Multiracial Emerging Adults' Perspectives on Participating in Mental Health Care: A Qualitative Study

Background and Purpose: Despite almost twenty years of innovative interventions focusing on equity in health care, disparities in mental health outcomes persist for one of the fastest-growing populations in the U.S. – multiracial emerging adults. In fact, studies have shown, compared to monoracial individuals, multiracial individuals have the highest prevalence of mental health conditions, such as depression and anxiety. These studies highlight the critical need for effective mental health care. Without this care, multiracial individuals will continue to be at an elevated risk for adverse outcomes, including suicidal behavior. However, to address the mental health needs of multiracial individuals, providers need information on client experiences that influence therapeutic outcomes. The purpose of this phenomenological qualitative study was to describe multiracial emerging adults’ perspectives on mental health care. This study addressed the following questions: How do multiracial emerging adults describe their lived experiences with mental health care? And, how can providers deliver quality mental health care for multiracial emerging adults?

Methods: This study used qualitative data collected from 12 individuals who identified as multiracial or had biological parents from two different racial-ethnic groups. Participants were between the ages of 18 and 29. Two trained graduate students conducted semi-structured interviews that lasted between 60 and 90 minutes. All qualitative data were digitally recorded and transcribed. An iterative process involving transcript review, memoing, and team observations was used to develop a codebook. Data were coded by the research assistants, and a faculty member analyzed interrater reliability amongst coders by examining Kappa coefficients in NVivo. Data were managed using NVivo 12, and themes were derived using thematic analysis until agreement was achieved. The team also sought divergence between participants.

Results: Participants experienced poor quality mental health care. Specifically, participants shared that they could not be open and genuine with providers, did not feel supported by providers, experienced racism (e.g., microaggressions) by providers, and had insufficient access to care. For example, one participant shared, “I feel like [my therapist] takes my racial identity into account, but it just feels like she's just telling me the [negative] issues of those racial identities, whereas that's not what I want to hear.” Participants stated the following was needed for providers to deliver quality mental health care: providers need to improve their cultural competence; providers need to discuss racial and ethnic identity when providing care; providers need to come from diverse racial and ethnic groups; and mental health care settings and administrative forms need to be inclusive. For example, one participant shared, “It [diverse provider] would just give me more comfort and ease and I don't think I would have to filter myself.”

Conclusions and Implications: Quality mental health care for multiracial emerging adults likely needs providers that practice cultural humility and foster conditions of acceptance and inclusivity. Professionals in the mental health system need to be skilled at broaching (i.e., able to invite conversations related to race and culture in the therapy room) and have inclusive settings.