Social Networks and Their Role in Facilitating Formal and Informal Mental Health Service Use

Background and Purpose: It is recognized that mental health services should be grounded in a vision of recovery. This vision emphasizes the importance of looking beyond formal mental health services to informal resources that can promote health and wellbeing. Research on the relationship between social networks and mental health service use has been mixed, and to date has focused primarily on formal services. Few studies have investigated the relationship between social networks and informal services (e.g., self-help groups, clergy), and few have examined differences between family and friend networks. Using the Network-Episode Model, this study examined associations between social network characteristics and use of formal and informal sources of mental health care in a community sample.

Methods: We analyzed data on 9,282 respondents who participated in the National Comorbidity Survey Replication, a nationally representative survey of household residents 18 years and older conducted between 2001 and 2003. The current analysis includes data on demographics (e.g., gender, race/ethnicity, age, marital status, education, and income), clinical need (e.g., health and mental health severity), barriers to services, social network characteristics, and informal and formal sources of mental health care. Social network variables included items related to both structure (e.g., frequency of contact) and content (e.g., nature and quality of support) of support. Multivariate logistic regression models were used to examine formal and informal mental health service use as a function of social network characteristics, sociodemographics, clinical need factors, and barriers to service use.

Results: Respondents were primarily female (55%), with a mean age of 45 years (SD=17) and 72% identifying as White, 13% as Black and 10% as Hispanic. The most frequently used source of mental health care that respondents reported were mental health specialty care (13%) and general medical care (12.5%), followed by religious or spiritual advisors (5%) and self-help programs (3%). Multivariate results suggest a significant positive association between the level of contact with family and friend supports and using mental health specialty and general medical care, controlling for sociodemographics, clinical need factors, and barriers to service use. Our results suggest that the relationship between social networks and service use depends on the type and quality of support received. Specifically, positive family relations were robust predictors of mental health specialty and general medical care, while supportive friends were significantly associated with using self-help programs and marginally associated with using religious or spiritual advisors.

Conclusions and Implications: Our findings suggest the differential role of family and social networks in determining pathways to formal and informal mental health services. People seek help from a number of different individuals to cope with mental health problems. Support networks appear to play an important role in obtaining help. These findings highlight the importance of targeting individuals with mental illness who have inadequate social supports. The structure and quality of social networks and patterns of service use may be important considerations in structuring intervention strategies and charting care.