this information. Culturally appropriate approaches to relaying information to parents about child service need may help reduce these differences.     

Racial/Ethnic Differences in Caregiver Strain and Perceived Social Support Among Parents of Youth with Emotional and Behavioral Problems

This study examined several hypotheses related to racial/ethnic variations in caregiver strain and perceived social support among parents caring for children with emotional/behavioral problems. A subsample of youth from the Patterns of Care (POC) study, which drew a stratified random sample of high-risk youth active to 1 of 5 public sectors of care, was used to test these hypotheses. When controlling for youth age, parental education, presence in an alcohol/drug or mental health (ADM) sector, and severity of child problems, African Americans reported significantly lower caregiver strain then did non-Hispanic Whites (NHWs), whereas Asian/Pacific Islanders (APIs) and Latinos did not differ significantly from NHWs. Contrary to prediction, both African Americans and APIs reported significantly lower perceived social support than NHWs, whereas Latinos did not differ significantly from NHWs. When perceived social support was controlled, the tendency of African American and API parents to report lower caregiver strain than NHWs became more pronounced. Thus, differences in perceived social support did not explain African Americans' lower caregiver strain. Other cultural variables such as familism and tolerance should be examined to identify processes that result in reduced perception of caregiver strain among African American parents caring for children with emotional/behavioral problems.     

Compliance with Mental Health and Other Specialty Care Referrals among Medicare/Medicaid Dual Enrollees

Objectives: To examine and compare non-compliance with mental health and other specialty referrals among low-income elderly.Methods: A survey of 2,128 community-dwelling elderly assessed mental health and other specialty referral in the past year and compliance with these referrals. Non-compliant participants and those who had encountered difficulties in arranging referral appointments were asked about the barriers.Results: 16.7% with mental health referrals vs. 4.8% with other specialty referrals did not comply (p < .001). The main reason for non-compliance with mental health referrals was lack of perceived need.Discussion: Lack of perceived need for professional help is a major barrier to specialty mental health care.