“Oh I'm Not Going to Discuss This with Him”: Older African-American Church Community Members' Expectations of Formal Mental Health Care Providers

Purpose: With approximately ¼ of older adults in community settings struggling with depressive symptoms, interventions that target this population must consider the cultural context of settings in which we hope to provide services, and understand the attitudes and expectations of the individuals that we hope to serve.

Methods: The sample consisted of older African American women and men who attended three different churches in southeastern Michigan. There was one focus group for women and one focus group for men at each of the three churches. The sample consisted of 29 women (ages 51-94, mean age: 67) and 21 men (ages 50-87, mean age: 64), most of whom were retired. Participation was voluntary, and individuals had to be at least 50 years of age. No other exclusion criteria were applied. Focus groups were recorded and transcribed. Data were analyzed using a team-based rigorous data reduction method by three coders, and included a content analysis of all the focus groups through an independent, then collective, review of the transcripts to identify groups of text for embedded meaning, and identify relevant and emerging concepts and terminologies.

Results: A number of issues emerged as important to ensure the comfort and willingness of these older adults to engage in services for mental health. Confidentiality and protection from exposure to community stigma were very important; referral from a trusted, community-based source, such as a pastor, seemed to be a primary gateway for access to formal services. While opinions regarding racial and gender identity preferences varied, appropriate training and credentialing was important. There was a need for consistency in providers, and an expectation of respect for their individuality, rather than being simply an assigned case number. The environment of offices and accessibility of care played an important part in expectations and attitudes, with welcoming environments and rapid availability likely to increase willingness to engage in services. Quality care was described as care that recognized individuals as more than simply a mechanical body, that took into consideration the combination of their physicality and their spiritual self.

Implications: This study has implications for providing more effective and culturally-tailored formal depression care that acknowledges the unique concerns about engaging in mental health care, and integrates the role of spirituality and faith communities for older African American women and men.