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Mental health outcomes are influenced by several factors- the availability and quality of mental health services, individual engagement, and institutional policies and social structures that shape the environment people live in. Strategies to enhance mental health outcomes and access often focus on public education strategies to reduce stigma, thus assuming that individual perceptions of mental health play a predominant role in the prevalence of mental illness and treatment access. This study examined the level of need and the specific barriers to mental health treatment in a large metropolitan area (Chicago). A case example will be presented of a community-based model aimed at achieving mental health equity among populations living in marginalized communities. Results indicate that marginalization and vulnerability associated with mental health is a function of structural inequities that create and concentrate mental health access inequity among particular populations.
Methods:
This study focused on 10 contiguous neighborhood areas located on the southwest side of Chicago with majority Latino residents. The study had three specific aims:
to understand the prevalence of mental illness and trauma
to evaluate the desire for service utilization
to extract barriers to treatment
A mixed method design was employed to include: 1) secondary data analysis on adverse childhood experiences (ACEs) from the CDC’s Behavioral Risk Factor Surveillance System in Illinois; 2) survey of 2,787 residents; 3) US Census ACS data to assess socio-economic indicators; 4) 10 focus-groups with community residents; 5) 12 in-depth interviews with diverse stakeholders.
Results:
Preliminary analysis concentrating on community survey data, focus groups, and interviews with diverse stakeholders indicates the following:
Community leaders surveyed 2,787 residents in public community events/locations.
Survey data finds 52% of respondents report experiencing symptoms of depression, 39% of anxiety. 78.4% of respondents report an interest in counseling services. When assessing barriers the following barriers were selected by respondents, cost (61%), not knowing where to go for services (41%), lack of health insurance (40%), no services available near home (36%), lack of childcare (24%), transportation barrier (22%), language barrier (21%), hours of operation not convenient (19%), feeling counseling services would not help (13%), family disapproval (9%), stigma (8%).
Focus groups were conducted with community residents in each of the 10 communities surveyed ranging in size from 9-45 participants. Twelve semi-structured open-ended interviews were conducted with key community stakeholders.
Initial qualitative analysis confirms the survey findings, in which structural barriers (cost, lack of health insurance, lack of available services) not social barriers (feeling counseling services would not be helpful, family disapproval, stigma) are the barriers to care.
Implications:
Structural barriers, not stigma, is the primary barrier to mental health equity among participants in the study. Strategies to achieve mental health equity need to consider financial barriers, including insurance coverage, for individuals living in marginalized communities. The presentation will conclude with the example of a community-centered mental health service delivery model made financially sustainable by a hospital that provides free trauma-focused long-term mental health services for the uninsured adult population of Chicago’s southwest side.