Marginalized Youth Feel Unheard and Unhelped By Mental Health Professionals

A new study suggests the way that marginalized youth view their mental health treatment they have received plays a role in the continuation of their care once they reach adulthood.


A new study, published in the American Journal of Orthopsychiatry, investigates former system youths’ perspectives on mental health and professional care. Results of over 60 marginalized youth with diagnoses of mood disorders suggest that the developmental transition to adulthood combined with the transition through levels of care adds nuanced variations to personal health identity and illness perceptions. The study suggests a better understanding of this unique experience is needed to increase rates of engagement and quality of care.

“High need paired with low receipt of mental health care places marginalized young adults at heightened risk for poor outcomes during a complicated time of institutional and social role transitions,” the authors, led by Michelle R. Munson, associate professor at New York University’s Silver School of Social Work, write.

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The transition from adolescence into adulthood is a pivotal developmental period. Marginalized youth, “those living in poverty, aging out of foster care, involved with the justice system, living with disabilities, and/or young parents,” suffer from mental health concerns at disproportionately higher rates compared to their counterparts.

“It has been documented that former system youth are often misdiagnosed, given multiple diagnoses, and are often provided a proliferation of psychotropic medications and mental health services experiences that likely contribute to complicated understandings of the meaning of mental illness and treatment,” Munson and colleagues write.

“The transition to adulthood is especially complicated for youth leaving public social service systems because they often face disrupted access to services as they exit child-serving systems, even though they remain in need.”

When youth enter adulthood and are finally given autonomy over their mental health decisions, the way they perceive health care providers and their relationship to their mental health often determines their continued participation in care. It is unclear if service discontinuation is due to the individuals’ choice to stop care or their disrupted access to care, and little is known about youth perceptions surrounding this transition.

“Several theories posit that how people think and feel about their health influences their subsequent health behaviors,” Munson explained. “The individual’s interpretation of their mental health is something that patients and practitioners need to uncover—together—as part of a therapeutic relationship. This is critical to keeping young adults invested in their own healing.”

In the current study, Munson and colleagues explore illness and treatment perceptions among marginalized youth to inform better the way health care providers understand youth engagement and impact of important mental health services for these high needs individuals.

Sixty marginalized young adults between the ages of 18-25, all of who received Medicaid-funded mental health care during their childhoods, were recruited for the study. The study used an in-depth interview process examining topics such as how life has changed for the participants since turning 18, what has been the most challenging part of the process, and whether they continued to access mental health care and why or why not. Answers were coded and analyzed independently by four analysts. Also, each participant completed the dimension of illness perceptions on the IPQ-R self-report form.

Results of the simultaneous, convergent mixed-method design, which concurrently collected and analyzed both qualitative and quantitative data side-by-side, confirms former theories suggesting the way one thinks about their mental health shapes their mental health behaviors.

“The present study illustrates how the environment, social relationships, and cultural contexts shape how these young adults perceive their illness and treatment options and how these perceptions are shaped by both prior experiences within the public system and prior relationships with mental health providers.”

In conclusion, co-author Sarah Carter Narendorf, of the University of Houston, explained:

“While part of the problem is lack of access, poverty, and stressful competing demands, like parenting and education, another large part is that young adults who are marginalized do not feel heard, respected, and helped by professional mental health providers. They do not feel understood. They haven’t for a very long time.”

“If we want to help these young adults, it is on us to learn to help providers come from a place of cultural humility and listen for their stories, their experiences, their mental health narratives. If we do not, we will continue to fail these young people.”



Munson, M. R., Narendorf, S. C., Ben-David, S., & Cole, A. (2019). A mixed-methods investigation into the perspectives on mental health and professional treatment among former system youth with mood disorders. American Journal of Orthopsychiatry89(1), 52. (Link)


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  1. “If we want to help these young adults, it is on us to learn to help providers come from a place of cultural humility and listen for their stories, their experiences, their mental health narratives. If we do not, we will continue to fail these young people.”

    But it seems impossible for people, who’ve unjustly been given “omnipotent moral busy body” status – the right to play judge, jury, and executioner to other people – to have humility. I’m quite certain having some checks and balances on our “mental health” workers are needed.

    I know I had to leave my psychiatrist because my medical records had been handed over. I read them, and realized my psychiatrist had turned my entire real life into a “credible fictional story,” as he described my real life, after I confronted him with his many, many delusions about me. He hadn’t heard a word I’d said.

    I do agree, the “mental health” workers need to get rid of their hubris, and stop trying to dictate other people’s life stories. I’ll write my own story, thanks, not interested in your insane, inaccurate, and defamatory beliefs about my life.

    How appalling psychiatrists believe they can declare a person’s entire real life to be “a credible fictional story.” Insane, delusional, and ungodly disrespectful, is what the psychiatrists are.

    Oh, and now that the truth is attached to my work, they’re terrified of my work, because it’s “too truthful,” in its visual documentation of the psychiatrists’ crimes and iatrogenic harm of millions of innocent humans. I hope we may end our modern day psychiatric holocaust soon.

    Think some humility is in order, unrepentant mass murderers and repeaters of the worst of history? I’d be ashamed of murdering 500,000 people a year with your neurotoxins, if I were a psychiatrist. I’m quite certain some humility, repentance, and utilizing your malpractice insurance for what it is intended, would be the appropriate behavior.

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  2. I haven’t been “heard, respected, or helped” by many working for “mental health” since I was labeled. Those working for centers adopt a certain attitude toward the “SMIs” in their care.

    This attitude is one of condescension to inferiors. I imagine ethnic minorities get a double or triple dose of this smug, patronizing treatment.

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  3. This research makes me want to cry. The wheel of Adolescence care has already been invented but banished to the dustbin and landfills to make good and sure any good would be totally forgotten. Thanks so much folks whoever you are. Job well done! It will take another generation for old stuff to be found on archeological digs and new support for new Adolescent paradigms for care.
    Back in the day, there actual oh my! Adolescent Units with kids and teens from every medical department under the sun. All mixed together.
    Back in the previous day, Dr Peter Blos and Dr Peter Blos Jr wrote extensively on this era of childhood transition and nope no bio psychiatry at all, at all.
    There were issues of all kinds but again coming from both inside and out side- I would have given my eye teeth to have been placed in an unit like the Adolecent Unit I worked on or in some of the therapeutic mileu places.
    One of the weaknesses was the young staff almost peers but not and substance abuse on both sides
    If a survivor approach would have been taken maybe better care.
    And trauma- Staff was suppose to be cool and in control. Not really at times, because trauma we all deal with it.

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  4. Mental health fixation belongs to apollonian fundamnetalists. Stupid won’t help those more deep than he himself.

    Psychiatry has killed Hemingway and Plath. Because their language was more complex than psychiatric jargon.
    Because words means everything. And psychiatry is a war of the blunt apollonic pseduo scientism with metaphor.
    All the people I knew and who were killed by psychiatry, they were psychologically more important that those privileged who have killed them.


    James Hillman “Re- Visioning psychology”

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  5. I read the words, heard, respected, and understood. It seems like that’s really the most basic types of things every human being should get all along. Is it just ignorance on the part of parents or whoever is there for them, or is it the culture which says we should be ashamed of being needy. Needy is a strength not a weakness. We took over the planet with it because it makes us cooperate. If we keep deciding it’s really a weakness, we will begin to lose it.

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  6. The question is: who are the professionals working for? It seems obvious that they are NOT working for the people who are alienated and distressed. They are working for people whose interest is in preserving the status quo. The alienated individuals recognize this fairly early, so of course they do not feel better–often they feel worse after meeting professionals who are supposed to “help”.

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