CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Exploring Why African-Americans May not be Utilizing Mental Health Services: Clinical Perspective A graduate project submitted in partial fulfillment of the requirements For the degree of Master of Social Work By Terrence Stewart May 2018 The graduate project of Terrence Stewart is approved: _______________________________________ __________ Dr. Wendy Ashley Date _______________________________________ ___________ Dr. Alex Acuna Date _______________________________________ ___________ Dr. Judith A DeBonis, Chair Date California State University, Northridge ii Dedication This paper it dedicated to J. Marks and other African Americans who are denied mental health treatment services due to the inability to access services and only seem to receive mental health services while being incarcerated. iii Table of Contents Signature Page ii Dedication iii Abstract vi Introduction 1 Literature Review 2 Method 8 Results 11 Discussion 18 Conclusion 23 References 24 Appendix A: Study Questions 27 iv Abstract Exploring Why African-Americans May not be Utilizing Mental Health Services: Clinical Perspective By Terrence Stewart Master of Social Work Purpose: The idea surrounding this research is to explore African American’s behavior towards mental health and how clinician’s behavior and practices may have an impact on African American’s mental health treatment. In addition, the research explores mental health clinician’s engagement with African Americans and the level of care being provided. Clinicians who currently or previously worked with African Americans took a survey which consisted of questions relating to themes relating to relationship building, engagement, and cultural competencies. Previous research will explore African Americans engagement when participating in mental health treatment. The study question was, are African Americans who are utilizing mental health services are being provided an adequate level of care from mental health clinicians? The objective of this exploratory study was to bring awareness and to this issue to reduce inadequate levels of care when working with African Americans that have mental health related issues. vi Introduction Mental health is part of our overall health and well-being. More often than not mental health is over looked as an actual health related issues. NAMI states, mental health is not solely based on emotions but are medical conditions that have an impact on how we live our lives and without proper treatment for mental health related issues conditions can worsen and make day-to-day life hard (NAMI 2017). African Americans are overrepresented in high-risk populations and are known to experience disadvantages in utilizing mental health services (Hackett 2014). According to Project LETS (Let’s Erase the Stigma), African Americans do not seek mental health treatment due to the mistrust, inadequate treatment, and lack of cultural competency (African American Communities Mental Health, 2017). Culture plays a significant role in a person’s beliefs and moral system. In an effort to better understand the barriers that prevent African Americans from receiving adequate mental health services, this study used an anonymous online survey to gather clinical staff perspectives on the approaches clinicians use to engage, establish rapport and provide mental health services to African American clients on a multiple system level. 1 Literature review Mental Health Impact on African American Communities Mental health plays a vast role in the functioning in all communities. In comparison to the other communities, there are a great deal of African Americans who struggle with mental health related issues. The Health and Human Service Office of Minority Health (OMH) estimates that African Americans are 20% more likely to experience serious mental health issues compared to the general population (Office of Minority Health 2016). Furthermore, African Americans are 10% more likely to report having serious psychological distress that Non-Hispanic whites (Office of Minority Health, 2016). According to NAMI, African Americans are more likely to be exposed to risk factors that contribute to their overall mental health (African American Mental Health, 2017). NAMI expands on this by stating African Americans occasionally experience more serious forms of mental illness because their mental health needs are not met (African American Mental Health, 2017). Stigma Over one third of African Americans who have already received mental health treatment reports that having anxiety and/or depression would be considered crazy (Alvidrez, 2008). Alvidrez implies that many African Americans do not utilize mental health services because they do not want to be stigmatized. Furthermore, Alvidrez’s (2008) research displays that one of the main contributors towards African Americans not utilizing mental health services is stigma. Our culture has a major impact on our beliefs and perspectives. Culture also has an impact on how we view mental health and the culture we associate with influences what we think and what we do (Schatell, 2017). 2 William (2011) suggest, family does influence our cultural practices and cultural perspectives are often learned and practiced within the family. Furthermore, African Americans may also be resistant to utilizing mental health treatment because they are afraid that it would give their family a bad representation as it relates to the family not being able to handle their issues internally (William, 2011). Most African Americans do not want to bring their family on the forefront of their mental illness. In a previous research study, African Americans who had received mental, and others who have not received services, stated that embarrassment and shame was a barrier to them receiving mental health services (Thompson, Bazile, & Akbar 2004). Social Economical In the United States, African Americans have the lowest household income compared to other cultural groups. According to the United States the real median income of nonHispanic White ($62,950), Black ($36,898), and Hispanic-origin ($45,148) households increased 4.4 percent, 4.1 percent, and 6.1 percent, respectively, between 2014 and 2015. Among the race groups, Asian households had the highest median income in 2015 ($77,166), though the 2014 to 2015 percentage change in their real median income was not statistically significant (Proctor, 2016). In one qualitative study, an African American woman who lived in a rural area was limited to the mental health treatment facilities that only accepted Medicaid (Speed 2013 p. 73). In the county she lived in, there are not mental health providers that accepts Medicaid, thus leaving her to have to travel outside of her county to receive services. In additional studies researchers have been able to display a correlation between African Americans with a lower social economic status and the lack of access to adequate health 3 services (Kushel, Gupta, Gee, & Haas, 2006). In Kushel, Gupta, Gee, & Haas (2006) research, it was determined that African Americans with instability housing and food insecurity had a high rate of acute services and a lower use of health care services. Cultural Competency In a 2013 commentary review, a health professional stated that there was no curriculum taught on how to address issues or race, ethnicity, culture, or class even though they served a large number of African American clients (Drake, 2013). In a journal exploring clinician strategies, the author (Curtis-Boles) emphasizes the importance of cultural competency. Curtis-Boles (2017) states that cultural competency isn’t just a tactic that is best for the client, but it meets the ethical needs mandated by the American Psychology Association (Curtis-Boles, 2017). In treatment, values systems behaviors, frame references, and symptoms may be viewed as deviant and dysfunctional when those symptoms could be a cultural idiosyncrasy (Atdijan & Vega, 2005). In a report by the United States Department of Human and Health Services, it stated that African Americans may experience cultural-bond symptoms and higher stress levels due to the conditions in which African- Americans live in. Furthermore, these symptoms and stressors can differ from other ethnic groups (US Department of Human and Health Services, 2001). Misdiagnosis In a study conducted in 2008 African American participants who needed to be treated for Post-Traumatic Stress Disorder (PTSD) were more than likely not to received PTSD focus treatment. (Davis, Ressler, Schwartz, Stephens, & Bradley, 2008). The 4 study further discusses how PTSD in the African American community is undertreated due to the clinicians being poorly educated. Snowden (2003), states that a clinician who’s makes unjustified decisions of a client based on biases of the client’s culture, race, or ethnicity may led the clinicians to make a poor clinical decision (Snowden, 2003). In another previous research studying racial bias and diagnosis it is stated that although clinicians are experts in their field using biomedical and behavioral evidence when creating a treatment options and conducting a diagnosis, it may be inevitable to dismiss race, gender, socioeconomic status, and other biases (Perry, Neltner, & Allen, 2013). This research further explores how the Diagnostic and Statistical Manuel of Mental Disorder (DSM) bias and Eurocentric view point may contribute to the misdiagnoses and over diagnoses of African Americans receiving mental health treatment. Mistrust In the