Social Support Network Experiences with Mental Health Care for Rural African American Men with Serious Mental Illness

Background: Disparities in access and utilization of mental health care services among African Americans are widely acknowledged (DHHS, 2001; Whitley & Lawson, 2010). Alliances with social support systems may provide a method to address stigma in the community and increase support for individuals seeking mental health care. Previous research has found that support network members are largely ignored by formal mental health care service providers (Guarnaccia & Parra, 1996; Johnson, 2000). This study aims to understand how the social support networks of African American men with serious mental illness (SMI) interact with the mental health care system in rural communities. The goal is to develop suggestions for improving relations between social supports and mental health care systems.

Methods: Individual, semi-structured interviews were conducted with social support network members (e.g. family, friends, fictive kin) of African American men with SMI (n=26). Participants resided in communities with populations less than 50,000, located in two Midwestern states. Participants were recruited from African American clients receiving services at community mental health agencies who were asked to identify members of their social support network. Members were defined as individuals who contributed significantly to the client’s life and decision making process. Interviews were coded using qualitative thematic coding analysis (Boyatzis, 1998) and ELAN audio annotating software (MPIP, 2008).

Results: Analysis of interviews yielded themes about social support network engagement with the mental health care system, barriers to collaboration, satisfaction with services, and suggestions for social support network outreach. Seventy-three percent of social support network members reported that they had no involvement in their loved one’s mental health care. The primary reasons given for not engaging with the mental health care system were a lack of understanding about what occurred in mental health treatment as well as a belief that family would be contacted by agency staff if their involvement was needed. Among both involved and non-involved social support members there was discussion of how confidentiality restrictions and the related paperwork served as an impediment to involvement with the mental health care system. Social support network members who were involved in care all reported that they were satisfied with the services provided to their family members. However, social support network members who were not involved in care reported a wide array of positive and negative opinions about services and agency providers. Finally, recommendations were developed through discussions with social support network members for simple programs that mental health care agencies can employ to increase family knowledge and involvement.

Implications: This research provides new information about the experiences of rural African American families who are dealing with a loved one’s mental illness. It offers insight into the reasons social support networks members may not feel comfortable engaging with the mental health care systems and a critical examination of how respect for confidentiality must be addressed in a manner that does not isolate clients from their social supports. This study also offers practice suggestions for how providers can meet social supports “where they are” by offering introductory family-oriented events.