Obstacles to receiving mental health services among African American youth have been associated with stigma and shame, child-related factors, treatment affordability, availability, and accessibility, clinician and therapeutic factors, the school system, religion/spirituality, and social networks. When examining the prevalence rates of African American youth that have experienced cognitive and behavioral challenges, the underutilization of mental health services is startling. The National Comorbidity Survey-Adolescent Supplement revealed that 46.8% of African Americans under 18-years-old may have a mental health disorder. Additionally, African American children between the ages of five- and twelve-years old commit suicide at approximately double the rate of their White counterparts. Furthermore, the data from the Youth Risk Behavior Surveillance System (YRBSS) showed that Black students commit suicide at higher rates than White students. With all this information in mind, only three-quarters of African American children receive mental health care. 76.5% of African American youth from the ages of six to seventeen have mental health issues that need help, but their needs are not met. 50% to 75% of urban community-dwelling Black children and adolescents do not receive mental health care. A study showed that African American youth experiencing a major depressive episode are more unlikely to seek aid or speak to anyone about how they feel. 13% to 52% of African American child and adolescents who do not receive the mental health care that they need are at higher risk for detrimental health outcomes; hence, the importance of identifying the obstacles that may prevent unaddressed mental health service needs.
Stigma and shame
It is common for African American youth to look to their families and friends for support; however, some youth refrained from speaking to those close to them due to, “fearing that friends would laugh, joke, or tease them” (Lindsey et al., 2006, p. 53), or that family members might “feel offended that they weren't able to help or that they were a second choice” (Lindsey et al., 2013, p. 113). Youth may also not want to engage in therapy when their families or friends express negative thoughts or beliefs about the effectiveness of therapy “people can grow out of whatever mental health issues they think they may have” (Samuel, 2015, p. 39). Stigma and shame were obstacles for seeking mental health services in 85% of African American youth that were formerly in juvenile detentions. In another study, shame, embarrassment, and exclusion were considered barriers to mental health. Stigma and shame is also felt by the mother of African American youth who endorsement the item “If I took my child to a professional for help with emotional or behavioral problems, I think people in my community would find out” (Murry et al., 2011, p. 1124). Similarly, 16% of Black mothers reported the fear of judgment (e.g., what people might think about their child receiving mental/behavioral care) prevented them from seeking out mental health services. 56% stated they were fearful of being held responsible for any problems that their child expressed, and 22% stated they feared their neighborhoods/communities would view them in a negative way due to their child's mental/behavioral issues. Parents were concerned that their child might be labeled with stigmatizing terms (e.g. ‘crazy’), the stigma around using and the stigma around people perceiving their child as depressed.
Child-related factors
Black children/adolescents, parents, and care providers reported they did not think their child had any mental health problems or they believed the mental health problems were minor. Care providers refrained from providing parents with mental health resources if they thought the child's concerns were a “phase”. Another obstacle to seeking mental health services was self-reliance. Self-reliance can become detrimental when it reinforces an ideology that Black people are resilient due to the generational trauma they have overcome meaning Black people are able to cope with any mental health concerns they encounter because they could rely on their inner strength.