Factors Leading African Americans and Black Caribbeans to Use Social Work Services for Treating Mental and Substance Use Disorders

By Cheng, Tyrone C.; Robinson, Michael A. | Health and Social Work, May 2013 | Go to article overview

Factors Leading African Americans and Black Caribbeans to Use Social Work Services for Treating Mental and Substance Use Disorders


Cheng, Tyrone C., Robinson, Michael A., Health and Social Work


Compared with white Americans, African Americans with mental disorders or substance abuse problems are less likely to receive treatment (Wells, Klap, Koike, & Sherbourne, 2001). Studies have shown that only one-third of African Americans and black Caribbeans with mental disorders use mental health services (Fiscella, Franks, Doescher, & Saver, 2002;Jackson et al., 2007). African Americans and black Caribbeans with dual diagnosis (co-occurring substance use and mental disorder) are even less likely to use any professional services (Woodward et al., 2008).

Social workers provide a wide variety of mental health services to individuals, families, and groups and are the largest group of mental health practitioners in the country (Cohen, 2003; Hartman, 1994; Robiner, 2006). They tend, however, to be considered less effective providers of mental health services than psychologists and psychiatrists, bearing the burden of association with negatively stereotyped child protective workers and homeless-services workers (LeCroy & Stinson, 2004). Because social workers' role in mental health care is potentially vital, perhaps especially so for minority groups, we need to definitively identify factors promoting minority Americans' use of social work services in mental health contexts. Following the lead of Woodward et al. (2008) in their study, we examined dually diagnosed African Americans' and black Caribbeans' use of treatment services provided by social workers.

The conceptualization of our study is rooted in the behavioral model of health services use, a framework developed by Aday and Andersen (Aday, 1993; Aday & Andersen, 1974; Andersen, 1995) that proposes indicators and predictors of health services use. For several decades now, Aday and Andersen's model has been widely incorporated in studies of adults' use of mental health services (Dhingra, Zack, Strine, Pearson, & Balluz, 2010; Gamache, Rosenheck, & Tessler, 2000; Lipsky, Caetano, & Roy-Byrne, 2011; Maulik, Mendelson, & Tandon, 2010; Nejtek et al., 2011; L. A. Schmidt, Tam, & Larson, 2012; Stockdale, Tang, Zhang, Belin, & Wells, 2007; Theriot, Segal, & Cowsert, 2003) and social work services (Moore, 1993).

The literature on how members of ethnic groups use social workers for delivery of mental health services is scant. We deemed it important to investigate how choosing to use the services of social workers for treating mental health and substance use disorders might be related to an individual's perceived need for services, belief system, family resources, proximity to services, social--structural factors, and demographic characteristics.

Under Aday's behavioral model, need for services motivates service use and the selection of a service provider; moreover, need (or perceived need) may be self-identified or may be identified by a professional (Aday, 1993). Research with samples drawn from the general population found dual diagnosis to predict receipt of mental health care or substance abuse treatment (L. M. Schmidt, Hesse, & Lykke, 2011; Watkins, Burnam, Kung, & Paddock, 2001). However, one study linked dual diagnosis solely to perceived need to use information--not to obtain professional services or medication (Meadows et al., 2002). Many who might benefit from a comprehensive treatment plan (targeting mental health and substance abuse) either deny their substance abuse or do not know about services appropriate for them (Drake et al., 2001). It is not surprising, then, that although 35 percent to 54 percent of individuals with dual diagnosis receive treatment, only 7 percent to 16 percent are treated for both substance abuse and mental disorder (Harris & Edlund, 2005). Among African Americans and black Caribbeans specifically, the dually diagnosed are less likely than those diagnosed with mental disorder alone to use either professional services or informal support (for example, from family and friends; Woodward et al. …

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