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Why Lower Income Mothers Do Not Engage With the Formal Mental Health Care System: Perceived Barriers to Care

University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Cynthia S. Robins

Westat in Rockville, Maryland

Catherine G. Greeno

University of Pittsburgh, Pittsburgh, Pennsylvania

Helen Cahalane

School of Social Work at the University of Pittsburgh, Pittsburgh, Pennsylvania

Valire Carr Copeland

School of Social Work at the University of Pittsburgh, Pittsburgh, Pennsylvania

R. Marc Andrews

Single Point of Access & Case Management, Family Services of Western Pennsylvania in Tarentum

Lower income mothers who bring their children for mental health services also have high rates of depression and anxiety, yet few seek help. Maternal and child mental health are intimately intertwined; thus, the distress of both is likely to continue if the mother's needs are unaddressed. Because mothers overcome numerous instrumental challenges to help their children, the authors identify potential perceptual barriers to mothers' help seeking. An ethnographic analysis of in-depth qualitative interviews with 127 distressed mothers suggests several critical perceptual factors. For example, mothers attributed their distress to external causes (e.g., poverty, negative life stressors), which they believed individually focused mental health services could not affect. Interviewees also anticipated negative ramifications for seeking care, including being labeled unfit mothers, and thus potentially losing custody of their children. The authors discuss the implications of these and other key themes for engaging lower income mothers and their children.

Key Words: mental health services • perceptual barriers to care • treatment engagement

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