Minority Youth: Needs for mental health services grow with population

There were 48 million minority children in 2014, a number that will increase to 64.4 million by 2060.

By: Assistant Professor Miwa Yasui

(This article appeared in the Summer 2015 issue of SSA Magazine.)

The increasing proportion of minority groups has marked the United States as one of the most culturally diverse countries in the world. The U.S. Census reports that in 2014, there were 52 million white children under the age of 18, a number that will fall to 35.6 million by 2060. There were 48 million minority children in 2014, a number that will increase to 64.4 million by 2060. The Census reports that by 2020 over half of child population in the United States will be members of ethnic and racial minority groups (non-white or Hispanic), and this number is projected to reach 64% by 2060. Immigration trends, technological advances, and increasing global economic and social interdependence have enhanced this diversity.

This growth of the minority child population is expected to continue, indicating a major shift toward a population that is radically changing in its diversity in racial and ethnic composition. Despite this increasing diversity, racial and ethnic disparities in mental health service access and treatment outcome continue to be an unrelenting and yet-to-be solved challenge. A number of published studies* estimate that racial and ethnic minority children and youth are one third as likely to receive mental health services as whites despite comparable rates of emotional or behavioral disturbances across ethnic/racial groups. The studies show that 6.6% of ethnic minority children and youth receive services compared to 20% of white children.

Implications on health outcomes are significant. Failure to participate in treatment for mental health issues have long term consequences—–children exhibiting socio-emotional problems at an early age are more likely to engage in problematic behaviors later in life, such as increased depression, anxiety, engagement with deviant peers, involvement with violent crime, poor academic performance, school dropout, drug and alcohol abuse, unsafe sex, and unemployment.

The severity of the poor prognosis of children with untreated mental health problems early in life posits an even larger concern among ethnic minority families who not only face common challenges of raising children but also sociopolitical influences such as discrimination, minority status, poverty, and acculturation. Thus despite the fact that ethnic minority children and families are believed to be at greater risk of mental health because of socioeconomic stressors such as racism, prejudice, lower socioeconomic status, under-education, and acculturation, research highlights numerous inadequacies such as underutilization of services, high premature termination rates, and ineffectiveness of traditional mental health services.

In response, research and practice have begun to examine the underlying causes of this disparity in engagement in mental health services among ethnic minority populations. Mental health providers have found effective ways to address barriers to the use of mental health services including: logistical concerns such as transportation and costs; stigma or prior negative experiences of health care; and lack of knowledge about mental health. However, limited research has challenged the fact that conceptualizations of mental health problems and their prescribed interventions often fail to encompass cultural, ethnic, and contextual factors, resulting in the inability to engage ethnic minority families successfully. As a result, many human services are predicated on the idea that “if you build it, they will come.” Yet research and the everyday experience suggests otherwise.

Improving methods of engagement by addressing the influence of culture and context is of particular importance considering the profound effects treatment engagement can have on both the dissemination and effectiveness of evidence-based treatments for diverse populations.

For the ethnic minority client, culture infuses individual beliefs, attitudes, and practicing behaviors through the constellation of familial expectations, beliefs, and practices, and further, community and societal norms, worldviews and practices; determining the very meaning of mental health and ways of treatment. Pathways to treatment engagement and participation therefore reflect a wealth of culture-specific (specific to cultural group) and culturally general (common across groups) beliefs and practices that are infused into a complex mosaic of culturally and contextually infused, yet individualized set of preferences, attitudes, and practices regarding mental health treatment.

Without a systematic approach to address the complex and amorphous presentation of culture, providers and clinicians will continue to grapple in the provision of culturally responsive mental health services that directly affect client engagement and treatment response. Effective clinical practice with ethnic and racially diverse populations hinges on the integration of culture into our national pursuit of reducing racial and ethnic disparities in mental health.

*Alegria et al. 2002; Cook, Barry & Busch, 2012; Kataoka et al. 2002; Kodjo, & Auinger, 2004; Pumariega et al. 1998; Yeh, et al. 2005.

Miwa Yasui is an assistant professor at SSA.