Chronic Illness and Mental Health Underutilization in African-Americans: A Labeling Theory Perspective
This paper explores the under-utilization of mental health services amongst African-Americans, with particular emphasis on labeling theory in defining the structural origins for perceived barriers to treatment. In the United States, with its tragic legacy of racially-based oppression, race is generally understood to have powerful connotations for social norms and individual self-concept, and in the case of discriminated minorities such as African-Americans, to have broad negative effects on quality of life. With health outcomes for African-Americans already poorer than their white counterparts, reducing barriers to all forms of treatment is essential to achieving a greater level of health parity. This is especially relevant for mental health services, as comorbid mental distress can serve to confound the treatment of physical ailments, most notably those that require long term care or lifestyle modification, where personal agency has its most significant impact. Indeed, mental health, more than any other component of overall health, can act as a gateway to a broader range of positive life choices, thereby facilitating improved health lifestyles. We will begin with an overview of the disparities between the races in terms of utilization and outcomes, including rates of inpatient care, We will then examine the perceived barriers to mental health treatment experienced by African-Americans, noting the stigma of seeking treatment, and the role of social integration in recovery and using labeling theory as a framework. Next, we will examine the consequences of these perceived barriers: how lack of mental health treatment creates negative health outcomes in the African-American population and contributes to disparity in survivability and mortality rates. Finally, some suggestions for improving utilization equity are advanced, based in successful programs from other fields and relevant research on attitudes towards accessing care.
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