Background. Elderly residents of public housing have
high rates of psychiatric disorders, but most
of those in need of care do not use any mental health service. This study
examines the use of
formal and alternative informal sources of mental health care in a sample
African-American public-housing residents.
Method. Data from an epidemiological survey of six Baltimore
public-housing developments for the
elderly (weighted N=818) were analysed to examine the utilization
of mental health services by
older African-American residents. Logistic regression analyses were used
to determine correlates of
using formal and informal sources by those needing mental health care.
Results. Thirty-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%) than informal sources (18·6%) for care.
The strongest correlates of using
formal providers were substance use disorder (OR=15·62), Medicare
insurance (OR=10·31) and
psychological distress (OR=10·27). The strongest correlates of
using informal sources were
perceiving little or no support from religious/spiritual beliefs
(OR=21·65), cognitive disorder
(OR=19·71) and having a confidant (OR=15·07).
Conclusions. Contrary to elderly African-Americans in general,
those in public housing rely more
on formal than informal sources for mental health problems. Nevertheless,
both sources fail to fill
the gap between need and met need. Interventions to increase identification,
referral and treatment
of elderly public-housing residents in need should target general
medical providers and clergy and
include assertive outreach by mental health specialists.