Prevalence of mental disorders among college students is comparable to that of non-students of the same age, and these disorders are increasing in number and severity (Blanco et al., 2008). Among African American college students, the underutilization of mental health services is especially prevalent. Adult African Americans are 10% more likely to report experiencing serious psychological distress than White adults (U.S. Department of Health and Human Services Office of Minority Health, 2017). African Americans are reported to have more chronic mental illnesses, such as psychotic disorders, and higher levels of disability (Rüsch et al., 2009). Yet, an estimated 25% of African Americans in need of professional mental health treatment fail to receive such services, as compared to 13% of Whites (Wells, Klap, Koike, & Sherbourne, 2001). This large treatment gap is greatly impacted by a lack of mental health knowledge (Rüsch et al., 2009). This study explores the effectiveness of psychoeducational training sessions in increasing mental health literacy, as well as the willingness to seek help for mental health issues among African American college students.
The prevalence of mental illness is the greatest among adolescents and young adults age 16 to 24 years. There is also a strong reluctance to seek professional help among this group (Gulliver, Griffiths, & Christensen, 2010). Cultural factors significantly impact groups that have strong social networks and less access to professional mental health care, such as African Americans. In general, culture biases against health care professionals prevent many African Americans from seeking help due to prior experiences of inadequate treatment, misdiagnoses, and a lack of cultural understanding from mental health providers (Rao, Feinglass, & Corrigan, 2007). Despite the abundance of research supporting the positive outcomes of intervention through mental health services, many African American young adults, including those of college age, will not voluntarily enter treatment, while others will pursue services but will not adhere to the prescribed treatment (Corrigan, 2004).
Mental health literacy.
Mental health literacy consists of the knowledge, beliefs, and abilities that enable the recognition, management, and prevention of mental health problems (Jorm et al., 1997). Lack of knowledge of mental illnesses is of primary concern with regard to help seeking and treatment outcomes, as it may result in difficulty recognizing the risk factors, signs, and symptoms related to specific mental illnesses, as well as the appropriate professional help and pharmacological treatments for these illnesses. Delayed or untreated mental disorders are associated with school and job failure, teenage child-bearing, and early, violent, or unstable marriages (Kessler et al., 1997; Kessler, Foster, Saunders, & Stang, 1995; Kessler, Walters, & Forthofer, 1998). In contrast, possessing such knowledge promotes mental health stigma reduction, increased help-seeking behaviors, early detection, and positive treatment outcomes for mental illness (Robinson, Li, & Li, 2013). The likelihood of help-seeking is greatest among young adults who possess the ability to recognize symptoms of mental illness and have the knowledge and encouragement to seek help.
Attenuated Psychosis Syndrome
Young adulthood is often associated with increased psychosocial stressors which give rise to a critical risk period for severe mental illnesses, such as psychosis. Studies examining lifetime prevalence rates of psychotic symptoms in the general population have consistently shown that a large percentage of people report having experienced psychotic symptoms, without meeting full criteria for a psychotic disorder diagnosis (Hanssen, Bijl, Vollebergh, & Van Os, 2003; Kendler, Gallagher, Abelson, & Kessler, 1996). Before the onset of psychotic disorders such as schizophrenia, there is typically a gradual decline in functioning, accompanied by the onset of subclinical or attenuated psychotic symptoms (APS) (American Psychiatric Association, 2013). Therefore, the APS phase may be the optimal period for preventive intervention due to the developmental vulnerability of adolescents and young adults. Interventions that provide culturally sensitive strategies to delivering knowledge of mental illness and help-seeking options may have the greatest likelihood of reducing effects of untreated subclinical psychotic symptoms (Adebimpe & Cohen, 1989).
Psychoeducational Training Session
We conducted a study to explore if psychoeducational training sessions were effective in increasing mental health literacy and enhancing help-seeking behavior among African American college students attending a Historically Black university. We trained 177 college students between ages of 18 and 28 (male =52, female=125) who identified as Black or African American. This study, approved by the university Institutional Review Board, was a pre- and post-test design with a training session in between the pre and post-tests (about 75 minutes). Questionnaires and vignettes (pretest and posttest) were used to measure mental health literacy—knowledge of mental illness (psychosis related in particular) and help seeking behaviors, and to screen for APS. The training sessions included a Power Point Presentation introducing the concept of attenuated psychosis syndrome and discussing stigma, help-seeking pathways, and resources on campus and in the community. The presentation was intended to be culturally sensitive and accessible to the college age population, and included African American characters, as well as songs and lyrics depicting subclinical and full-blown psychotic symptoms.
The results of this study show that participants’ ability to accurately identify APS symptoms increased by 26% following the psychoeducational training sessions. Additionally, following the psychoeducational training sessions, 52% of participants reported a high likelihood of seeking help for mental health issues.
Furthermore, findings of this study show that culturally sensitive psychoeducational training sessions would increase mental health literacy and enhance knowledge of severe mental illness and key symptoms. Research also supports improving mental health literacy as a useful tool in influencing help-seeking behaviors (Wright, McGorry, Harris, Jorm, & Pennell, 2006). Such evidence is similar to the current findings in that participants’ positive attitudes toward help seeking increased following the mental health literacy intervention.
Our results also showed that participants screened as having a higher risk for psychosis would have higher help-seeking behavior following the psychoeducational training session. What is more, these participants identified a campus counselor or psychologist as the individual from whom the character should most likely seek help for related symptoms. The accurate identification of appropriate help-seeking options among participants further supports the effectiveness of the psychoeducational training. Researchers have shown that barriers to mental help-seeking may be due to the cultural mistrust held by many African Americans in predominately White treatment settings (Dzokoto, Hicks, & Miller, 2007). Therefore, in addition to training treatment providers to be more culturally competent, it is critical to educate African American college populations about severe mental illness symptoms and treatment resources. Such education sessions may shorten the duration of untreated illness, which may improve the outcome of future treatment.
In summary, colleges and universities are optimal settings for improving mental health literacy because of the high-risk age group served at these institutions. Nearly half of American youth attend some form of post-secondary education (National Center for Education Statistics, 2005). Reducing delays between first onset and treatment may improve the prognosis for mental illness among student populations and prevent the adverse social outcomes often associated with mental illness. Results from the current study suggest that enhancing mental health literacy has implications for influencing help-seeking behavior. In order to promote help-seeking behavior among ethnic minority college students, culturally responsive campus-based mental health services should be offered within higher education.