Large-scale epidemiologic studies indicate that the majority of adolescent and emerging adults who need treatment do not receive it (Costello et al., 2014; Merikangas et al., 2011; Villatoro & Aneshensel, 2014). The NCS-A study, for example, found that only about one-third of adolescents with a lifetime mental health disorder received services for their illness (36.2%; Merikangas et al., 2011). Although disorder severity is known to be associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders have never received treatment for their symptoms (Merikangas et al., 2011). Service use rates for a lifetime mental health disorder appear to be highest among those with ADHD (59.8%) and behavior disorders (45.4%) (Merikangas et al., 2011), indicating that the majority of youths receive treatment for a lifetime mental health disorder due to behavioral problems (rather than mood-related problems). The majority of adolescents also enter treatment with comorbid mental health disorders, which also seems to increase their odds of receiving treatment. For example, about 20% of youths with one class of disorder received treatment, while approximately 51% of those with two classes and 72.2% of those with three or more classes of disorders received services (Merikangas et al., 2011). This finding is consistent with other large-scale studies (Barksdale et al., 2009).

Non-Latino black and Latino adolescents with lifetime mental health disorders use mental health services at a lower rate in comparison to white youth across both mood and behavioral disorders, but the findings are statistically significant relative to mood disorders (Merikangas et al., 2011). This may be, in part, due to how the behavioral presentation of ethnic minority youth, particularly males, is interpreted by adults in their lives (e.g., teachers, principals). As a general matter, non-Latino black and Latino adolescents with mood disorders may be particularly vulnerable to being underserved in mental health treatment settings (this will be discussed further in a later section). When gender is considered, adolescent females are more likely to receive treatment for a lifetime anxiety disorder, while the opposite is true for adolescent males with lifetime ADHD (Merikangas et al., 2011).

Findings from the NCS-A study are confirmed by other nationally representative studies, particularly in regard to other diagnostic categories. For example, a study based on data from the National Survey on Drug Use and Health (NSDUH) found that treatment for 12-month MDD is lower among ethnic minority adolescents (African Americans, Latinos, and Asian Americans) relative to whites. Ethnic minorities were also significantly less likely to receive medication for MDD and treatment from a mental health provider relative to whites. Studies based on both the NCS-A and the NSDUH data reflect a disturbing trend of lower mental health service use for ethnic minority youth, especially among African American youth. The NCS-A, in particular, reflects the fact that relative to white youth, African American youth experience statistically significant lower use of specialty mental health, complementary/alternative medicine, and any mental health service use (Costello et al., 2014). In fact, while not statistically significant, African American adolescents are more likely than white adolescents to receive mental health service via human service sectors such as school-based and specialty mental health settings. Barksdale and colleagues (2009), in their examination of systems of care data, also found a persistent pattern of lower mental health service use (i.e., outpatient, school-based, and residential/inpatient services) for African American youth relative to white youth.

Large-scale, nationally representative studies have increased in sheer numbers, but vital information about outcomes specific for young males of color is missing. In particular, these studies miss an opportunity to determine within- group differences among young males of color regarding the factors that lead to unmet mental health need. We need to know the factors that underlie mental health service use among young males of color for several reasons. First, this information will lead to the development of interventions and strategies to remove barriers that contribute to the underutilization of mental health services. Second, we need to determine the role other service systems play (i.e., juvenile justice, child welfare, schools) as it relates to the mental health need and service use divide for young males of color. For example, as it relates to school- or juvenile justice-based mental health service use, what are the challenges related to addressing the mental health needs of young males of color? The following discussion will begin to extrapolate empirical findings regarding these challenges and point to possible solutions.

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