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Boundary Maintenance as a Barrier to Mental Health Help‐seeking for Depression Among the Old Order Amish
Author(s) -
Reiling Denise M.
Publication year - 2002
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.2002.tb00907.x
Subject(s) - mental health , service provider , community cohesion , depression (economics) , help seeking , psychology , cohesion (chemistry) , psychiatry , nursing , medicine , social psychology , service (business) , business , marketing , chemistry , organic chemistry , economics , macroeconomics
This paper describes “boundary maintenance” as a barrier to help‐seeking for depression within an Old Order Amish enclave. Observations and qualitative interview data were collected from 50 members of the Old Order Amish enclave and from the 8 mental health providers in their rural community. The Amish reported fairly high levels of depression, concomitantly high levels of reluctance to seek treatment for depression from mental health providers, and very low levels of service utilization. The functionality of boundary maintenance to group cohesion was discovered to be a significant barrier to help‐seeking for depression from outside providers. Boundary maintenance was achieved through two social control mechanisms: religious‐based stigmatization of depression and the construction of mental health providers as illegitimate help agents. Suggestions have been made to assist providers in achieving cultural competence among the Amish, in order to reduce the threat that the Amish perceive to their cultural boundaries.