Who Receives the Care They Want? Predictors of Receiving Desired and Needed Care Among Black Adults

Background: Autonomy or choice and control are critical to mental health recovery. Stigma, medical trauma from race-based inequities, oppression, and the lack of culturally appropriate providers are known systemic barriers that can prevent Black populations from receiving mental health care despite expressed needs or desires. However, less is known about predictors of alignment/misalignment where individuals do/do not receive needed or desired mental health care. This study, therefore, was conducted in partnership with a Black-serving advocacy and community building organization to examine autonomy of Black adults in mental health care.

Methodology: Black adults were surveyed (N=674) for a state-level Black community health assessment. A binary dependent variable (match) captured whether individuals received the mental health care they needed/desired. Predictors were lifetime prevalence of illness diagnoses; history of health and mental health care usage; overall self-rating of health; health insurance status; perceived cost; and self-rated neighborhood characteristics. Binomial logistic regression examined whether match varies by the hypothesized predictors, controlling for gender, age, income, education, and country of birth.

Results: Among those who self-reported that they needed or desired mental health services in the past year (N=352), 48% received the needed/desired care, while 52% did not. The odds of receiving needed/desired care were significantly higher for individuals living in neighborhoods with better air and water quality (OR = 2.17, 95% CI [1.19, 3.95]) and better access to fruits and vegetables (OR = 3.33, 95% CI [1.70, 6.52]). The odds of receiving needed/desired mental health care was also significantly higher for individuals with fewer lifetime illness diagnoses (OR = .80 , 95% CI [.70, .93]), and better self-rated overall health (OR = 1.76, 95% CI [1.14, 2.71]), as well as for US-born Black individuals (OR = 3.96 , 95% CI [1.53, 10.26]).

Conclusions and Implications: Further research is needed to understand why only some Black adults were able to receive needed/desired mental health care, independent of insurance, cost, health care usage, and other demographics. The intersectionality of race and other factors (e.g., immigration, healthiness, neighborhood quality) may be important to consider, highlighting the need to address race and other factors within racial groups so everyone can receive the needed/desired care. Furthermore, our next step in the community partnership is data interpretation with the surveyed Black community through regularly held “community conversations” to understand why Black adults did not receive the needed/desired care and what the implications are for mental health recovery. Community-based practices such as this democratize data as it provides an opportunity for the community to describe the data representing their lived experiences. Expanding the community ownership, understanding, and thus utility of data also dismantles the ivory tower, too common in research. Additionally, this study emphasizes the importance of Black-only samples or datasets that highlight within group differences, so research is not limited to comparing racial groups against a dominant “idealized” group. Importantly, community-based approaches can also inform policy and intervention development in ways that target specific needs to truly address health disparities between and within groups.