Methods: Three focus groups and 10 individual interviews with practitioners from five adult/geriatric outpatient mental health clinics in central Texas were conducted.  Purposive sampling was used to select racially/ethnically diverse practitioners from both urban and rural areas. Structured interview guides were used to elicit the practitioners’ perspectives on reasons for dropout, successful retention strategies, and racial/ethnic differences in factors associated with continued service use or dropout. A thematic analysis of the transcribed text was done by the authors and the emergent categories/themes were compared and discussed to reach consensus.

Results: Practitioners identified physical/functional health problems as common barriers to continued service use, regardless of race/ethnicity and geographic area. However, they stated that Hispanics and African Americans were more likely than non-Hispanic whites to drop out for following reasons: Distrust of the mental health service system, sense of shame and stigma about mental illness, resigned attitude toward their suffering, low motivation for and discomfort with therapy, cultural values of self-reliance, and perceived socioeconomic and cultural distance between them and their white peers. Service retention contributors were family support, bilingual/bicultural counselors, and primary physician referrals.

Implications for Practice: The findings underscore the importance of involving and educating the family system to dispel misperceptions about mental illness and mental health treatment. Practitioners need to build trust among older minority mental health clients.  Most importantly, in face of the rapidly increasing number of minority older adults, special attention needs to be paid to training of bilingual/bicultural practitioners.