Ethnic Identity and Enhanced Engagement in Mental Health Services Among Young Adults with Serious Mental Illnesses

Background: Young adults from minoritized racial and ethnic groups have lower rates of engagement in treatment for serious mental illnesses (SMI). Previous research suggests a relationship between ethnic identity development and engagement in mental health services, but it remains unclear how a sense of belonging and attachment to one’s racial and ethnic group influences participation in treatment among young adults with SMI. In order to better understand these processes and their implications for mental health service delivery, we examined whether ethnic identity was associated with two dimensions of treatment engagement: attending services and investment in treatment (i.e., commitment and active participation in the helping process), and how ethnic identity might influence engagement through proximal indicators of service use, among a sample of primarily ethnic and racial minority young adults living with SMI.

Methods: Bivariate analyses and structural equation modeling (SEM) were used to examine relationships between ethnic identity, proximal mediators, and dimensions of engagement. Eighty-three young adults with SMI were recruited from four outpatient psychiatric rehabilitation programs and assessed at least three months after initiating services. Ethnic identity was measured by the Multigroup Ethnic Identity Measure (Phinney, 1992; a = .89). Sessions attended and a modified version of the Yatchmenoff (2005) engagement measure were used to assess engagement in services (a = .87). Mediators were based on the Young Adult Framework of Mental Health Service Use (Munson et al., 2012) and scale items were adapted using well-established Likert scale methods (Fishbein and Ajzen, 2010). Data analysis was conducted using Mplus. Analysts used robust maximum likelihood estimation with FIML for missing data. The SEM model was just identified because of the inclusion of correlated disturbances for the mediators.

Results: Participants were receiving mental health services in an urban city; mean age was 27; 64% of participants were male and 95% identified as Black, Latinx, and Multiracial. Stronger ethnic identity was associated with greater investment in treatment (correlation=0.46, p<.05), but not with treatment attendance. The SEM analysis was consistent with a model suggesting that a stronger ethnic identity is associated with change in three proximal indicators of service use: hope (0.53, p<.05), self-efficacy (-0.09, p<.05), and credibility of the treatment providers (0.32, p<.05). Further, these mediators were associated with investment in treatment (hope and credibility, p<.05, and self-efficacy p = 0.055).

Implications: Findings suggest that strong ethnic identity improves investment in treatment by enhancing one’s hope and self-efficacy and by reducing distrust of providers. Ethnic identity was positively associated with these psychological strengths among study participants that were important for mental health service engagement. Studies show that developing a positive ethnic identity has protective psychological effects for minoritized youth. But, SMI frequently arises during emerging adulthood, leading to constraints on identity exploration and developmental life transitions. Incorporating practices that affirm and strengthen a young person’s ethnic identity into services may be a promising approach for improving engagement in treatment and for reducing disparities in care among those with SMI who are from minoritized groups.