In a new study, researchers examine the impact of peer support on reducing racial disparities in outpatient mental health treatment for racially marginalized youth. Racial disparities, or inequalities in treatment that are not attributable to the particular health issue(s) or treatment preference of the individual, were reduced for Black and Latinx youth who were provided with peer support. Peer support for both groups was also found to increase participation in outpatient mental health services.
The findings of this study point to the importance of culturally competent and age-appropriate support and mental health treatment for racially marginalized youth. The researchers, led by Victoria D. Ojeda, an associate professor in the Division of Global Public Health at the UC San Diego Department of Medicine, write:
“Peer support services have the potential both to support youth engagement in general and reduce racial/ethnic disparities by providing culturally and developmentally appropriate supports that build on mutuality, empathy, and trust.”
Disparities in mental health treatment and outcomes for minority adults and youth are well-documented. Racial bias has been implicated in the over-diagnosis of schizophrenia in African-American individuals. Racial discrimination endured by marginalized youth contributes to increased mental health issues and poor mental health outcomes, which in turn can negatively impact, among other areas, academic engagement, substance use, and risky sexual behavior.
Another study found that repeated exposure to racial discrimination contributed to increased mental health issues. Additionally, although Black and Latinx youth experience higher rates of depression than their non-Latinx White counterparts, they receive less mental health treatment, pointing to a need to examine the barriers that are preventing minority youth from accessing appropriate care.
Here, peer support enters as a potential remedy to the disparities experienced by racially marginalized youth. Peer support offers youth struggling with mental health issues the opportunity to engage with individuals who have lived through similar struggles with experiences.
The personal expertise of youth peer providers, coupled with specialized training, allows for an approach to addressing mental health issues that can enable a sense of trust and participation, as youth may feel as if their peer providers more deeply understand and can relate to their experiences—as opposed to a therapist who may not have experienced similar issues. Peer providers can also offer a sense of inspiration for youth as someone who embodies resilience and recovery, and in turn, provide hope for youth that they, too, can recover.
Yet, although peer providers are becoming increasingly used in youth mental health programs, the research evidence on peer support is primarily focused on adults. The available research suggests that for adults, peer support has been shown to increase participation in treatment and decrease disparities, which is promising for the impact it could have on youth. This gap in the research literature prompted researchers in the current study to examine how peer support impacts youth.
For their analysis, researchers used data spanning three years, provided by the Los Angeles County Department of Mental Health and the San Diego County of Behavioral Health Services, which identified African-American, Latinx, and White youth receiving outpatient care for severe mental health issues. What qualified as “serious mental illness” was defined by the state of California, and diagnoses of youth included in the study were ‘”schizophrenia,” “bipolar disorder,” and “major depressive disorder.”
Researchers used program surveys to determine what services were provided by each outpatient treatment facility, if peer support services were available, as well as whether any of the peer specialists were Black or Latinx, to assess whether shared racial identity impacts the effect of peer support services. Ultimately, 183 out of 335 programs responded to the survey, with 76 of those programs reporting having peer providers as part of their staff. These 183 programs provided care to a total of 13,363 youth ages 16-24 struggling with severe mental health issues.
The majority of youth included in the study were female (55.5%) and Latinx (67.4%), with the average age being 19 years old. The study also included 2,303 (17.2%) Black youth, and 2,058 (15.4%) non-Latinx White youth. Major depressive disorder was the primary diagnosis of the youth involved in the study, at 62.4%, followed by bipolar disorder (22.5%), and schizophrenia (15.1%). A little less than half of the youth (46.4%) attended programs with peer specialists, with the majority (53.7%) being in programs that did not have peer providers.
Looking broadly at the results, researchers found that Black and Latinx youth that attended programs with peer specialists had “significantly greater” outpatient mental health visits than those without, indicating the positive impact that peer specialists can have on treatment engagement.
When examining racial disparities, researchers found that the programs in LA County that did not have peer specialists were attended by Black and Latinx youth to a “significantly lower” degree when compared with White youth. For programs that did have peer providers, no such disparities were found.
Researchers also explored racial and ethnic concordance, or shared racial/ethnic identity, between peer specialists and the youth they serve. Although there were no significant differences regarding racial concordance with Black youth, researchers found that Latinx youth who had peer specialists who were also Latinx had a higher number of annual outpatient mental health visits.
Although the findings are promising, this research had some limitations. For example, researchers only focused on commonly used mental health services, they did not have data on how peer support impacted the overall mental health of the youth, and their study was limited to a survey that measured a particular point in time, among other limitations.
Yet, despite these limitations, this study demonstrates the power of peer support for minority youth. Having peer providers at outpatient mental health sites not only results in increased engagement in treatment but also can reduce racial disparities in service use.
Further, as noted, racial concordance between peer providers and clients is important for the Latinx community, as it was demonstrated to contribute to an increase in attendance of treatment for Latinx youth.
The researchers suggest having minority peer providers on staff may be reflective of and potentially increase the cultural competence of the program. In addition, having access to peer specialists who share the racial identities of their clients may allow for an increased level of trust and rapport.
In their summary, the researchers call for further investigation into how concordance with age and other identities, such as sexual orientation, may impact youth and mental health recovery. Additionally, they highlight areas for further exploration brought forth by their findings associated with racial concordance. They point to how additional inquiry needs to examine what actually constitutes “shared experience” and how this appears to extend beyond shared mental health experiences, to other domains such as racial/ethnic identity, and perhaps different identities and life experiences as well.
The researchers also call for an examination of the particular roles and characteristics of peer specialists, in addition to the context of the treatment program in which they are provided, to gain further insight and knowledge into the impacts of peer support overall.
Overall, the study points to the vital role that peer support can play in providing engaging, culturally competent, age-appropriate care to minority youth struggling with severe mental health concerns. It also highlights peer support as a potential remedy to the racial discrimination that is all too prevalent within the mental health system.
Ojeda, V.D., Munson, M.R., Jones, N., Berliant, E., & Gilmer, T.P. (2020). The availability of peer support and disparities in outpatient mental health service use among minority youth with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research. DOI: https://doi.org/10.1007/s10488-020-01073-8 (Link)