Mental Health Services For Latino Adolescents With Psychiatric Disorders
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Mental Health Care for Latinos:
Richard L. Hough, Ph.D., Andrea L. Hazen, Ph.D., Fernando I. Soriano, Ph.D., Patricia Wood, M.P.H., M.A., Kristen McCabe, Ph.D. and May Yeh, Ph.D.
Abstract
OBJECTIVES:
The major objectives of this study were to examine the prevalence of mental disorders and the use of mental health services among Latino adolescents who were receiving services in at least one of five public sectors of care in San Diego County.
METHODS:
Survey data were gathered for a random sample of adolescents aged 12 to 18 years (N=1,164) who were receiving public-sector care. Mental disorders were assessed with the Diagnostic Interview Schedule for Children, and use of mental health services was assessed with the Service Assessment for Children and Adolescents.
RESULTS:
Rates of disruptive disorders were significantly lower among Latino adolescents than among white adolescents. Although more than half of the Latino sample received specialty mental health services, those with psychiatric disorders were significantly underserved compared with their white counterparts. Latino adolescents with psychiatric disorders entered specialty mental health services at a later age and had made significantly fewer specialty mental health service visits in the previous year. In multivariate analyses, Latino youths were significantly less likely than white youths to use specialty mental health services independent of diagnosis, gender, age, and the service sector from which they were selected.
CONCLUSIONS:
Public service systems need to ensure that Latino youths are appropriately assessed for disruptive disorders and that they are provided with appropriate specialty mental health care.
Introduction
The consensus among mental health researchers is that a small proportion of adolescents with emotional or behavioral problems receive the mental health services they need. Although data for adults suggest that Latinos with serious mental disorders are significantly less likely to use mental health services than comparable white Americans or African Americans, little is known about whether there are significant disparities in the receipt of needed services among Latino adolescents compared with adolescents from other racial and ethnic backgrounds. Even less is known about whether there are disparities by ethnic or racial group in the delivery of mental health services to the high-risk adolescents who are in public systems of care. This question is an important one, given the high probability that such youths will experience chronic and long-term psychiatric and behavioral problems.
Research on the use of mental health services by adolescents is difficult and rare, partially because adolescents may receive services in multiple public sectors of care. Some studies suggest that Latinos may be underrepresented in specialty mental health programs and public school programs for children with serious emotional disturbances, may receive fewer support services in child welfare, and may be overrepresented in the juvenile justice sector compared with white youths. McCabe and colleagues found that Latino youths were the most consistently underrepresented in five public sectors of care in San Diego County. The Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) community surveys found that youths in Puerto Rico were significantly less likely than youths in Atlanta, New Haven, and New York to receive mental health services from mental health specialists, in medical settings, and at school.
Research among adults suggests that the prevalence of mental disorders is low in recent-immigrant and unacculturated Latino populations and increases with the duration of residence in the United States. Studies of adults also suggest that less-acculturated Mexican Americans or those who are more recent immigrants are significantly less likely to receive needed mental health services than those who are more acculturated.
Some research suggests that youths from ethnic minorities who have behavioral health problems may be more underserved than white American children with the same problems and that a persons racial or ethnic background is a more important predictor of use of outpatient services than are his or her observed problems or symptoms. However, few of these studies have included Latino youths, none have focused on services provided for high-risk youths with open cases in public-sector provider agencies, and none have examined the potential effects of acculturation on service use patterns.
The study we report here examined possible disparities in the prevalence of mental disorders and the receipt of mental health services between high-risk Latino, white, and African-American adolescents in a sample from five public sectors of care in a large county in Southern California.
Methods
Survey design
The Patterns of Care study obtained data on a simple random sample of 1,715 youths aged six to 18 years from open cases in five San Diego County public service sectors–mental health services, alcohol and drug programs, public school programs for children and adolescents with serious emotional disturbances, the child welfare sector, and the juvenile justice sector–during the last six months of county fiscal year 1996-1997. The sample was stratified by race or ethnicity (white, Latino, African American, and Asian or Pacific Islander) and by the level of restrictiveness of the care setting (for example, home versus aggregate care). Interviews were conducted with both a primary caretaker and the youth for 80 percent of the sample, with only the primary caretaker for 15 percent of the sample, and with only the youth for 5 percent of the sample. Written informed consent was obtained from the primary caretakers and emancipated youths (those not living with family or a caretaker) and written assent from youths living with family or a caretaker. Internal review board approval for the survey was received from the various academic and research institutions with which the researchers were affiliated and, as appropriate, from the boards of the various service sectors.
The overall completion rate was 66 percent of located and eligible adolescents. Additional details of the sampling procedure have been published previously. Only the adolescent component of the sample–those aged 12 to 18 years (N=1,164)–was examined for the study reported here. Youths who were classified as biracial or “other” were excluded from