Mental Health Care Access and Treatment Utilization in African American Communities: An Integrative Care Framework

By Kawaii-Bogue, Babe; Williams, Norissa J. et al. | Best Practices in Mental Health, Fall 2017 | Go to article overview

Mental Health Care Access and Treatment Utilization in African American Communities: An Integrative Care Framework


Kawaii-Bogue, Babe, Williams, Norissa J., MacNear, Kameron, Best Practices in Mental Health


In the wake of our health care system's expansions and changes, the need for behavioral health professionals will increase. This increased need for behavioral health professionals will serve as a response to the call for effective and efficient mental health care access, treatment, and prevention protocols. In conjunction with such changes, mental health professionals must be able to draw upon evidence-based protocols and best practices to ensure that the health care system is meeting the mental health needs of racially and ethnically diverse clients. Although previous studies have examined racial disparities in the mental health care system (Kataoka, Zhang, & Wells, 2002), evidence-based mental health service delivery protocols for racial and ethnic minority groups are still considerably underdeveloped.

Social determinants of health influence how mental health care is delivered (Marmot, 2008). Therefore, it is important to consider within- and between-group differences that influence the ways intersectional identities predict mental health outcomes. For example, several studies have framed the essential role that ethnicity plays in mental health care service delivery (e.g., Chang & Downey, 2012). Yet there is a dearth of literature examining evidence-based models for mental health service delivery in African American communities.

In an attempt to respond ethically to the mental health needs of African Americans, this article will provide a systematic review of mental health care access and treatment barriers in African American communities. It will begin by outlining the barriers and facilitators to mental health care access and treatment in the context of existing service delivery models used within African American communities. It will then propose next steps, including suggested components of an integrative mental health service delivery framework for African American communities.

Mental Health Care Disparities in African American Communities

To determine the effects of ethnic disparities in mental health care, we must first become familiar with the mental health needs of each ethnic group as opposed to merely reporting ethnic variations in the rates of mental disorders. For the purposes of this article, we assert that mental health disparities arise when the mental health care needs of one ethnic group are met to a lesser degree than the needs of another ethnic group. For example, previous studies suggest that African Americans encounter a complex system of inequitable and ineffective mental health care experiences (Hines-Martin, Malone, Kim, & Brown-Piper, 2003; Holden & Xanthos, 2009; Snowden, 2001). Although African Americans have lower rates of mental illnesses than other ethnic groups, mental illnesses are more severe and persistent in African Americans, arguably due to inadequate access and treatment (Breslau et al., 2005).

Compared to their white counterparts, African Americans are disproportionately affected by mental illnesses, in part, because of certain barriers that affect their mental health care access and utilization (Chang & Downey, 2012). Some studies (Anderson, 2013) have suggested that African Americans are disproportionately at risk for mental illness due their overrepresentation in socially marginalized groups (i.e., prison, foster care, and child welfare systems; impoverished and homeless communities; and victims or witnesses of violent crimes).

Service utilization across racial groups is another factor influencing ethnic disparities in mental health care outcomes (Sherer et al., 2002). Treatment access barriers disproportionately affect African Americans; yet, once in treatment, this population also faces obstacles in obtaining effective mental health care. In order to combat the existing racial disparities in mental health care, there is a need for more culturally effective access and treatment systems equipped to meet the unique needs of African American communities. …

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