USE OF FORMAL AND INFORMAL SOURCES OF MENTAL-HEALTH-CARE AMONG OLDER AFRICAN-AMERICAN PUBLIC-HOUSING RESIDENTS

Background. Elderly residents of public housing have high rates of psy chiatric disorders, but most of those in need of care do not use any m ental health service. This study examines the use of formal and altern ative informal sources of mental health care in a sample of elderly Af rican-American public-housing residents. Method. Data from an epidemio logical survey of six Baltimore public-housing developments for the el derly (weighted N = 818) were analysed to examine the utilization of m ental health services by older African-American residents. Logistic re gression analyses were used to determine correlates of using formal an d informal sources by those needing mental health care. Results. Thirt y-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) th an informal sources (18.6%) for care. The strongest correlates of usin g formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The st rongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive d isorder (OR = 19.71) and having a confidant (OR = 15.07). Conclusions. Contrary to elderly African-Americans in general, those in public hou sing rely more on formal than informal sources for mental health probl ems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treat ment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.