| In today's society we have increasing social awareness around, and understanding of, the etiology of mental health problems; yet, we have limited knowledge about mental health care -- particularly as it pertains to children and youth. In this dissertation, I merge sociologists' interest in the structural origins of mental health with mental health scholars' interest in identifying the predictors of service use. Using a nationally representative sample of youth, I apply an existing theoretical model of service use -- the Children's Network Episode Model (C-NEM, Costello, Pescosolido, Angold, and Burns, 1998) -- to provide a systematic examination of the formal mental health service sector for youth in the United States. My analysis centers on the role of mental health problems, child and family social location, and youth social networks in service utilization. Using data from the National Longitudinal Study of Adolescent Health (Add Health), I find that across the United States, in any given one year period, between 9.5 and 13% of youth aged 12-17 receive formal mental health services, and about 17% receive care at least once from 1994-1996. Almost equivalent proportions of youth see a private medical doctor for counseling as use school-based services, and the combination of the two is the most common among multi-sector users. Not surprisingly, mental health matters most for using services. However, disparities in service use exist, independent of mental health problems. The effect for young African Americans may be particularly detrimental, as Black youth are significantly less likely to use mental health services compared to white youth. Social networks play a counter-intuitive role in youth mental health service use -- deterring formal service use. Indeed, I find that youth with highly supportive family and school networks use services at significantly lower rates than youth without similarly supportive networks, suggesting that youth who have strong interpersonal networks may be using those relationships as informal sources of support. I discuss the policy implications of this research and present several important research directions. |
