Navigating a System Not Built for Us: A Qualitative Investigation of Mental Health Care Access Barriers for Black Youth and Their Families

The sharp rise in suicide rates among Black youth underscores the urgent need for equity-driven, culturally responsive approaches to improving mental health care access and engagement. Despite increased availability of mental health resources, Black families experience persistent disparities due to systemic and cultural barriers. This qualitative study examined the perspectives of Black parents/guardians and community stakeholders in a large urban city in California regarding access to pediatric mental health care. Semi-structured interviews and one focus group were conducted, and data were analyzed using grounded theory. Five themes emerged as primary barriers: (1) delayed treatment and institutional indifference, (2) relational harm and therapeutic mistrust, (3) cultural misalignment and emotional labor, (4) racialized surveillance and stigma, and (5) institutional signals of exclusion. Participants also identified community-informed recommendations, including community-based destigmatization, partnerships with trusted community institutions, workforce representation and Black provider recruitment, and structural investment and resource equity. Findings highlight the need for culturally grounded approaches to reduce disparities and inform policy, practice, and future research within the Black community.