(Mar. 28, 2017) Access to mental health care improved slightly from 2004 to 2012 by several yardsticks of care, but whites had greater access to treatment than any other racial or ethnic group in each year, and the disparities grew worse over time, according to a new study.
Benjamin Lê Cook and colleagues said "disparities in mental health care remain wider than in most other areas of health care services, and mental illness remains as one of the highest health burdens for minority populations." The authors used a sample of 214,597 adults surveyed in the federal government's annual Medical Expenditure Panel Surveys to compare access between whites and blacks, Hispanics and Asian Americans.
Access was defined as "having any mental health care, any outpatient mental health care and any psychotropic medication." Inpatient and emergency department treatment accounted for less than 1% of total service usage and were not separately reported.
The Findings
Reporting in Psychiatric Services, Lê Cook and his co-authors compared disparities between whites and the three racial-ethnic minority groups from 2004-2005 to 2011-2012. The comparison found:
- All groups reported increased access to mental health care from the first period to the second. Usage rates for any form of mental health care rose from 16.3% to 19.5% for whites, from 7.7% to 9.2% for blacks, from 7.9% to 8.7% for Hispanics and from 3.7% to 4.9% for Asians.
- Whites consistently reported higher rates of access than any other racial-ethnic group in each year from 2004 to 2012.
- Asians consistently reported lower rates of access and wider disparities than any other group in each year from 2004-2012.
- Black-white differences for any mental health care widened from 8.2% to 10.8% between the periods. (In 2004-2005, 16.3% of white adults and 7.7% of blacks received any mental health care; by 2011, the rates were 19.5% for whites and 9.2% of blacks). Disparities also grew for access to psychotropic medication (from a difference of 7.5% in 2004-2005 to 10.0% in 2011-2012).
- Hispanic-white disparities for any mental health care widened from 8.4% to 10.9% between the two periods; differences in access to psychotropic medication increased from 7.3% to 10.3%.
- Asian-white differences for any mental health care grew from 12.6% in 2004-2005 to 14.5%. Disparities in access to psychotropic medications marginally shrunk from 10.3% in 2004-2005 to 9.7% in 2012.
The lack of progress toward equal access "suggests that calls to reduce mental health care disparities have not been successful," the researchers said.
Explanations
The authors cited several factors in the growth of disparity despite the overall improvement in access.
Most prominently, a number of psychotropic medications became available in generic versions from 2004-2012, leading to a significant increase of their use by whites but not among blacks and Hispanics. The authors speculated that high uninsured rates among blacks (19% uninsured) and Hispanics (29%) compared with whites (11%) were a significant contributor to this trend.
They also cited problems that primary care providers exhibit in detecting psychological distress among minority group members compared with whites and the limited availability of managed care organizations and medical specialists in racially segregated communities.
The cultural barriers to seeking mental health care within Asian communities were described in some detail. "Asian Americans tend to report psychiatric symptoms only when they become severe and may report these symptoms in physical or psychosomatic terms, such as loss of sleep and fatigue," the authors said.
The authors said their analysis would provide a baseline for measuring whether the Affordable Care Act reduces racial disparities in mental health care by lowering financial barriers to treatment and thus making it more accessible.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Lê Cook, B. et al. (1 January 2017). Trends in racial-ethnic disparities in access to mental health care, 2004-2012. Psychiatric Services.
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