Faulty assumptions behind persistent racial/ethnic disparities in behavioral health care

June 09, 2016

Racial and ethnic disparities in the treatment of mental health and substance use disorders may result from key faulty assumptions about the best ways of addressing the needs of minority patients. Those assumptions are detailed, along with recommendations for potential improvement strategies, in an article in the June issue of Health Affairs

"Despite increased attention to racial/ethnic disparities in health care since the early 2000's, national reports show that disparities in access to mental health and substance use treatment have not changed," says Margarita Alegría, PhD, chief of the Disparities Research Unit in the Massachusetts General Hospital (MGH) Department of Medicine, lead author of the article. "Even when minority patients enter care, the care they receive is often low quality because the current design of our health care system doesn't incorporate the latest research findings on novel treatment models or engagement strategies for ethnic/racial minorities."

The 2014 National Health Quality and Disparities Report of the U.S. Agency for Healthcare Research and Quality noted that racial and ethnic disparities in access to treatment of mental health and substance use disorders had changed little between 2008 and 2012. Overall, minority group patients were less likely to receive treatment for depression and less likely to remain in treatment for substance use disorders. Those who did enter treatment for drug or alcohol use were less likely to complete a treatment program.

Even though more than 30 million Americans have gained access to health insurance under the Affordable Care Act, the paper's authors note that current policies designed to improve access to health care may not address issues affecting minority patients. Based on published studies and their own experiences with patients, they describe three mistaken assumptions that may lie behind the persistence of racial/ethnic disparities in behavioral health care: In contrast to those assumptions, studies have documented that bringing minority patients into behavioral health care may require frequent, persistent follow-up and re-scheduling from their providers - something that may conflict with the more recent standard clinical practice of dropping patients after missed appointments. Since the needs and preferences of patients from different racial and ethnic groups can vary widely, a range of approaches on how and where behavioral health treatment can be accessed and delivered is required. And implementing evidence-based interventions in real-world setting has often proven difficult because of a lack of supporting infrastructure to providers that see minority patients and the lack of linguistic and cultural diversity of the workforce.

To help counter these limitations, the authors make three recommendations: "Current payment models can impede the implementation of behavioral health innovations," says Alegría, who is a professor in the department of Psychiatry at Harvard Medical School. "To be most effective, payment structures should facilitate care continuity, flexible scheduling and alternative forms of treatment such as telemedicine. The collection of data regarding patient satisfaction with and adherence to care should include racial, ethnic and language background of patients that could help us track and report on disparities and treatment outcomes and be used to incentivize the reduction of disparities. And partnerships among researchers, clinicians, administrators and policymakers can help us ensure that the substantial evidence we have already accumulated on behavioral health disparities can be effectively and consistently translated into improved patient care."
-end-
The co-authors of the Health Affairs article are Kiara Alvarez, PhD, Rachel Ishikawa, Karissa DiMarzio and Samantha McPeck of the Disparities Research Unit in the MGH Department of Medicine. Support for the study includes National Institute on Minority Health and Health Disparities grant P60 MD002261, National Institute of Mental Health grant P50 MH 073469, National Institute on Drug Abuse grant R01DA034952 and Patient-Centered Outcomes Research Institute contract CD-12-11-4187.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals, earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service and returned to the number one spot on the 2015-16 U.S. News & World Report list of "America's Best Hospitals."

Massachusetts General Hospital

Related Mental Health Articles from Brightsurf:

Mental health strained by disaster
A new study found that suicide rates increase during all types of disasters -- including severe storms, floods, hurricanes and ice storms -- with the largest overall increase occurring two years after a disaster.

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

World Mental Health Day -- CACTUS releases report of largest researcher mental health survey
On the occasion of 'World Mental Health Day' 2020, CACTUS, a global scientific communications company, has released a global survey on mental health, wellbeing and fulfilment in academia.

Mental illness, mental health care use among police officers
A survey study of Texas police officers examines how common mental illness and mental health care use are in a large urban department.

COVID-19 outbreak and mental health
The use of online platforms to guide effective consumption of information, facilitate social support and continue mental health care delivery during the COVID-19 pandemic is discussed in this Viewpoint.

COVID-19 may have consequences for mental health
The COVID-19 pandemic appears to be adversely affecting mental health among hospitalised patients, the healthcare professionals treating them and the general population.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental ill health 'substantial health concern' among police, finds international study
Mental health issues among police officers are a 'substantial health concern,' with around 1 in 4 potentially drinking at hazardous levels and around 1 in 7 meeting the criteria for post traumatic stress disorder and depression, finds a pooled data analysis of the available international evidence, published online in Occupational & Environmental Medicine.

Examining health insurance nondiscrimination policies with mental health among gender minority individuals
A large private health insurance database was used to examine the association between between health insurance nondiscrimination policies and mental health outcomes for gender minority individuals.

Mental health care for adolescents
Researchers examined changes over time in the kinds of mental health problems for which adolescents in the United States received care and where they got that care in this survey study with findings that should be interpreted within the context of several limitations including self-reported information.

Read More: Mental Health News and Mental Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.