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Black youth have experienced the largest increase in suicide attempts compared to their white peers in recent years. The Centers for Disease Control and Prevention (CDC) reports that suicide is the 3rd leading cause of death for Black youth (ages 15-24) in the United States. Suicide related hospitalizations for Black youth have also steadily increased from 2008 to 2015. Despite these high rates, many Black youth have never sought mental health treatment and are significantly less likely to utilize services compared to White peers. Service use differences are likely contributed to current and historical systemic barriers (i.e., poverty and racism) faced by Black communities. Other barriers to service engagement and utilization include high costs of quality mental health services, transportation, and recognition of mental health symptoms. In addition, stigma around mental health and suicide is still prevalent in the Black community, making Black youth and their families reluctant to seek services. Considering the aforementioned factors, there is a clear need to study service engagement and utilization barriers and facilitators as it relates to improving suicide care for Black youth.
Methods:
The sample for this study included 106 Black youth (ages 10 to 19) who enrolled in care coordination services prior to being discharged from inpatient psychiatric facilities in one southeastern state in the U.S. The mean age was 14.9 (SD =1.8). Most participants were female (76.4%), 91.0% identified as heterosexual, and 82.5% were diagnosed with a mood disorder. At baseline, 30, 60, and 90 - days after enrollment, care coordinators assessed service and engagement barriers (e.g., treatment demands, financial hardship, waiting lists), and facilitators (e.g., access to MH care, family support, access to other services of participants). Service utilization rates over the length of the care coordination program were also examined. A series of Generalized Linear Mixed (GLM) Models were conducted to explore change in service use over 90 days while enrolled in the care coordination program.
Results:
The most frequently endorsed barriers were being on a waiting list (18%), financial hardships (4%), and transportation problems (4%). The most frequently reported service and engagement facilitators included having supportive family (95%), access to mental health services (85%), and access to healthcare (77%). Medication management and individual therapy were the most utilized services for Black youth. The GLM results indicated that the odds of receiving medication management for Black youth were 0.545 times the odds of receiving medication management for white peers. For every 30 days of being engaged in the care coordination intervention, the odds of receiving individual therapy increased about 13%. Being on a waitlist and having access to mental health services significantly impacted retention in individual therapy.
Conclusions/Implications:
The findings of this study highlight important clinical implications for engaging Black youth in behavioral health and suicide prevention services. Access to supportive services may be of particular importance in developing culturally responsive interventions to reduce suicide attempts and deaths. Further attention should be given to the influence of non-mental health and other informal supports on service engagement and utilization.