What is it about?

We interviewed 120 teenagers (mostly African American) and their caregivers (mostly parents) who live in an urban setting and had access to a pediatric clinic offering mental health services free of charge. We found that, with reasonable access to care and affordability, teenagers were more likely to see a mental health therapist/counselor when their caregivers/parents hold more positive opinions about professional mental health services and think that the teenager is struggling. Interestingly, the teenagers’ opinion about professional mental health services did not relate to whether or not they end up seeing a therapist/counselor. The finding suggests that caregivers/parents, rather than the teenagers themselves, have the primary influence on their use of mental health services.

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Why is it important?

Most adolescents with mental health problems do not engage in available treatments, especially those from urban, low income, and ethnic minority families. Undertreated mental health issues can lead to detrimental outcomes, such as long-term disabilities and death by suicide. This study shows the central role caregivers/parents play in getting teenagers the mental health services they need. To address the current mental health crisis, the results highlight the pressing needs in working with caregivers/parents to improve youth mental health services usage, as well as to empower teenagers in the decision-making process.


Whether or not to see a therapist/counselor can be a complicated decision to make, with numerous factors to consider. Some factors are circumstantial and could be hard to control (e.g., scheduling and insurance issues), while others are more subjective and personal (e.g., values and knowledge). As a clinical child psychologist, I strive to empower teenagers and families in exploring their options and making informed decisions that fit their unique situations and priorities. Nonetheless, I have come across many who voiced their regrets in not engaging in mental health services sooner. I sincerely hope this study and related research will help youth and their families make decisions that will lead to the healthiest long-term outcomes and thereby improve the mental health wellbeing of our next generation.

Yi Tak Tsang
Wayne State University

Read the Original

This page is a summary of: Caregivers as gatekeepers: Professional mental health service use among urban minority adolescents., American Journal of Orthopsychiatry, January 2020, American Psychological Association (APA),
DOI: 10.1037/ort0000432.
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