African American Youth Disparities with Mental Health

Disparities with Mental Health among African American Youth

Introduction

African American youth continue to face various disparities with regard to their mental health challenges. For instance, black American youth are less likely to receive mental health treatment as compared to white adolescents. According to Lindsey et al. (2012), the said unwillingness to offer treatment is usually not due to financial reasons. Rather, is due to the fact that they are black. Essentially, black Americans with mental health challenges often receive negative perceptions from providers. In addition, the mental health problems that they experience makes them stigmatize themselves (Linsey et al., 2012). Wallace (2012) suggests that when African American youth do receive treatment, their mental health disorders are often diagnosed incorrectly or misdiagnosed, undertreated, or mistreated. In addition, research on mental health research has also been carried out on this front. Apart from receiving minimal attention in as far as their mental health is concerned, it would be prudent to note that African American youth are less likely to utilize mental health resources. Essentially, black adolescents underutilize services available for mental health. According to Planey et al. (2019), underutilization of resources by black Americans with mental health problems happens to be problematic owing to the fact that the prevalence of African American adolescents who endure behavioral and mental health challenges is high. Findings from the National Comorbidity Survey - Adolescent Supplement indicate that almost half of black American participants had endured a mental health problem before eighteen years of age (Planey et al, 2019). Despite the said prevalence, it is important to note that only one quarter of black American youths receive treatment when it is needed. Planey et al (2019) found that black American youths with major depressive disorder were less likely to visit a mental health unit and talk to a mental health professional compared to their white counterparts.

Apart from the disparities that African Americans receive in mental health facilities, it would also be prudent to note that youths who are underserved in mental health services are also likely to be discriminated against in schools. Green et al (2020) found that most schools provide mental health services to students. It is important to note that although African American youths do receive mental health services in schools, in some instances, they receive the said services in separate settings from their white peers (Green et al, 2020). In addition, some schools could tie the said services to certain negative outcomes such as trauma-informed practices (Joseph et al, 2020). Essentially, students of color face unique trauma experiences which expose them to externalizing behaviors. As a result, the said students are excluded from school and are at a greater risk of academic underperformance, future incarceration, fractured relationships, crime, and mental health strains (Joseph et al, 2020). Moreover, the psychological well-being of youth of color is largely affected owing to the said trauma experiences. The purpose of this paper is to determine the mental health disparities that African American youth experience so as to address the said disparities and improve the psychological well-being of black youths, as well as their academic performance. The study will also include some facilitators to seeking mental health services among African American youths. However the study will primarily focus on the disparities of mental health among the said group. Findings from this research will have a meaningful impact owing to the fact that they will help reinforce the need to eliminate the barriers associated with access to mental health services among African American youths. Enhanced access to the said services is likely to result in better academic performance among the said youths.

Method

Search Strategy

The study utilized a systematic review approach to locate relevant research studies for the present research, i.e. in relation to determining the disparities that African American youths with mental health problems experience owing to their race. Databases used to search for the articles were: PUBMED, EMBRACE, and CINAHL (Cumulative Index to Nursing and Allied Health). Key words used for the study were: mental health, disparities, youth, and African American. The study also used Boolean operators so as to extract the studies included. For instance, disparities or barriers, and mental health or mental illnesses or mental disorders, and African American or black American or people of color, and youth or adolescent were used. The search was limited to articles which were published between 2012 and 2020.

Inclusion Criteria

The journal articles selected for this study had to meet certain inclusion criteria. First, the articles had to report on disparities related to seeking or receiving mental health services among African Americans. Second, the articles had to report specifically on black American youths who were 18 years of age or below. Third, the articles included in the study had to report on the barriers that prevent African American youths from seeking treatment in out-patient mental health service systems. In addition, the articles had to report on the experiences that the said youths endure as well as the experiences of their families and caregivers. The articles chosen were those written in English language.

Narrative Critical Review

A narrative critical review presents an overview of the findings from the five studies selected for this study. In a study that was conducted by Lindsey et al (2012), the authors used four focus groups that were guided by the unified theory of behavior to help them understand the perceptions and help-seeking behaviors to mental health services. The four focus groups involved two care giver groups and two adolescent groups - whereby the caregiver group had 11 participants, while the adolescent group had 16 participants. The said participants were from two elementary schools from the urban local community. The adolescent group included 8 girls and 8 boys aged 11 to 14 years. The use of focus group method was effective for this study owing to the fact that the participants had the chance to explore the facilitators and barriers to seeking help for mental health services in a broad manner. On the other hand, participants from the caregiver group included 10 male participants and one female participant aged between 31 to 67 years. The adolescent group was used so as to determine their experiences when they sought help owing to their emotional health challenges. On the other hand, the caregiver group was used for the study to determine how the said group sought mental health services for their children. Facilitators of all the focus groups were graduates in social work or psychology while social workers with PhD facilitated 1 caregiver and 1 adolescent. Discussions for the four focus groups were conducted for about one hour and a half. Data was then analyzed by use of a template analysis whereby elements of UTB construct were used. The said construct was used for this study owing to the fact that it provides a variety of proximal influences related to behavioral performance. Themes related to behavioral intentions were: expectancies, attitudes, social norms, self-construct, effect, efficacy, knowledge, environmental constraints, and salience. With regard to attitudes, the authors found that most caregivers had positive attitudes towards seeking help while only a few had negative attitudes. On the other hand, the adolescent group had mixed reactions having both negative and positive attitudes. However, they were positive that seeking therapy would help them solve their personal problems.

With regard to expectancies, both the caregiver group and the adolescent group had similar and variety of voices regarding their expectations towards seeking help. The caregivers felt that seeking mental health services should be determined by whether their children would be comfortable with the therapist. On the other hand, the adolescents did not feel that the race of the therapist would prevent them from seeking help. With regard to the belief on what a close friend or a family member should do, the caregivers were more concerned about the negative views of those around them. On the other hand, the youth were more concerned about being gossiped about or being teased by their peers if they sought for help. With regard to self-concept, the youths agreed that they should seek help if they needed to while the caregivers felt that they were being blamed for the mental health problems of their children. When it came to emotions regarding the use of mental health services, caregivers felt that it was important to seek mental health while the adolescents had problems expressing their feelings. With regard to self-efficacy, caregivers felt that it was good to seek help. However, they felt that they were not competent enough to help their children. With regard to knowledge, caregivers indicated that they were not aware of causes of the mental health problems that would make them seek treatment for their children. Some of the caregivers felt that seeking help from therapists would help them gain knowledge on mental health issues.

Environmental constrains were also cited by the participants as a hindrance to seeking treatment. For instance, lack of a mental health facility was cited as one of the hindrances. On the other hand, the UTB construct on salience indicated that the adolescents opted to remain silent about their mental health issue indicating that if they told someone else then there would be negative outcomes associated with such disclosure. In addition, the adolescents indicated that they felt safe if they communicated their mental health concerns with their family members. Despite the findings from this study, I feel that female participants were largely left out of the study. Therefore, the results may not be a true reflection of the factors that hinder African Americans from seeking help. In addition, the authors did not include all the 16 adolescents and the 11 caregivers that they had intended. Rather, only seven adolescents and five caregivers matched their inclusion criteria. Therefore, the participants that were added to the focus groups do not match with the purpose of the study. Further, the adolescents included in this study were aged between 11-14 years. Therefore, it did not capture the entire age group.

In another study by Wallace (2012) the authors wanted to determine the resiliency in mental health among African Americans. The authors used data from a secondary data analysis from Youth Risk Resiliency Survey (YRRS) - 2003. A total of 1,500 participants aged 15-18 years were included in the study. Data was then analyzed using SPSS version 18.0. The level of education and age were used to measure behavioral characteristics. Gender was used as a binary variable while community connectedness, spirituality, and mindset were used to determine outcomes. Likert type response code was used to assess mindset with scores that ranged from 1-6. A subscale score that also ranged from 1-6 was used to measure spirituality. On the other hand, scores ranging from 1-7 were used to measure community connectedness. To compare the individual characteristics with regard to community connectedness, spirituality, and mindset, Pearson’s correlation, analysis of variance, and student’s t-test were used. With regard to mindset, Wallace (2012) indicates that participants who had positive feelings regarding mindset received higher grades compared to those who had negative feelings with regard to education. In this case, females had negative feelings and thus their grades were low. Therefore, it is worthwhile noting that females tend to lack resiliency and confidence compared to their male counterparts. With regard to spirituality, the authors did not find any differences related to gender. However, students who were aged 18 years had higher scores in relation to spirituality and lower grades in their courses compared to their younger counterparts. From the said results, the author suggests that an individual’s spiritual connectedness determines their level of resiliency.

A study by Planey et al (2019) examines the barriers and facilitators to utilization and seeking help on mental health among African Americans. To determine the said barriers and facilitators, the authors used a systematic review from 15 studies conducted between January 2000 and May 2017. The studies included in the systematic review used only empirical mixed-method, quantitative, and qualitative studies. Essentially, qualitative studies were used to identify specific barriers and facilitators to using mental health services while quantitative studies were used to describe the results of facilitators and barriers or predictors and correlates to service use and help-seeking in mental health. Participants for qualitative studies ranged from 11-100 while participants for the quantitative studies ranged from 96-1005. Samples included for the studies was extracted from mental health centers, juvenile detention centers, schools, and local communities from urban and rural areas. From the various systematic reviews, the authors found that the barriers to help-seeking and health service use were related to themes which were inclusive of, but were not limited to; social network, school system, accessibility, availability, and affordability of treatment, religion and spirituality, stigma, clinician and therapeutic factors, and child-related factors. On the other hand, facilitators to seeking mental health services were inclusive of, but they were not limited to; geographic region, referrals and mandates by parents and gatekeepers, religion and spirituality, therapeutic factors, supportive social network, caregiver experiences, and severity of child mental health.

Green et al (2020) conducted a study that analyzed a sample of adolescents and parents using the National Comorbidity Survey Adolescent Supplement to determine the differences in the type of service that students receive in schools. The authors conducted this study so as to come up with strategies for schools to provide mental health services for youths who are underserved. The study involved a face-to-face study of youths aged 13-18 years. 9,224 youths and a national household sample of 904 adolescents was used. A fully structured interview and a Composite International Diagnostic Interview (CIDI) were used to assess mental illnesses using the DSM-IV criteria. The aim of the study was to examine the disorders and the sociodemographic characteristics associated with the service types that students receive in schools. Some of the disorders that were assessed were inclusive of, but they were not limited to; CD, ODD, hypereactivity disorder, dysthymic disorder, eating disorders, anxiety disorders, and mood disorders. Surveys from parents and adolescents were used to assess whether the youth received competent mental health services. Services received in schools were classified in terms of different classroom placements, different school placement, and school counseling. Self-reports were used to assess race while questions were used to measure learning disabilities. Discrete time survival analysis was then used to estimate the probability of placements. Results from the studies showed that one out of five respondents had received mental health services in their lifetime. Among the students who reported having been placed in separate classrooms and separate schools owing to behavioral problems were 357 and 268 respectively. Among the students who reported receiving treatment in different classroom and different schools were students aged between 16 and 18 years. In addition, black adolescents reported being placed in separate classrooms more times than their white peers. The study fails to explain the strategies of reducing disparities in mental health among black Americans, which was the main purpose of the study.

Joseph et al (2020) also found that African American youths face racial bias while receiving mental health services. Therefore, the authors opted to focus on a study to propose discipline interventions that would help schools incorporate racial equity when providing mental health services. The authors used the restorative practice philosophies, trauma-informed practice literature, and the critical race theory to determine the practices that can be incorporated in schools to enhance racial equity. The authors found that to eliminate racial biases, the notion of color blindness must be eliminated. Essentially, using CRT, the authors argue that the experiences of African American students must be incorporated when implementing decisions and policies in discipline. In addition, social workers should be trained on trauma-informed practices so that they can be able to incorporate the said practices in schools. Trauma-informed practices are especially important and they should be race-centered so as to help traumatized students. While the study provides the strategies that can be used to reduce racial biases in schools, it did not discuss the disparities in mental health which are the main purpose of the study.