VIABLE STRATEGIES TO REDRESS THE MENTAL HEALTH TREATMENT UNDERUTILIZATION OF YOUNG MALES OF COLOR
We propose that the mental health treatment challenges of young males of color, while daunting, can be addressed via the careful coordination of intervention strategies and services. We offer solutions that can occur within the context of families and also at the provider level—to include those who actually provide the one-to-one services, and the settings or sectors in which services are provided.
A Race-Sensitive Focus on Treatment Engagement
Despite the advances of evidence-based treatments and renewed policy efforts to improve access to care, the fact remains that the majority of youth in the United States do not receive treatment for their mental health needs (Costello et al.,
2014; Merikangas et al., 2011). No group is more disproportionately impacted by the lower likelihood of mental health treatment receipt than young males of color. As mentioned earlier, young males of color face a number of challenges regarding their conceptualizations of emotional and psychological struggles, and with respect to their conceptualizations of mental illness. Notions of masculinity and the primacy of social network support can hinder psychological help seeking that leads to formal care. Young Latino males face an even greater challenge if there are language differences between themselves and service providers. These challenges in service utilization call for a renewed focus on the need for targeted treatment-engagement interventions and strategies designed to meet young males of color where they are (i.e., facing the stigmatization associated with mental illness and treatment, and the uncertainty as to whether mental health professionals will truly understand their unique needs).
What we know is that some treatment-engagement interventions have a proven efficacy. In a recent analysis of the treatment-engagement literature, Lindsey and colleagues (2014) identified 22 successful interventions that have been applied to youth and families to improve mental health treatment utilization. Lindsey and colleagues point out, however, that these “common elements of treatment engagement” have been mostly applied to the caregivers of children with mental health needs, not the children themselves. The systematic review by Lindsey and colleagues confirmed the findings of an earlier review by Kim, Munson, and McKay (2012) that adolescents have been left out in terms of engagement interventions designed specifically for them.
This brings us to the matter of how best to engage young males of color in mental health treatment. While there are very few engagement interventions specifically targeted to adolescents (cf. Lindsey et al., 2013), we do know from available evidence what specific strategies might be targeted to improve mental health treatment for young males of color. We highlight a few here.
Assessment entails measuring the strengths and needs of young males of color with the goal of building rapport and treatment alliance with them. Assessment is an engagement strategy identified by Lindsey and colleagues' (2014) review as a strategy appearing with the highest frequency in randomized controlled trials of engagement interventions, and the strategy with the highest percentage of appearing in a winning treatment arm. This is a particularly important engagement strategy for young males of color, who might present to treatment with great reticence about pursuing mental health services. Building rapport by demonstrating genuine concern and care has been identified by young males of color as an important strategy for mental health providers to use when working with them (Lindsey et al., 2010).
A second important engagement strategy pertains to providing psychoeducation about services. This strategy involves providing information about what to expect from services, including frequency of sessions, session length, and roles of the therapist and client (Lindsey et al., 2014). Young males of color often equate mental health services as being part of a “system” that is inherently designed to mistreat or fail them (Lindsey et al., 2010). Mental health service providers are seen in the same light as police officers or even social workers, professionals with whom young males of color have not always enjoyed positive interactions. Thus, presenting mental health services as a source of support, explaining the nature of services to be delivered so that expectations about services can be clarified, and examining the needs of young males of color (e.g., need for interpretive services or clinicians who are bilingual) all reflect ways in which psychoeducation as an engagement strategy might yield stronger connections to treatment.
Finally, motivation enhancement involves identifying and probing the advantages to change, optimism, and intention to change. It also can include exercises designed to increase the client's readiness to participate in services, including exercises designed to mitigate psychological barriers to change and treatment participation (Lindsey et al., 2014). This is a key engagement strategy for young males of color, who often present to treatment with stigma regarding mental illness and services. Stigma-reduction strategies such as motivation enhancement can build up their cognitive and psychological strength to thwart off threats to the perception that services can be helpful.
