This pilot study examines the specific views of low-income African American community members about mental illness and mental health services in order to develop less stigmatizing interventions appropriate for use in minority communities. The pilot will be conducted with Family Services of Western Pennsylvania (FSWP), the community-based mental health agency that is participating in a larger overall academic/community collaboration to improve clients’ engagement, prevent treatment drop-out, enhance treatment outcomes, and increase clients’ satisfaction. The work is based on literature reporting that l ow income and marginalized minorities experience a multitude of health problems (Snowden, 2001), have rates of mental disorders are at least as high as whites, and are disproportionately exposed to higher rates of stress by living in low income communities with high rates of violence, financial problems, unemployment, and relationship difficulties (Kessler & Neighbors, 1986; Robins & Regier, 1991), and have overall higher rates of both physical and mental health problems than the general population (DHHS, 1999; Durant et al., 1995; Edlund et. al, 2002; Williams & Collins, 1995; Kessler et al, 1999). The association between lower socioeconomic status and mental illness is not completely understood, but the combination of greater stress in the lives of the poor, greater vulnerability to a variety of stressors, and lack of access to relevant services could explain a high incidence of some mental disorders. These factors may be exacerbated by the experiences of African Americans who do seek mental health care who frequently report negative experiences characterized by misdiagnosis, culturally insensitive therapists, and a resultant high rate of premature drop out (Anderson et al, 2006; Chung & Snowden 1990; Parham 2002; Sue & Sue, 1999; Snowden 2001; Ward, 2005; Ward & Bernstein 1991). Given that African Americans represent 12% of the US population, or 33.9 million people (2001 census), our failure to address their mental health needs constitutes a major public mental health problem.
This study was designed to lay the groundwork for attempts to bridge the gap between service needs and service delivery to low-income African Americans by accumulating data that will help services to be defined in ways that actually meet their needs rather than seeking to find ways to shoehorn them into existing services. Rather than making assumptions based on the research literature, we hope to provide direct insight into why many low income African Americans do not even consider mental health services as one way of coping with the problems they experience. The focus will be on gaining an initial understanding of how mental health care is perceived, how the community reacts to those who appear to have a mental health problem, and what they believe would make it more likely that low income African Americans in need would use services. Specifically, standardized instruments, in-depth ethnographic interviews, and focus groups will be used to:
- Determine community attitudes and perceptions about mental illness and mental health services that influence mental health treatment participation among 100 consecutively consenting low-income African Americans in East Liberty and New Kensington.
- Identify African American patterns of help seeking from alternative sources outside the mental health system in times of trouble.
- Determine how African American community members see the potential personal and social costs and benefits to seeking mental health care.
The resulting data will be used to design and evaluate mental health services that could be more relevant, more engaging, and more effective for African Americans seeking service in the collaborating agency and similar community mental health centers. Finally, the data will be used to design a larger study of the effectiveness of engagement and treatment strategies specifically targeted to low income African Americans.