Skip to main content

Advertisement

Log in

A Community Mental Health Needs Assessment of a Racially and Ethnically Diverse Population in New England: Narratives from Community Stakeholders

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Despite the existence of numerous efficacious treatments for mental disorders, many individuals in need do not receive adequate treatment particularly racial and ethnic minorities. Community stakeholders can provide: (1) a more nuanced understanding of community mental health needs, and in (2) informing the planning and provision of mental health services. Qualitative data for this mental health needs assessment come from 61 individuals who represent local residents and/or consumers of mental health services, Executive Directors, providers of mental health and non-mental health community based services. We identified systems-related and psychosocial barriers to seeking mental health services: difficulty navigating the mental health system, language barriers, dearth of culturally competent providers; and mental health stigma and mental health literacy and non-Western notions of mental health. Collaborative efforts across stakeholders are called for to address the mental health needs of racial and ethnic minorities in a local community.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ahrnsbrak, R., Bose, J., Hedden, S., Lipari, R., & Park-Lee, E. (2018). Substance abuse and mental health services administration key substance use and mental health indicators in the United States results from the 2016 National Survey on Drug Use and Health. September 2017. Retrieved Jan 20 from https. www. samhsa gov/data/sites/default/files/NSDUH-FFR1–2016/NSDUH-FFR1–2016. htm.

  • Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C.-n., Takeuchi, D., ... Meng, X.-L. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services,59(11), 1264–1272.

    PubMed  Google Scholar 

  • Alegria, M., Lin, J., Chen, C.-N., Duan, N., Cook, B., & Meng, X.-L. (2012). The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Services Research,47(3 Pt 2), 1322.

    PubMed  PubMed Central  Google Scholar 

  • Alvidrez, J., Snowden, L. R., & Kaiser, D. M. (2008). The experience of stigma among Black mental health consumers. Journal of Health Care for the Poor and Underserved,19(3), 874–893.

    PubMed  Google Scholar 

  • Alvidrez, J., Snowden, L. R., Rao, S. M., & Boccellari, A. (2009). Psychoeducation to address stigma in black adults referred for mental health treatment: A randomized pilot study. Community Mental Health Journal,45(2), 127.

    PubMed  Google Scholar 

  • Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J., Al-Hamzawi, A., Borges, G., ... De Graaf R. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine,44(6), 1303–1317.

    PubMed  PubMed Central  Google Scholar 

  • Barnes, D. M., Keyes, K. M., & Bates, L. M. (2013). Racial differences in depression in the United States: How do subgroup analyses inform a paradox? Social Psychiatric and Psychiatric Epidemiology,48(12), 1941–1949.

    Google Scholar 

  • Barrera, M., Jr., & Castro, F. G. (2006). A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice,13(4), 311–316.

    Google Scholar 

  • Barrera, M., Castro, F. G., & Steiker, L. K. H. (2011). A critical analysis of approaches to the development of preventive interventions for subcultural groups. American Journal of Community Psychology,48(3–4), 439–454.

    PubMed  Google Scholar 

  • Berdahl, T. A., & Stone, R. A. T. (2009). Examining Latino differences in mental healthcare use: The roles of acculturation and attitudes towards healthcare. Community Mental Health Journal,45(5), 393–403.

    PubMed  Google Scholar 

  • Bernal, G., & Sáez-Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology,34(2), 121–132.

    Google Scholar 

  • Bhui, K., Rudell, K., & Priebe, S. (2006). Assessing explanatory models for common mental disorders. Journal of Clinial Psychiatry,67(6), 964–971.

    Google Scholar 

  • Blanco, C., Patel, S. R., Liu, L., Jiang, H., Lewis-Fernández, R., Schmidt, A. B., ... Olfson, M. (2007). National trends in ethnic disparities in mental health care. Medical Care,45(11), 1012–1019.

    PubMed  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology,3(2), 77–101.

    Google Scholar 

  • Bridges, A. J., Andrews, A. R., III, & Deen, T. L. (2012). Mental health needs and service utilization by Hispanic immigrants residing in mid-southern United States. Journal of Transcultural Nursing,23(4), 359–368.

    PubMed  PubMed Central  Google Scholar 

  • Cardemil, E. V. (2010). Cultural adaptations to empirically supported treatments: A research agenda. The Scientific Review of Mental Health Practice,7(2), 8–21.

    Google Scholar 

  • Cardemil, E. V., Adams, S. T., Calista, J. L., Connell, J., Encarnacion, J., Esparza, N. K., ... Kokernak, G. (2007). The Latino mental health project: A local mental health needs assessment. Administration and Policy in Mental Health and Mental Health Services Research,34(4), 331–341.

    PubMed  Google Scholar 

  • Cardemil, E. V., Nelson, T., & Keefe, K. (2015). Racial and ethnic disparities in depression treatment. Current Opinion in Psychology,4, 37–42.

    Google Scholar 

  • Chapman, P. L., & Mullis, R. L. (2000). Racial differences in adolescent coping and self-esteem. The Journal of Genetic Psychology,161(2), 152–160.

    CAS  PubMed  Google Scholar 

  • Cohen, R., & Zammitti, E. (2017). Access to care among adults aged 18–64 with serious psychological distress: Early release of estimates from the National Health Interview Survey, 2012–September 2015.

  • Collier, A. F., Munger, M., & Moua, Y. K. (2012). Hmong mental health needs assessment: A community-based partnership in a small mid-western community. American Journal of Community Psychology,49(1–2), 73–86.

    PubMed  Google Scholar 

  • Cook, B. L., McGuire, T., & Miranda, J. (2007). Measuring trends in mental health care disparities, 2000–2004. Psychiatric Services,58(12), 1533–1540.

    PubMed  Google Scholar 

  • Corona, R., Gonzalez, T., Cohen, R., Edwards, C., & Edmonds, T. (2009). Richmond Latino needs assessment: A community-university partnership to identify health concerns and service needs for Latino youth. Journal of Community Health,34(3), 195–201.

    PubMed  Google Scholar 

  • Doornbos, M. M., Zandee, G. L., DeGroot, J., & De Maagd-Rodriguez, M. (2013). Using community-based participatory research to explore social determinants of women's mental health and barriers to help-seeking in three urban, ethnically diverse, impoverished, and underserved communities. Archives of Psychiatric Nursing,27(6), 278–284.

    PubMed  Google Scholar 

  • Druss, B. G., Silke, A., Compton, M. T., Rask, K. J., Zhao, L., & Parker, R. M. (2010). A randomized trial of medical care management for community mental health settings: The Primary Care Access, Referral, and Evaluation (PCARE) study. American Journal of Psychiatry,167(2), 151–159.

    Google Scholar 

  • Fábos, A., Pilgrim, M., Said-Ali, M., Krahe, J., & Ostiller, Z. (2015). Understanding refugees in Worcester, MA. The Mosakowski Institute of Public Enterprise,32, 1–34.

    Google Scholar 

  • Fogel, J., & Ford, D. E. (2005). Stigma beliefs of Asian Americans with depression in an internet sample. The Canadian Journal of Psychiatry,50(8), 470–478.

    PubMed  Google Scholar 

  • Fortuna, L. R., Alegria, M., & Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety,27(5), 485–494.

    PubMed  PubMed Central  Google Scholar 

  • Georg Hsu, L., Wan, Y. M., Chang, H., Summergrad, P., Tsang, B. Y., & Chen, H. (2008). Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry,71(3), 210–218.

    CAS  PubMed  Google Scholar 

  • Green, A. R., Ngo-Metzger, Q., Legedza, A. T., Massagli, M. P., Phillips, R. S., & Iezzoni, L. I. (2005). Interpreter services, language concordance, and health care quality. Journal of General Internal Medicine,20(11), 1050–1056.

    PubMed  PubMed Central  Google Scholar 

  • Hancock, G. A., Reynolds, T., Woods, B., Thornicroft, G., & Orrell, M. (2003). The needs of older people with mental health problems according to the user, the carer, and the staff. International Journal of Geriatric Psychiatry,18(9), 803–811.

    PubMed  Google Scholar 

  • Hays, P. A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, DC: American Psychological Association.

    Google Scholar 

  • Hsu, E., Davies, C. A., & Hansen, D. J. (2004). Understanding mental health needs of Southeast Asian refugees: Historical, cultural, and contextual challenges. Clinical Psychology Review,24(2), 193–213.

    PubMed  Google Scholar 

  • Jimenez, D. E., Bartels, S. J., Cardenas, V., & Alegría, M. (2013). Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. International Journal of Geriatric Psychiatry,28(10), 1061–1068.

    PubMed  PubMed Central  Google Scholar 

  • Jorm, A. F. (2012). Mental health literacy: empowering the community to take action for better mental health. American Psychologist,67(3), 231.

    Google Scholar 

  • Kelly, E., Fulginiti, A., Pahwa, R., Tallen, L., Duan, L., & Brekke, J. S. (2014). A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. Community Mental Health Journal,50(4), 435–446.

    PubMed  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives General Psychiatry,62(6), 593–602.

    Google Scholar 

  • Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2010). The epidemiology of mental disorders. In B. Levin, L. K. D. Hennessy, & J. Petrila (Eds.), Mental health services: A public health perspective (3rd ed., pp. 169–200). New York, NY: Oxford University Press.

    Google Scholar 

  • Keyes, E. F. (2000). Mental health status in refugees: an integrative review of current research. Issues in Mental Health Nursing,21(4), 397–410.

    CAS  PubMed  Google Scholar 

  • Kouyoumdjian, H., Zamboanga, B. L., & Hansen, D. J. (2003). Barriers to community mental health services for Latinos: Treatment considerations. Clinical Psychology: Science and Practice,10(4), 394–422.

    Google Scholar 

  • Lagomasino, I. T., Dwight-Johnson, M., Miranda, J., Zhang, L., Liao, D., Duan, N., et al. (2005). Disparities in depression treatment for Latinos and site of care. Psychiatric Services,56(12), 1517–1523.

    PubMed  Google Scholar 

  • Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research,3(4), 201–214.

    CAS  PubMed  Google Scholar 

  • Link, B., Castille, D. M., & Stuber, J. (2008). Stigma and coercion in the context of outpatient treatment for people with mental illnesses. Social Science & Medicine,67(3), 409–419.

    Google Scholar 

  • Lo, S., & Tran, T. (2012). Profiles of Asian American Subgroups in Massachusetts: Vietnamese Americans in Massachusetts. Institute for Asian American Studies Publications (30).

  • Lopez, S. J., Edwards, L. M., Teramoto Pedrotti, J., Ito, A., & Rasmussen, H. N. (2002). Culture counts: Examinations of recent applications of the Penn Resiliency Program or, toward a rubric for examining cultural appropriateness of prevention programming. Prevention & Treatment, 5(1), No Pagination Specified Article 12.

  • Messih, M. (2016). Mental health in LGBT refugee populations. American Journal of Psychiatry Residents’ Journal,11(07), 5–7.

    Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook: CA: Sage.

  • Miranda, J., Duan, N., Sherbourne, C., Schoenbaum, M., Lagomasino, I., Jackson-Triche, M., et al. (2003). Improving care for minorities: Can quality improvement interventions improve care and outcomes for depressed minorities? Results of a randomized, controlled trial. Health Services Research,38(2), 613–630.

    PubMed  PubMed Central  Google Scholar 

  • Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W.-C., & LaFromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology,1, 113–142.

    PubMed  PubMed Central  Google Scholar 

  • Mishler, E. G. (1991). Research interviewing: Context and narrative. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Moos, R. H., & Moos, B. S. (1994). Family environment scale manual. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Nadeem, E., Lange, J. M., Edge, D., Fongwa, M., Belin, T., & Miranda, J. (2007). Does stigma keep poor young immigrant and US-born black and Latina women from seeking mental health care? Psychiatric Services,58(12), 1547–1554.

    PubMed  Google Scholar 

  • O’Hara, M., & Akinsulure-Smith, A. M. (2011). Working with interpreters: Tools for clinicians conducting psychotherapy with forced immigrants. International Journal of Migration, Health and Social Care,7(1), 33–43.

    Google Scholar 

  • Ortega, A. N., & Alegría, M. (2002). Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans. Mental Health Services Research,4(3), 131–140.

    PubMed  Google Scholar 

  • Paone, T. R., & Malott, K. M. (2008). Using interpreters in mental health counseling: A literature review and recommendations. Journal of Multicultural Counseling and Development,36(3), 130–142.

    Google Scholar 

  • Parker, G., Cheah, Y.-C., & Roy, K. (2001). Do the Chinese somatize depression? A cross-cultural study. Social Psychiatry and Psychiatric Epidemiology,36(6), 287–293.

    CAS  PubMed  Google Scholar 

  • Patton, M. (2002). Qualitative Research and Evaluation Methods: Thousand Oaks. CA: Sage.

    Google Scholar 

  • Post, M. A., Ward, E., Longo, N. V., & Saltmarsh, J. (2016). Introducing next-generation engagement (pp. 1–11). Next generation engagement and the future of higher education: Publicly Engaged Scholars.

    Google Scholar 

  • Pumariega, A. J., Rothe, E., & Pumariega, J. B. (2005). Mental health of immigrants and refugees. Community Mental Health Journal,41(5), 581–597.

    PubMed  Google Scholar 

  • Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology,117(2), 300–313.

    PubMed  Google Scholar 

  • Saechao, F., et al. (2012). Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States. Community Mental Health Journal,48(1), 98–106.

    PubMed  Google Scholar 

  • Shannon, P. J., et al. (2015). Beyond stigma: Barriers to discussing mental health in refugee populations. Journal of Loss and Trauma,20(3), 281–296.

    Google Scholar 

  • Simpson, S. M., Krishnan, L. L., Kunik, M. E., & Ruiz, P. (2007). Racial disparities in diagnosis and treatment of depression: A literature review. Psychiatric Quarterly,78(1), 3–14.

    Google Scholar 

  • Sue, S. (2003). In defense of cultural competency in psychotherapy and treatment. American Psychologist,58(11), 964–970.

    Google Scholar 

  • Teuton, J., Dowrick, C., & Bentall, R. P. (2007). How Healers manage the pluralistic healing context: The perspective of indigeneous, religious and allopathic healers in relation to psychosis in Uganda. Social Science & Medicine,65, 1260–1273.

    Google Scholar 

  • Wang, P. S., Demler, O., & Kessler, R. C. (2002). Adequacy of treatment for serious mental illness in the United States. American Journal of Public Health,92(1), 92–98.

    PubMed  PubMed Central  Google Scholar 

  • Wells, K. J., Battaglia, T. A., Dudley, D. J., Garcia, R., Greene, A., Calhoun, E., Mandleblatt, J., Paskett, E. D., Raich, P. C., and Patient Navigation Research Program. (2008). Patient navigation: state of the art or is it science? Cancer,113(8), 1999–2010.

    Google Scholar 

  • Zestcott, C. A., Blair, I. V., & Stone, J. (2016). Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review. Group Processes & Intergroup Relations,19(4), 528–542.

    Google Scholar 

Download references

Acknowledgements

The current study was a collaborative effort among Clark University and the City of Worcester Division of Public Health. Funding for this community mental health needs assessment was provided by the Fairlawn Foundation of the Greater Worcester Community Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rosalie A. Torres Stone.

Ethics declarations

Conflict of interests

The corresponding author declare no conflict of interests. The content does not necessarily reflect the views of the funding agency.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Torres Stone, R.A., Cardemil, E.V., Keefe, K. et al. A Community Mental Health Needs Assessment of a Racially and Ethnically Diverse Population in New England: Narratives from Community Stakeholders. Community Ment Health J 56, 947–958 (2020). https://doi.org/10.1007/s10597-020-00562-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-020-00562-2

Keywords

Navigation