Barriers to Mental Health Treatment Services for Low-Income African American Women Whose Children Receive Behavioral Health Services: An Ethnographic Investigation

Abstract

Despite the prevalence of mental illness among low-income African American women, only a limited number seek and/or accept help from mental health service delivery systems. A qualitative analysis of 64 ethnographic interviews of low-income African American women whose children receive behavioral health services was completed to assess what barriers to care were reported for the women themselves. These African American women were interviewed as part of a larger study seeking to determine why mothers seek mental health treatment for their children, but not themselves, after many of the women (n D 32) met the baseline criteria for anxiety and/or depression. Our finding revealed that (1) the fear of losing their children, (2) economic stressors, (3) role strain, (4) perceptions of the system, and (5) violence and survival are key factors to consider when engaging low-income African American women in mental health treatment services. These factors have

Engaging Parents in Evidence-Based Treatments in Schools: Community Perspectives from Implementing CBITS

“…Parents who identified barriers to attending CBITS parent sessions, such as long work hours, transportation, and childcare, recommended that sessions be held in the evening or that childcare and transportation be provided if possible. Much of the literature has described these common logistical barriers (e.g., Davis et al, 2009), along with underutilization of care resulting from stigma-related concerns, fear, or distrust of traditional systems of care especially among ethnic minority and/or immigrant populations (Copeland & Snyder, 2011; Nadeem et al, 2007). However, the findings from this study highlight the importance of not assuming that parents are disinterested in care or will not prioritize participation in services.…”

Poverty and Mental Health: How Do Low‐Income Adults and Children Fare in Psychotherapy?

“…Latino and African American individuals frequently report being treated poorly or misjudged because of their race or ethnic background (LaVeist, Diala, & Jarrete, ). In addition to general fear and distrust, some groups of low‐income adults report specific fears that prevent service utilization such as the fear of losing custody of their children (Copeland & Snyder, ). Immigrants report concerns about their immigration status, resulting in a reluctance to access care (Kaltman, Hurtado de Mendoza, Gonzales, & Serrano, in press).…”

“…Even in mental health clinics, there may be limited agency or systemic support for intensive outreach. In addition to lack of training and support, some clinicians may be quick to label clients as “resistant” or not committed to care after limited outreach (McKay et al, ). When low‐income adults and families are successfully engaged in services, are the evidence‐based treatments we have effective?…”

“…Some low‐income individuals may not be familiar with mental health services and thus be reluctant to prioritize treatment over more immediate concerns. However, research suggests that when clinicians and all program support staff are trained to be aware of these barriers among low‐income individuals and families in addition to utilizing strategies for overcoming such barriers, engagement in services improves (Korfmacher et al, ; McKay et al, ). Significant reductions in the no‐show rate for first appointments have been found when clinicians employ strategies such as telephone engagement that aims to restructure logistical barriers, explore parental concerns and beliefs about coming to treatment, and highlight parental strengths (McKay, McCadam, & Gonzales, ).…”

Development and pilot testing of an adaptable protocol to address postpartum depression in pediatric practices serving lower-income and racial/ethnic minority families: contextual considerations

“…The lower-than-expected percentage of women with positive screens for depressive symptoms found in the current study could potentially be explained by the concerns expressed during the focus groups that some women may be less comfortable disclosing depressive symptoms to their child's pediatric provider than they would be with their own provider if those concerns are validated. Focus group participants further hypothesized that if some women do in fact feel uncomfortable, the discomfort might stem from a lack of trust in the healthcare system, cultural and linguistic factors, and fear of involvement of child protection service, consistent with theoretical concerns expressed in prior studies [3,37,38]. These findings suggest that increasing the percentage of women screened for PPD in safety-net pediatric practices may be necessary, but not sufficient to address disparities in PPD care.…”