Mental Health Service Use, Barriers, and Service Preferences During COVID-19 among Low-Income Housing and Market-Rate Housing Residents of Harlem in New York City

J Community Health. 2024 Jun;49(3):439-447. doi: 10.1007/s10900-023-01301-w. Epub 2023 Dec 8.


This study examined the differences in mental health service use, barriers, and service preferences among 393 low-income housing (LIH) and market-rate housing (MRH) Harlem residents in New York City. One-third (34.6%) endorsed the need for professional support for psychological issues, 27.2% and 15.8% reported using counseling services and psychotropic medication, with no differences between housing types. LIH residents (21.6-38.8%) reported significantly higher use of all types of mental health resources (e.g., websites, anonymous hotlines, self-help tools) compared with MRH residents (16.1-26.4%). Eighty-six percent reported barriers to mental health access, with LIH residents reporting more than double the barriers. Particularly, LIH residents reported greater difficulty getting time off work (34.1% vs. 14%), lack of health insurance (18.7% vs. 9.8%), lack of trust in mental health providers (14.6% vs. 4.7%), and stigma (12.2% vs. 5.1%) compared with MRH residents. Residents most preferred places of services were health clinics and houses of worship; provided by healthcare and mental health providers; and services delivered in-person and phone-based counseling. In contrast, residents least preferred getting support at mental health clinics; from family/friends; and by the Internet. No differences were found between service preferences by housing type. LIH residents reported higher use of mental health services and resources, but they face significantly more barriers to mental health care, suggesting a need to address specific barriers. Preferences for mental health services suggest a need for expanding mental health services to different settings given the low preference for services to be delivered at mental health clinics.

Keywords: Barriers to care; Low-income housing; Mental health; Mental health service; Minoritized population; New York City.

MeSH terms

  • COVID-19* / epidemiology
  • Housing
  • Humans
  • Mental Health Services*
  • New York City / epidemiology
  • Poverty