Policy Memorandum

POLICY MEMORANDUM

To: Kana Enomoto, M.A., Acting Administrator of The Substance Abuse and Mental Health Services Administration (SAMHSA)

From: Christopher Sanchez

Re: The Social and Economic Factors of Unmet Mental Health Care needs for Children of Minority Families

Date: September 17, 2015

Executive Summary

Throughout the United States, children are dealing with mental health issues that interfere with normal development and functioning. “This is a topic that has received increased national publicity after the Surgeon General’s warning in 2000, that the nation is facing a public crisis in mental health care for infants, children, and adolescents” (Sturm et al., 2003). However, children of Minority families are at an even greater risk of unmet mental health treatment and experience significant emotional, behavior and lifestyle disturbances because of this. The Colorado Children's Campaign, a nonprofit advocacy organization states “In the absence of appropriate supports, relationships and intervention, challenging experiences in the earliest years can disrupt a child’s healthy development and have detrimental effects on the future mental and physical health of young children” (Barnes et al., 2015). Factors related to socioeconomic status, insurance costs, education and stigma surrounding mental health treatment all impact the quality of care or lack thereof that children receive. Although organizations and governments have made improvements to access and affordability of these services for children and families, we are still experiencing a lack of utilization among parents of Children with Special Health Care Needs (CSHCN).

Problem

Parents of children with long-term emotional or behavioral conditions often struggle to access and afford mental health services for their children. Detection and treatment of emotional and behavioral problems at an early age is becoming more and more important since these problems can negatively influence children’s daily lives and tend carry through the individual’s lifetime if left untreated. Understanding the underlying factors that contribute to a lack of caregiver action is essential to making progress in the mental health and behavioral treatment of minority children. One of the greatest predictors for understanding unmet mental health care is parental characteristics, specifically culture and beliefs. “Commonly, a negative expectation about treatment among minority groups has been found to adversely affect parent’s help-seeking behavior for their children” (Eiraldi et al., 2006).

The stigma and lack of information associated with mental health services greatly affects the delivery of treatment for many minority families. “Reasons for racial differences in access to mental health care may be related to the informal and social contacts preferred by people of color” (Harrison et al., 2004). As observed by Harrison in the Community Mental Health Journal, African Americans communities have been observed turning to significant others in the community, especially family, friends, neighbors, voluntary associations, and religious figures as a means of coping with mental health issues, rather than seeking professional assistance. One study investigating channels to youth mental health treatment found that for more than two-thirds of minority parents, seeking help from professionals and agencies was not their first choice (Harrison et al., 2004). This suggests that there is possibility for negative stigma behind mental health treatment; minority parents and youth enter professional agencies with greater resistance and with less positive attitudes than Caucasian parents. In examining parents expectations about mental health service outreach, African-American parents expressed significantly more negative expectations in comparison to non-minority parents (Eiraldi et al., 2006). Across numerous studies, we can observe that ethnic minority individuals often have negative experiences with the mental health system and may be predisposed to expect more negative outcomes from health care providers.

For those parents and care-givers of minority children that decide to seek professional help, they are often met by an even greater barrier than social stigma and cultural belief. The family’s socioeconomic status and the high costs of insurance often threaten access to treatment. Families with a lower level of income are much more likely than families with higher levels of income to have unmet mental health care needs. For many families, poverty is indicated as one of the most pervasive treatment barriers to utilization of mental health services, especially among African-American children (Eiraldi et al., 2006). It should also be noted that cost of diagnostic and treatment services, and the availability of affordable transportation are also reported as major treatment barriers for minority parents (Eiraldi et al., 2006).

Largely associated with a family's ability to afford treatment is their insurance status. The two most frequently reported reasons for unmet mental health treatment are “cost too much" and "health plan problem" (Eiraldi et al., 2006). In a recent study, 24.3 percent of minority parents reported that their children did not receive all needed mental health services because they cost too much and over 20 percent reported a health plan problem as the greatest barrier (DeRigne, 2010). Within the minority community, children are continually uninsured despite government and organization efforts. “In 2002, 8% of nonminority, 14% of African-American and 23% of Latino children and adolescents were uninsured” (Eiraldi et al., 2006).

The need for social reform both within the social constructs of society and within government policies is impending for the mental health of America’s youth. The challenges facing the families of minority children require creative solutions to cultural, educational and economic barriers. Although reforms have offered new services to children and families suffering with mental health issues, the levels of utilization are not nearly what they need to be to combat this growing problem.

Works Cited

Barnes, Sarah; Belzley,Cody; Bill Jaeger; Poole, Steven; Talmi, Ayelet. "Young Minds Matter: Supporting Children’s Mental Health Through Policy Change." The Colorado Children's Campaign. N.p., Aug. 2015. Web. 09 Sept. 2015.

DeRigne, LeaAnne. "What Are The Parent-Reported Reasons For Unmet Mental Health Needs In Children?." Health & Social Work35.1 (2010): 7-15. MEDLINE Complete. Web. 11 Sept. 2015.

Eiraldi, Ricardo B, et al. "Service Utilization Among Ethnic Minority Children With ADHD: A Model Of Help-Seeking Behavior." Administration And Policy In Mental Health 33.5 (2006): 607-622. MEDLINE Complete. Web. 09 Sept. 2015.

Harrison, Myla E; Mary M McKay; and William M, Jr Bannon. "Inner-City Child Mental Health Service Use: The Real Question Is Why Youth And Families Do Not Use Services."Community Mental Health Journal40.2 (2004): 119-131.MEDLINE Complete. Web. 09 Sept. 2015.

Sturm, Roland, Jeanne S Ringel, and Tatiana Andreyeva. "Geographic Disparities In Children's Mental Health Care." Pediatrics 112.4 (2003): e308. MEDLINE Complete. Web. 10 Sept. 2015.