This mixed methods study sought to refine the causal explanations for racial disparities in mental health care by exploring with youth of color (YOC, ages 12–21) how they became candidates for psychiatric care (“candidacy”). The thesis focused on developing and testing hypotheses about the Candidacy Model (CM) as a mediator of the relationships between mental health needs, racism, and health care utilization; examining those relationships when the candidate for care was represented by an agent; and characterizing how YOC and their agents experienced the assertion and adjudication stages of CM during a psychiatric emergency services visit. Despite a rich and growing literature on patient and environmental factors associated with lower access to psychiatric services, health services research in the United States has paid little attention to how YOC actualize their candidacy for mental health services. The CM suggests that vulnerable populations must negotiate with health care systems to have their needs considered medically treatable and to experience treatment in conditions that are congruent with their lifestyles. Theorizing that CM acts as a mediator between healthcare needs, racism, and treatment, this thesis explored how the specific stages of CM influenced mental health outcomes for YOC. The hypothesized relationships between candidacy, needs, racism, and utilization were tested using data from two national surveys, and in two different contexts: among young adults (ages 18-21) and among adolescents (ages 12–17) whose candidacy was co-constructed with their guardians. Through qualitative research (interviews and observation), over two years the research team explored with YOC and their guardians how current and prior candidacy experience influenced their use of psychiatric emergency services, an undesirable source of mental health care, and often the last resort for patients unable to access ongoing care. I found limited evidence that CM stages mediated the relationship between health care needs and treatment. Experiencing racism decreased the likelihood of being a successful candidate for care. Explorations with YOC and guardians found that people of color were marginalized when their assertions were ignored and when they were excluded from mental health care decision making. Repeat visits to the psychiatric emergency room reflected a negotiation strategy, in which the YOC and guardian triangulate and learn over time how to negotiate for a desired outcome. This thesis deepens knowledge of CM and of the role of negotiations in mental health care access for YOC, providing theoretical insights that will inform interventions to improve mental health equity. / 2025-08-23T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46595 |
| Date | 23 August 2023 |
| Creators | Herrera, Carolina-Nicolé S. |
| Contributors | Clark, Jack A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-ShareAlike 4.0 International, http://creativecommons.org/licenses/by-nc-sa/4.0/ |
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