Over the years, mental health researchers have become increasingly interested in conducting research pertaining to the utilization rates of mental health services (Sue & Sue, 1990). Research has concluded that certain populations may utilize mental health services more so than others. In particular, individuals from underrepresented and minority populations are less likely to utilize mental health services than other populations due to a number of challenges including but not limited to cultural mistrust, low socioeconomic status, religious orientations, and perceived stigmas (Thurston & Phares, 2008). Moreover, mental health services are underutilized among racial and minority groups despite higher rates of mental health problems.
The National Survey for Drug Use and Health (NSDUH, 2014) reports 43.8 million adults in the United States suffer from any mental illness (AMI). Nearly one in five adults ages 18 or older (18.5 %) suffer from a mental, behavioral, or emotional disorder (NSDUH, 2014). In contrast, an estimated 10 million adults (4.2%) reported suffering from a serious mental illness (SMI), a mental, behavioral, or emotional disorder that interferes and negatively affects an individual’s life. Moreover, individuals who suffer from psychological distress are at a higher risk of developing a serious mental illness which support the increased rates of mental health problems among minorities (Corrigan, Druss, & Perlick, 2014).
African-Americans make up approximately 13 percent of the United States population and of those 16 percent were diagnosed with a mental illness in the previous year
(Substance Abuse and Mental Health Services Administration, 2014). The Office of Minority Health reported 3.4% of African Americans suffered from serious psychological distress (U.S. Census Bureau, 2010; Office of Minority Health, 2015). The OMH (2016) also reported that 20% of African Americans are likely to report experiencing psychological distress based on psychosocial factors, such as poverty, lack of health insurance, and limited mental health access. Accordingly, African Americans who live below the poverty level are at a greater risk of experiencing psychological distress compared to those over twice the poverty level (OMH, 2015). In 2014, 26.2% of African Americans were reported as living below the poverty level. This is the highest poverty rate of any racial and ethnic group, which, in turn, may contribute to the high rates of mental illness in the African American community. Fortunately, evidence-based interventions have been created to assist individuals who suffer from any or a serious mental illness with coping strategies to deal with personal stressors (Corrigan, Druss, & Perlick, 2014). Even though interventions are available, unfortunately, approximately only 50% to 60% of adults who are in need of professional counseling actually receive services
(Kessler et al., 2001). Statement of the Problem Recent research identifies physical well-being, psychological, and environmental concerns as important indicators that may contribute to the need for professional counseling services (National Alliance Mental Illness, 2016). According to the Health and Human Services Office of Minority Health (2015), an estimated 20% of African Americans are at a greater risk of experiencing a serious mental health issue than the general population due to major depression, attention deficit hyperactivity disorder, suicide, and post-traumatic stress disorder. In 2012, the National Healthcare Disparities Report indicated that African American adolescents and adults were less likely to receive treatment for depression compared to the general population
(U.S. Department of Health and Human Services, 2013). In particular, experiencing violence and being victims of violent crimes may contribute to number of major depression and post-traumatic stress disorder diagnoses in the African American community (National Alliance of Mental Illness, 2016). Therefore, seeking treatment and self-disclosing may decrease the rate of untreated serious mental illness within this population.
While seeking treatment and self-disclosing may decrease the rate of untreated serious mental illness, it is important to examine how a counselor’s race may either contribute to the problem concerning underutilization and self-disclosing or how the counselor’s race may influence utilization and self-disclosing. For instance, Nickerson, Helms, and Terrell (1994) found that African Americans reported more negative attitudes towards utilizing mental health services if the institution's staff was primarily Caucasians. “The more negative one’s attitude” the less likely one was to utilize mental health services. The participants felt that the institution was less educated on the history of their race, as evidence by the lack of African Americans employed at institution. Also, racism, discrimination, and experiencing slavery has been noted to contribute to the distrust and perception that American institutions are incompetent to serve the African American community (Williams, 2012 & Murray, 2015).
For decades, researchers have conducted studies to explain in depth the necessity and negative impact that the lack of competence creates. Moreover, due to the lack of African American clinicians in the mental health field, research suggested that the lack of diverse ethnic representation and racial consciousness hinders the client from feeling that a counselor from a different race is competent and possess the willingness to understand the client and his or her life experiences (Allen et al., 2010). Therefore, the need for competent counselors is vital and may assist in decreasing the probability of one developing a negative attitude towards seeking mental health services, may increase utilization rates, and untreated mental diagnosis can become treated. When untreated mental diagnoses are treated and treatment attendance increases without premature terminations, this may contribute to better environmental, mental, and physical outcomes including decreasing poverty rates, violence, and chronic mental and medical conditions (DHHS, 2018).
Individuals from underrepresented and minority populations counseling utilization rates are influenced but not limited to one’s racial identity status (Helms, 1990), attitude towards utilizing counseling services (Duncan, 2003), level of religious commitment (Larson & Chastain, 1990), willingness to utilize counseling services (Hammer & Vogel, 2013), and self-disclosure in counseling (Duncan, 2003). For instance, to address racial discrimination, research suggested that racial identity has been used by African Americans as a coping mechanism (Brondolo, Brady ver Halen, Pencille, Beatty, & Contrada, 2009). Lee and Ahn (2013) found a significant relationship between different aspects of racial identity and discrimination. African Americans who experienced discrimination are more likely to connect with members of the same race versus those from a different racial or ethical background to feel a sense of comfort and safety. In an earlier study, Cramer (2009) found that individuals who are in need of services will refuse and are less willing to utilize counseling services based on their negative attitude towards counseling, lack of social support, and the lack of desire to disclose in counseling. Also, Corrigan and Matthews (2003) noted that negative stigmas associated with utilizing counseling services may prevent African Americans from disclosing mental health issues to others or while in counseling to avoid being criticized.
Similar to racial identity, religious commitment and engaging in religious activities such as praying and singing are coping mechanisms used to address distress and mental illness among African Americans (Ayalon & Young, 2005). In contrast, individuals with less religious commitment may disengage from religious activities based on lacking a relationship with God or viewing mental illness as a punishment from God (Ecline, Park, Smyth, & Carrey, 2011). African Americans tend to resolve mental health issues within the family and community (e.g., religious institutions) rather than seeking professional mental health treatment (Potters, 2007; Muturi & An, 2010). Also, research suggested that the history of racism and oppression has contributed to African Americans’ tendency to refrain from disclosing distress (Whaley, 2001; Laughton-Brown, 2010). Therefore, treatment attendance is negatively impacted, which may increase rates of untreated mental health and medical issues in the African American community.
Study Purpose
The goal of this study is to examine racial identity, attitudes toward utilizing counseling services, and religious commitment as predictors of willingness to utilize counseling services and self-disclosure among African American adults. Racial identity status is identified as a key factor in explaining African Americans’ attitudes and willingness towards utilizing counseling services (Helms, 1990). Also, studies suggest that racial identity is associated with an individual’s psychological functioning, which, in turn may, impact the likelihood of utilizing mental health services (Sellers, et al., 2003). Further, assessing the attitudes towards utilizing counseling services may assist in identifying perceptions that may positively impact their willingness to utilize services and self-disclose in counseling.
Research suggests that African Americans are more religiously committed than any other racial or ethnic group (Newport, 2012). Therefore, African Americans tend to rely more on their religious commitment to their faith than seeking assistance from counseling and self-disclosing information that may foster criticism from friends and family. Further examination of these constructs will expand the current literature surrounding racial identity, attitudes towards utilizing counseling services, religious commitment as predictors of willingness to utilize counseling services and self-disclose in counseling in the African American community. This research will assist in developing a greater understanding of how to identify ways that can facilitate racial identity development and promote help-seeking behaviors among African American adults.
Background and Significance
African Americans and Help-Seeking
African Americans tend to underuse and pre-maturely terminate mental health services and health care systems despite the increasing rates of physical and physiological concerns among African Americans (Snowden, 2001; Regier et al., 1993). African Americans who have limited mental health care access are more likely to have a diagnosis of a serious mental illness including inmates, drug and alcohol users, and individuals who are homeless (Breslau et al., 2005 & Mental Health America, 2018). Breslau et. al., 2005 reported that the number of mental health diagnoses amongst African Americans are lower than other ethnic groups. However, African Americans’ mental health diagnoses have been identified as more severe and continuous compared to other ethnic groups attributable to the lack of mental health utilization. Also, recent research found that African Americans are more likely to seek help for their mental health diagnosis, but are less likely to openly discuss psychological problems (Ward, Wiltshire, Detry, & Brown, 2013).
While many seek some form of treatment, internal and external barriers may negatively impact African Americans’ mental health utilization. Mental illness stigma and distrust is identified as some of the main internal and external barriers that contribute to underutilization or discontinuity of services among African Americans