Within the next 20 years, mental health problems are projected to be the leading cause of disability in Canada. Given that one in four Canadians is expected to be over the age of 65 by 2036, older adults’ mental health problems are a growing public health concern, especially because the rate of mental health service use is particularly low among this age group. Although there have been several decades of mental health research, it is still not well understood why older adults are not accessing treatment. A possible explanation for this is that identifying reasons for poor access alone does not capture the multifaceted, complex nature of individuals’ experiences with mental health problems and their paths into treatment. To address this gap in the literature, this study explored older adults’ experiences seeking psychological care and the factors that influence this dynamic process using the Network Episode Model-II (NEM-II; Pescosolido & Boyer, 2010; Pescosolido et al., 2013). To achieve this objective I conducted 15 individual semi-structured interviews with adults 60 years of age and older, who were receiving outpatient psychological services from a hospital in Winnipeg, Manitoba. Findings from this study suggest that participants’ background (social content), social support network, and the treatment system influence, and are influenced by, participants’ illness careers. Factors that delayed participants’ help-seeking included: a lack of support, “inappropriate” referrals or advice from treatment professionals, and a lack of knowledge among older adults about mental health and treatment options. This research has implications for researchers, clinicians, and public policy initiatives aimed at enhancing older adults’ access to psychological care. / October 2016

While there is a large body of research demonstrating that Asian-Americans underutilize mental health services compared to other ethnic groups, little is known about how Vietnamese-Americans use formal mental health services. The traumatic war, post-war and refugee journey contributed to incidences of PTSD and other mental disorders. This mixed-method study aims to understand how multigenerational Vietnamese-Americans view their serious mental illness and how past experiences, family structure, and social networks influence mental health and use of mental health services. The theories that guided the research were the Network-Episode Model and Social Network Orientation Theory. Quantitative analyses using data from the National Latino and Asian-American Study (NLAAS) examined the relationship of variables assessing acculturation, social support, cultural identity, and health/mental health status with formal mental health service use for the Vietnamese-American subsample (N=520). The qualitative study explored how Vietnamese-Americans in multigenerational households experience severe mental illness and the reasons that influenced their mental health help-seeking and service use. Semi-structured interviews with 17 members of six multigenerational Vietnamese families from the greater Boston and Los Angeles area were conducted in English, transcribed, and analyzed using thematic analysis. Findings from the study highlight the differences between 1st and 2nd generation Vietnamese respondents and provide insight into how generational culture – the prevailing attitudes, values, and beliefs of each generation – influences the social network support of Vietnamese-Americans and affects their mental health help-seeking behavior. The forced migration severed social networks, restricting 1st generation respondents to rely on small family networks for information and support. The traditional matriarchal hierarchy limited access to treatment as younger 2nd generation Vietnamese-Americans were unable to convince their parents to seek help for serious mental health problems or to get their approval to seek treatment. Cultural values such as belief in spiritual healers and self-reliance also insulated families from seeking professional help. The study found that the types of interactions respondents had with their social networks—whether positive or negative in orientation—shaped their beliefs about who and where they could go to for help with serious mental health problems and was instrumental in creating pathways to mental health service use.

Untreated substance use disorders are a major public health concern that has costly consequences at both the societal and individual level. Identifying the characteristics and resources of those who seek help for substance abuse problems in order to inform more effective intervention and treatment techniques is therefore an important research objective. Using the Network Episode Model (NEM) as a theoretical framework, this dissertation examines both substance abuse help-seeking (i.e. inpatient/outpatient treatment and 12-Step meeting attendance) and patterns of drug use over time among low-income African American women, with a special focus on the role of the social network system in shaping these outcomes. Drawing on social network theory, critical race theory, and health service utilization research, this test of the Network Episode Model addresses the relative absence of work examining the connections between network characteristics and help-seeking in multiply marginalized groups. The core relationships proposed by the NEM are systematically tested using longitudinal data gathered for the Black Women in the Study of Epidemics Project (N=643). Findings of multilevel models indicate strong support for the Network Episode Model. Specifically, measures of social influence, social control, and social integration significantly predict both patterns of drug use and help-seeking. Importantly, having contact with and receiving health advice from a physician emerged as a significant predictor of a number of positive outcomes, including quitting or abstaining from illicit drug use during the study and attending 12-Step meetings. Results also reveal that experiences specifically related to low-income African American women’s multiply marginalized status – such as experiencing gendered racism – significantly predict patterns of drug use over the study timeframe and may be an important risk factor for substance abuse. In all, this research reveals the important contributions of both traditional predictors and social network predictors on substance abuse help-seeking and patterns of drug use over time. Conclusions suggest that given the limited financial and material resources of multiply marginalized groups, learning how to mobilize or effectively build upon available social network resources to encourage substance abuse treatment may be a particularly fruitful strategy to explore.