Perceptions,Attitudes,and Experiences Regarding Mental Health Care Among Young Black Men

Abstract

Mental health service research has insufficiently examined young Black men’s (YBM; ages 18–25) mental health care consumption patterns, obscuring their unmet mental health needs. Concurrently, the literature indicates YBM face unmet service needs that impede their ability to address numerous negative social determinants of health (e.g., high adverse childhood experiences, low socioeconomic status, etc.). Because preventing or treating mental health issues at or near onset can dramatically improve outcomes, this study utilizes thematic analysis to elucidate the factors most consequential to YBM’s experiences as mental health service consumers. Eight YBM (M_age = 21.1 years) were purposively recruited to participate in semi-structured interviews to discuss attitudes regarding mental health care and cultural attitudes, gender-based attitudes, structural racism, and transition to adulthood. Of the eight participants, five had active health insurance, six had received mental health services before age 18 years, and three were currently receiving mental health services. Participants were attuned to their mental health needs and rejected stigmatizing attitudes about mental illness. Most participants reported hesitation about taking psychiatric medications. Participants had limited resources and encountered structural barriers to accessing mental health services. Most participants did not perceive racism as a source of mental distress. Culturally informed, consumer-oriented research is critical to tailoring and strengthening YBM’s mental health care. Future research should employ a population health approach to promote YBM’s mental health service uptake in adulthood.

The consumer experiences of young Black men (YBM; ages 18–25 years) who voluntarily seek mental health care remain understudied and insufficiently understood. Many YBM who interact with the mental health system primarily do so involuntarily, often through carceral systems (Youman et al., 2010), in which they are overrepresented (e.g., 18.3% of Black men born in 2001 will enter state or federal prison by the age of 38; Robey et al., 2023). In addition, an analysis of 595 jails found that YBM ages 18–24 years were jailed at higher rates and for longer periods than any other demographic group (Pew Trusts, 2023). Furthermore, Black people are overrepresented in the population receiving emergency or involuntary psychiatric care (Hamilton et al., 2015; Snowden et al., 2009a)—another care setting granting clients limited autonomy.

Conversely, while Black men remain overrepresented in involuntary psychiatric care, they are underrepresented in outpatient mental health services. Analysis of the National Survey on Drug Use and Health found that Black men ages 18–34 years were overrepresented among Black respondents reporting unmet mental health needs (Alang, 2019). Furthermore, Black people are more likely to receive services from primary care physicians (PCPs) than from mental health specialists (Snowden et al., 2009b). When medication management is not sufficient, PCPs refer clients to mental health specialists; however, retention after referral steeply declines (Fortuna et al., 2010). The fact that many YBM who voluntarily seek mental health care receive this care from non-specialists may impede their ability to engage services as informed, confident mental health consumers.

To that end, this study leveraged thematic analysis (TA) to qualitatively explore four key factors of YBM’s mental health attitudes and experiences as mental health care consumers: structural racism, cultural attitudes, gendered attitudes, and the transition to adulthood. Structural racism is a significant factor in Black men’s (including YBM’s) mental health experiences, resulting from the racism that continues to pervade clinical training, research, and practice (Chadha et al., 2020). Indeed, studies have observed that fear of racial discrimination prevents many Black adults from seeking mental health treatment (Alang, 2019) and that experiences of discrimination constitute a mental health stressor for racialized minorities (see meta-analysis by Emmer et al., 2024). Cultural attitudes and beliefs salient among Black Americans regarding mental illness and help-seeking—namely, skepticism of the mental health care system resulting from the profession’s structural racism (see reviews by Gordon-Achebe et al., 2019; Legha & Martinek, 2023)—markedly impact this population’s mental health care utilization (Eylem et al., 2020). Gendered attitudes that frame mental illness and help-seeking as weak and unmanly are associated with young men’s lower mental health care usage rates compared with their young women counterparts (Seidler et al., 2016). This study examines how the transition to adulthood shapes YBM’s health consumer behaviors, as young adults undergo the switch from pediatric to adult services and begin to engage the health insurance marketplace for the first time (Wood et al., 2018). Collectively assessing these factors enables the intersectional approach required to understand high-impact facilitators of and barriers to YBM’s mental health that stem from their engagement (or not) in relevant care services.

Promoting mental health service consumer competency among YBM would yield short- and long-term benefits. Over 75% of mental health problem onset occurs by young adulthood (Kessler et al., 2007), and early mental illness treatment is associated with decreased risk of illness chronicity (Moran et al., 2022; van der Gaag et al., 2013), illness severity (Colizzi et al., 2020), and interaction with the criminal justice system (Butsang et al., 2023). Untreated mental illness among YBM can lead to multiple adverse events for Black families, as paternal mental illness is associated with poor relationships with children (Fisher, 2016), absentee parenting (Reupert & Maybery, 2009), conflict in co-parenting relationships (Wells et al., 2023), intimate partner violence (Shorey et al., 2012), and adverse childhood experiences (Schmitz et al., 2024). By contrast, given evidence that engaging young men in mental health treatment can reduce their likelihood of enacting violence (Kelly et al., 2019; Swanson et al., 2015; Yu et al., 2017) and evidence that receiving mental health treatment in young adulthood improves education and employment outcomes (Bond et al., 2015), meeting YBM’s mental health service needs can yield benefits for their quality of life, their families, and the communities in which they reside. Realizing these benefits will require far more robust understandings of how YBM’s attitudes about mental health and help-seeking behaviors shape their decisions as mental health care consumers.

Method

Between February 2023 and April 2023, the author conducted semi-structured Zoom interviews (lasting 20 to 45 min) with eight participants, who were purposively recruited via the lead author’s professional network, an online advertisement, and participant referrals. A survey was distributed to recruit, screen, and collect demographic information for each participant. Using an interview protocol developed for this study, the author interviewed participants about their life course interactions with the mental health system, asking them to describe attitudes regarding mental health care and their consumer experiences before and after age 18. Participants were asked to note providers’ demographic characteristics, service setting, their presenting concern, and perceived effectiveness of care. Participants were asked about facilitators of and barriers to their care, including cultural and gendered attitudes, racialized experiences, and health care decision-making. The interview concluded with an open-ended question inviting participants to voice their opinions on how the mental health system can change to meet YBM’s needs. All interviews were audio recorded and transcribed verbatim by the author.

Interviews were analyzed using TA. The first stage in TA is familiarizing oneself with data, which includes transcription, reading of transcripts, and initial note-taking. Next, codes were generated, followed by collating codes into themes. Refinement of themes occurred afterwards, followed by report production that utilizes exemplar quotes to yield a compelling narrative tied to the research questions, theory, and extant literature. This study’s sample size (N = 8) meets the literature’s recommendation of a sample size of N = 6 or more (Fugard & Potts, 2015).

Results

All eight participants were U.S. citizens by birth and identified as Black males. Participants hailed from several states in the country, but the majority were recruited from Pennsylvania. Ages ranged from 18 to 25 years with an average age of 21.1. Participants varied by their education, employment, and health insurance status. School-based mental health services for both high school and college students emerged as an important resource for participants. Table 1 shows the participant demographics.

Table 1.

Participant Demographics

Demographics	N	%
Black race	8	100
Male gender	8	100
Average age (years)	21.1	N/A
Education status
High school diploma	2	25%
Associate degree/technical certification	1	12.5%
Undergraduate education beyond associate	4	50%
Graduate education	1	12.5%
Health insurance status
Uninsured/unsure/pending	3	37.5%
Insured	5	62.5%
History of receiving mental health care
In high school	6	75%
Currently	3	37.5%

The analysis yielded the following five themes: (a) Vulnerability and Escaping the Prison of Masculinity Norms, (b) Psychiatric Medications are Dangerous, Mind-altering Drugs, (c) Negotiating Psychological Safety, (d) Navigating Health Insurance Coverage as a Young Adult, and (e) Early-stage Racial Consciousness as a Buffer from the Effects of Racism. Descriptive profiles that summarize interview details for each participant are presented, followed by themes emerging from the data.

Descriptive Profiles

Participant 1 is a 22-year-old Black man from Washington, DC, living in Southern California. While attending boarding school in his parents’ native country, he experienced physical and emotional abuse from peers and instructors, and has since struggled with trauma-induced anxiety that eventually required hospitalization. Upon hospitalization, he was referred to mental health services. He reports positive experiences with mental health care, although he experiences mental health stigma within his family and community as well as accessibility, availability, and affordability issues. He is now navigating health care and insurance as a recent transplant to California.

Participant 2 is a 20-year-old Black man from western Pennsylvania. He reports attending two brief sessions with mental health professionals during his freshman year of high school to resolve academic and interpersonal issues. He reports that those interactions were positive but laments his mother’s decision to remove him from treatment prematurely. Although he is not currently in treatment, he is a proponent of mental health care.

Participant 3 is a 25-year-old Black man from the Philadelphia area living in western Pennsylvania. He first entered mental health services after an accident that left him with physical and mental injuries. He engaged in trauma therapy for a year in high school and reported a positive experience. He is currently engaging in therapy to help with difficulties adjusting to life after collegiate sports. He reports that he is a proponent of therapy but holds negative views about psychiatric medications.

Participant 4 is a 20-year-old Black man from Georgia living in Mississippi. He has never engaged in mental health services and reports good lifetime mental health. He is open to receiving mental health care should his health status change, but he has concerns about expressing vulnerability with others.

Participant 5 is a 20-year-old Black man residing in Louisiana. He reports a brief intervention with a school therapist to address feelings of isolation from his peers. He reports a positive experience from that interaction, aided by shared religious faith with the school therapist. He has not subsequently engaged in therapy and reports good mental health. He is a proponent of mental health care for Black men. At the time of the interview, he is navigating enrollment in state Medicaid.

Participant 6 is a 20-year-old biracial man from North Carolina living in western Pennsylvania. His parents are a significant barrier to addressing his mental health concerns. He reports his parents have untreated mental health issues and stigmatizing views of help-seeking and actively sabotaged his mental health treatment as a teenager. He had reported mental health symptoms to his PCP for many years as a youth before receiving help via medication management and a referral to a family therapist. Upon entering college, his mental health declined, necessitating a referral to student health. He reports positive experiences with medication and therapy. At the time of the interview, he is experiencing an insurance gap as he was removed from his parents’ plan.

Participant 7 is a 25-year-old Black man from western Pennsylvania. He reports no history of mental health care and good lifetime mental health. He is a proponent of mental health services and reports that his family is very supportive of him expressing himself should he experience mental health distress.

Participant 8 is an 18-year-old Black man from western Pennsylvania. He reports having only one period of mental distress following his grandmother’s death. He sought out a guidance counselor to aid him in processing his grief. Overall, he reports good lifetime mental health. He is a proponent of mental health care.

Themes

Vulnerability and Escaping the Prison of Masculinity Norms

All eight participants expressed egalitarian views toward mental health care:

P6: I don’t think that there is any significant sexual difference between the male and female brain where it would disqualify men from needing that service. I think a lot of people could benefit regardless of gender.

Stigmatizing messages about mental health care were transmitted through participants’ social networks, yet such messages did not alter participants’ positive impressions of mental health care:

P4: Well, you know, just you know, go on YouTube. You see certain youtubers, and they’re just like: oh, yeah, you don’t need therapists.

P5: [on podcasts] Oh, you have to be the alpha man. I think it was like in the middle of 2022 in which that’s all they had on Instagram, and it kept showing you it because that was a part of the algorithm and I just like I need to stop seeing it.

Here, participants discuss their discomfort with masculinized health stigma. Participants’ language reflects a frustration with a masculinity norm that requires them to disregard their vulnerability:

P5: We’re told to not express ourselves. We’ll keep all those feelings bottled in, and it comes out at the wrong time, and people are trying to display it as if something is wrong with us or we’re crazy. I see it happening a lot in my generation, because a lot of guys will always act tough for no reason. There are times you need to be vulnerable with yourself or around your peers, so that you can get somebody to fully understand you.

P2: I heard the man up part before, for sure. It ain’t just that easy man. People grieve and go through things differently. People got their own way of handling their stuff. So, what may work for you may not work for the next person.

Participants cited credible messengers— musicians and athletes—and gendered spaces (virtual and physical) as key strategies to promote mental health care seeking among YBM:

P4: A lot of us Black men look up to the rapper or the singer or the producer. If they start talking about “oh, yeah, I went to therapy, or therapy made me feel good,” I think you’ll start seeing more people get to more mental health care facilities.

P1: I feel like a lot of times athletes really deal with things like this. But it’s never really talked about. And a lot of time, I mean, like a lot of times, people, even a lot of times Black men, especially they join sports just as a place to have like an outlet, to pour out their trauma.

The literature on masculinity and mental health care overwhelmingly characterizes men as resistant to help-seeking (Sagar-Ouriaghli et al., 2019). By contrast, participants reported that mental health care was acceptable to YBM, and these positive attitudes toward mental health care were durable when experiencing masculinized health stigma. Participants voiced support for gender-specific messaging. Male-centric spaces were identified as acceptable mediums for care delivery and social marketing.

Psychiatric Medications Are Dangerous, Mind-Altering Drugs

Multiple participants—particularly those with short-term or no contact with the mental health system—expressed discomfort with psychiatric medications:

P3: Because it’s just for the most part, it doesn’t help. One, it’s just regulated crack. It’s no different than any other street drug. They don’t help, you know. Psychiatric medicine can’t stop somebody from killing themselves. Stop somebody from being depressed. It’s just gonna keep. . .make you high and just like really feen you out. Honestly, it messes up with . . . it doesn’t the address the actual issue. I’d rather somebody smoke weed than take psychiatric medicine to deal with depression or anxiety.

This characterization of psychiatric medications as “regulated crack” starkly illustrates this participant’s profound distrust of medical systems. For participants who equate psychiatric medications with illicit substances, psychiatric consultation referrals would likely foster a negative reaction. Such beliefs about psychiatric medications are likely a cultural artifact of Black Americans’ well-documented and persistently racist treatment by the U.S. medical system (Chadha et al., 2020). Participant 3’s reference to marijuana as an alternative to psychiatric medication may indicate more widespread views among YBM that this drug constitutes a natural remedy preferable to pharmaceuticals. Another participant characterized psychiatric medications as invasive and talk therapy as a non-invasive and therefore acceptable treatment:

P7: I don’t want to open up to a random person, and they prescribe me this medicine, and then I’m taking the medicine, and it’s doing something to me. It’s making me act, not myself. So, I don’t want that. I don’t want to be on medicine. I just want to talk to somebody, hopefully.

Participants expressed their desire for mental health professionals to maintain a clear distinction between therapy and medication management, cautioning that the latter may undermine the therapeutic alliance.

Negotiating Psychological Safety

Some participants expressed reservations about psychotherapy models, stemming from concerns about ensuring their psychological safety and the discomfort associated with emotional vulnerability:

P4: Do not make it so gut-wrenching. Even though it is serious, do not make it so gut-wrenching where it’s like, okay, you go in here, and you’re going to cry, you’re going to do this, you’re going to do that. You’re going to feel these emotions make it feel a little bit more like. . .ease them into it. Make it more homey.

Participants reported that male-centric spaces (e.g., barbershops) evoked feelings of psychological safety that enabled them to share mental health-related issues or events:

P1: Like putting these resources in places like barbershops where we joke and talk about things like this, or just like things we’re dealing with.

P2: Have it [i.e., psychotherapy] occur in recreational centers because a lot of kids play sports. Not even a class, because that feels more restrictive. Offer this while you’re doing a sports activity. After the activity, if you want to stay for 30 minutes more, we can just do a reflecting circle. Everybody can gather around and share their testimony. What’s going on in their life right now? How we could, you know, step into changing that. And what we can do to improve it.

Such statements by Participants 4 and 2 illustrate that receiving needed treatment does not necessarily instill clients with feelings of safety. Indeed, in his statement above, Participant 4 expresses a need for protection from the catharsis anticipated to come from traditional treatment, balancing treatment parameters with his need for psychological safety. Participant 2’s desire for a more communal form of treatment indicates his need for protection from individual-focused closed-setting therapy that, to him, represents invasive treatment.

Navigating Health Insurance Coverage as a Young Adult

Participants often experienced setbacks in their ability to maintain health insurance upon reaching adulthood. Participant 6 cited his removal from his parents’ health insurance and insurance portability barriers as disruptions to his mental health care:

P6: I met with the [redacted university] Student Health, where they put me on the medications that I’m on. Fluoxetine and they were like, okay, well, you should follow up like getting treatment over the summer, and I was like, okay, but at this time, my mother removed me from her insurance. So, I’ve been an uninsured adult.

Participants experienced challenges when transitioning from children and adolescent mental services to adult care. The university health clinic served as a bridge for the continuation of care, yet downsides to university care were noted:

P1: At the time, I was still going to Children’s hospital and she was saying that, oh, she’s going to have to refer me to some external sources. And one of the places she referred me to was my school, [redacted] University. I applied for counseling services there, and they told me that the wait list is so long that I probably would not hear anything until September or October. They reached out to me in maybe October, telling me, oh, I’m almost off the waitlist, and I still haven’t heard anything.

P6: I called [my campus’s mental health service provider] this semester, and they were like, yeah, no, we’re fully booked. You can utilize our drop-in hours, which are kind of inconsistent, and I wouldn’t be seeing a person regularly. So, I don’t feel like I would be able to do anything helpful because they would just look at someone else’s notes and be like, okay, here blah blah blah.

Campus health clinics constituted an essential source of care for college-going participants, providing them with an entry point to adult care, though not resolving their challenges with successfully navigating to health services in a broader community context.

Early-Stage Racial Consciousness as a Buffer From the Effects of Racism

Based on their level of prior engagement with mental health services, participants reported different effects of racism on their mental health. Namely, while participants with a history of prolonged mental health treatment identified racism as a mental health stressor, those who had received short-term treatment or no treatment reported no mental health impact. For those in the former group, racism’s impact was considerable:

P1: When someone gives you a microaggression or says certain things or like, says something mean. A lot of times, you get angry. You won’t necessarily act out on it, but like a lot of times, just constantly thinking about it and getting mad and just feeling some way does adversely affect you.

Participant 6 reported experiencing racism while receiving treatment in a medical context:

P6: I would also note because I’m mixed race, it would be worse if I went to my mother, who is Black. But whenever I went [to the service provider] with my dad, they treated us nicely, which was annoying. So eventually, I just was like, okay, just only go there with your dad, and it was frustrating because my dad has like a psychological aversion to anything medical.

By contrast, participants with short-term or no prior mental health care service receipt reported that racism did not affect their mental health; notably, this included participants who had directly experienced racism:

P2: Racism doesn’t impact me. Okay, you can call me the n-word. Cool whatever. You can call me all types of offensive words. What is that going to do? I don’t let it bother me. You’re not physically hurting me. You’re not mentally hurting me.

P7: It doesn’t affect me as much because I haven’t experienced it. I see it all the time, but from my personal experience, I’ve never really experienced it.

P4: I don’t carry myself in a way where I can receive racism if that makes sense.

This theme encompasses both convergence and divergence in the experiences of YBM. Participants with an extensive mental health care were primed to identify racism as an exacerbating stressor, whereas participants with a limited history of mental health care were not impacted by racism.

Discussion

The present study explored YBM’s mental health attitudes and help-seeking behaviors; to our knowledge, it is among the first studies of YBM’s experiences as mental health care consumers. As being a health care consumer denotes having autonomy over and choice regarding one’s care (Iriye & Keller, 2022), enduring racist paternalism in U.S. medical systems—including mental health services—continues to disempower Black consumers (Byrd & Clayton, 2001) in that providers presume their decision-making is compromised and that providers should dictate their treatment with limited consumer input (Byrd & Clayton, 2001; Cooper et al., 2012; van Ryn & Burke, 2000). Such stereotypes increase the risk of harm for health care consumers generally (Hamed et al., 2022) but especially for Black consumers.

Participants recognized the importance and appropriateness of mental health care for YBM, departing from prevalent masculinity norms regarding mental health help-seeking. Masculinized health stigma poses real threats to men’s mental health outcomes, as men who perceive mental health treatment-seeking as effeminate are more likely to avoid treatment, more likely to enter treatment only when they cannot avoid doing so, and, when in treatment, are likely to engage in counterproductive behaviors such as limited disclosure of mental distress, minimize symptoms, and have an inability to recognize the extent of their need and impairment (Seidler et al., 2016). Our YBM participants’ interviews highlight the construction of masculinities that are more beneficial to personal development. Participants displayed awareness of their mental health vulnerability and considered treatment not as a flaw in their masculine identity but as a means of achieving personal growth.

Participants reported receiving mixed messaging regarding mental health care from social media sources. While some of this messaging suggested mental health care was either ineffective or inappropriate for YBM—messaging that has been shown to reduce the likelihood of help-seeking (Nearchou et al., 2018)—other messaging (particularly from entertainment figures) was supportive of mental health care. Encouragingly, research indicates that entertainers who promote mental health can have a positive effect on younger cohorts (Francis, 2018; Lee, 2019; Pavelko & Wang, 2021). Given younger cohorts’ increasing use of social media to discuss mental health issues and find supportive communities when experiencing mental distress (Gandhi et al., 2021; Lerman et al., 2017; Park & Conway, 2018; Sit et al., 2024), our findings indicate that service providers and systems should consider connecting with YBM clients through live-streaming applications and podcasts that are male-centric with specific focus on music and sports content. Targeted marketing could help reduce masculinized attitudes toward mental health help-seeking per participants.

Corroborating prior studies conducted among Black populations, our participants reported beliefs that psychiatric medications are dangerous rather than helpful for people facing mental health issues (André Christie-Mizell et al., 2015; Givens et al., 2007; Schnittker, 2003)—a skepticism likely partly attributable to Black people’s historic and systemic abuse in U.S. medical systems (Schnittker, 2003). Indeed, one of our participant’s equating of psychiatric medication with illicit drugs is consistent with the belief held by some Black people that the U.S. government is involved in distributing drugs in Black communities (Finn, 2021). The description of marijuana as an alternative to psychiatric medication is troubling as the evidence of marijuana as a treatment for mental illness is lowly graded or unsupported (Black et al., 2019; Solmi et al., 2023). Furthermore, marijuana has been found to increase mental distress, particularly anxiety and psychotic symptoms (Black et al., 2019; Solmi et al., 2023). Despite this evidence, there exists a belief among some that marijuana is beneficial to mental health. This sample was comprised of young adults, who are more likely to support and use marijuana compared to older adults (Edwards, 2022). Attitudes toward marijuana use among individuals with a history of mental illness require further study. With the results of this study and extant literature (Barner et al., 2010), it can be theorized that the appeal of marijuana use for mental health could reflect a preference for natural remedies among YBM-seeking treatment. As underlined by our participants’ reported concerns that psychiatric medication’s adverse side effects outweigh its benefits, providers should think more critically about medication referrals for YBM, particularly early in the helping relationship.

Participants expressed a desire for mental health professionals to meet them where they are, both psychologically and physically. There are multiple evidence-based practices for increasing utilization of mental health services among minoritized men. Psychological interventions that are motivational and solution-focused work are encouraged for men who present with high levels of masculine role socialization and help-seeking stigma (Sagar-Ouriaghli et al., 2019; Seidler et al., 2018). Emphasizing positive masculinity traits such as “responsibility” and aligning treatment with “strength” can have a positive effect on help-seeking and treatment outcomes (Sagar-Ouriaghli et al., 2019). It is recommended that clinicians avoid diagnostic frameworks when initially working with men with masculinized health stigma (Sagar-Ouriaghli et al., 2019). Furthermore, distrust and stigma may necessitate different office hours, as well as virtual and smartphone utilization to enhance psychological safety (Watkins et al., 2017). Closed and carefully selected peer support tandems, peer support groups, and group counseling—all exclusive to men—are recommended products clinics should offer (Beasley et al., 2015; Hankerson et al., 2015). Men not only benefit from therapy but also from social marketing strategies. For example, brochures, documentaries, psychoeducational materials, and testimonials can serve as a buffer between more “invasive” direct contact services (Sagar-Ouriaghli et al., 2019). Health systems should recruit and designate credible messengers that can enter male-centric spaces to promote mental hygiene and help-seeking behaviors (Hankerson et al., 2015). Professionals who come to them, enter their world, and make the affirmative case for treatment may achieve better results.

Participants reported struggling with structural barriers such as insurance gaps, accessibility, and affordability of services. Health insurance in the United States is a complex system that confuses even the most knowledgeable and high-usage individuals (Singer, 2017). In addition to cost and administrative barriers, health insurance literacy is a barrier to care utilization and help-seeking behaviors. A study of enrollees in Connecticut’s health insurance exchange found that Black enrollees scored 21 points lower on health insurance literacy questionnaires than White (Villagra et al., 2019). In addition to racial minority status, male gender (Masterson & Megna, 2022), low educational attainment (Villagra et al., 2019), and young age (Norton et al., 2014) are associated with lower health insurance literacy scores. Black emerging adults are more likely to experience disruptions in health care as they encounter higher rates of termination of government-funded child and adolescent health care (Wood et al., 2018), are more likely to have parents who are unable to extend their health insurance to the age of 26 per the Affordable Care Act (Wisk & Sharma, 2019), and are more likely to live in states that have not expanded Medicaid (Artiga et al., 2015). Health systems must be attuned to the limited resources available to YBM.

Participants recounted numerous experiences of racism, but contrary to the well-established literature documenting discrimination’s effects on mental health (e.g., Assari et al., 2017), most did not report mental distress resulting from these experiences. Notably, participants with prolonged mental health treatment experience did report mental distress due to microaggressions and perceived discrimination, potentially indicating these participants had higher levels of racial identity development compared to participants with more limited treatment histories. Awareness of racial discrimination-based distress is theorized to activate at higher levels of racial/ethnic consciousness according to Thoits’ (1999) theory of identity-relevant stress; the stronger the salience of an identity, the more psychological distress is felt from stressors that threaten the identity (Thoits, 1999). Several studies have found that racial identity intensifies the association between discrimination and psychological distress, lending support to identity-relevant stress theory (McCoy & Major, 2003; Sellers et al., 2006; Woo et al., 2019). While such associations require more study, research on the poor mental health outcomes of Black Lives Matter activists suggests that such a phenomenon exists among a subset of racially conscious young Black adults (Alexander et al., 2022; Hope et al., 2022). More research is necessary to understand the salience of racial discrimination-based distress among YBM receiving mental health care.

This study’s novel findings should be interpreted in light of some limitations. Our small sample size—while appropriate for TA—limits the generalizability of our findings. This study did not assess substance use issues, so future studies should assess for the presence of substance use, which is a heightened concern among emerging adults (Salvatore, 2018). Furthermore, college-educated YBM were overrepresented in the study sample, which limits generalizability, as just 22% of Black men have obtained a college degree (Postsecondary National Policy Institute [PNPI], 2023). Perhaps due to the study’s purposive sampling, our sample had limited representation of YBM with severe mental health issues, meaning that our findings may better reflect the experiences of YBM with low-to-moderate mental health distress. Future studies should employ different recruitment strategies (e.g., recently discharged hospital patients) to increase representation of YBM with severe mental illness.

Conclusion

The present study’s findings can facilitate awareness of YBM’s experiences and needs as mental health care consumers. Namely, YBM exhibit great need for mental health care but face myriad challenges to accessing and utilizing services (Motley & Banks, 2018; Substance Abuse and Mental Health Services Administration [SAMHSA], 2015; Woodward et al., 2011). Despite these challenges, participants remained open to receiving services and relied on multiple protective factors to facilitate good mental health hygiene, such as family and social support (Gayman et al., 2018), spirituality (Pew Research, 2021), and racial identity development (Umaña-Taylor et al., 2014). This novel study corroborated prior findings that skepticism regarding psychotropic medications and limited consumer literacy constitute barriers to help-seeking. More robust research is needed to explore YBM’s perceptions of psychological safety and racism as a mental health stressor at the population level.