Racial Disparities in Mental Health Service Use: A Study of Adjudicated Adolescents

Background and Purpose: Numerous studies have found that racial and ethnic minority adolescents are less likely than White adolescents to receive mental health services. In recent years, several studies have found that such racial disparities persist even among incarcerated adolescents, who have high needs for mental health services. The current study sought to determine whether racial disparities characterized mental health service use among incarcerated youth in a northeastern state and, if so, whether such disparities existed even when controlling for other factors, such as mental health symptoms and family income. Methods: Structured, one-on-one interviews were conducted with 254 youth in a Western Pennsylvania residential facility for adjudicated youth. Youth ranged in age from 14 to 18 years old. The sample was 60% male and 60.1% Black, 25.9% White, and 14.1% Latino. Youth admitted to the residential placement facility had been adjudicated for a range of property and person offenses. The interview included demographic questions, service use questions from the Service Assessment for Children and Adolescents, and the Massachusetts Youth Screening Instrument (MAYSI). Statistical analyses included chi square, ANOVA, and logistic regression. All study protocols were approved by the University of Pittsburgh Internal review Board. Results: Almost all White youth (94.7%) received some professional service for mental health problems or drug use, compared to 78.8% of Black and 87.1% of Latino youth (chi square = 7.8, p < .05). In a multivariate analysis controlling for gender, family receipt of public assistance, and urban location, White youth were 4 times more likely (p < .05) than Black youth to have received services in the prior 12 months for mental health or drug problems, although the difference with Latino youth was not statistically significant. The other statistically significant predictor of service use was mental health problems, with the odds of service use increasing by 7% for each symptom reported. Of those who did receive services for emotional problems or drug use in the prior 12 months, Whites used more types of services than both Black and Latino youth (p < .001). In particular, White youth disproportionately received services from mental health, medical, and substance use professionals; no statistically significant differences existed for services received from schools and social services. Conclusions and Implications: The finding that Black youth were less likely than White youth to have received mental health services, even when controlling for mental health symptoms, has social justice implications for social workers. Further research needs to investigate the reasons why Black adjudicated youth were less likely to have received mental health services, particularly whether this was due to personal choice or external circumstances. Research also should examine whether receipt of services among high-risk youth helps avert the pathway to juvenile justice settings. -->