Perspectives on depression and accessibility of services in low-income communities in New York City: Results from a Community Needs Assessment

Background: Depression and serious psychological distress are recognized as persistent conditions among residents of low-income New York City neighborhoods according to publicly available survey data. Yet few research studies explore residents’ perceptions of mental health issues, including underlying causes or perceived access to treatment.

Methods: In 2014, a mixed-method community needs assessment was conducted including 1,908 surveys with primarily low-income New Yorkers in three boroughs; 64 focus groups; and 41 key informant interviews. Data focused on factors in the community that might facilitate or impede health, physical and behavioral health concerns, service utilization, and access to care.

Findings: Twenty percent of survey respondents reported current mental health issues, including depression or anxiety. Focus group findings suggest community members attribute poor mental health to socio-economic factors, including unemployment, immigration experiences, lack of affordable housing, and poverty.  Focus group participants and key informants often reported that they saw significant value in mental health service use. However, care was often difficult to access because of long wait times, insurance restrictions, and persistent social stigma.  In the words of one participant, “People don’t tell because they fear that they will be ridiculed and talked about. We should encourage people to get help. Or the problem will get worse.”

Implications: The common contention that contextual factors are associated with poor mental health suggests a need to incorporate a social determinants perspective within mental health services. This research also illuminates contextual barriers that must be addressed in order to increase access to existing services.