Access to Mental Health Care And
Disparities in the United States
Rahn Kennedy Bailey, M.D., F.A.P.A.
Chairman
Department of Psychiatry and Behavioral Sciences
Meharry Medical College
Nashville, TN
Behavioral/Mental health
•
One out of three individuals has suffered from a mental health or
substance abuse condition within the last 12 months.
•
36.2 million people paid for mental health services totaling $57.5 billion in
2006.
•
2007: Of the 95 million visits made to the emergency department (ED) by
adults in the U.S, 12.0 million (12.5%) were related to Mental Health and
Substance Abuse (MHSA).
•
Most common MHSA reasons for ED visits: Mood disorder (42.7%),
anxiety disorders (26.1%), & alcohol-related conditions (22.9%).
•
Mood disorders and Schizophrenia: Two mental conditions ranked
among top ten reasons for Medicaid hospitalizations, (210,000 and
112,000 stays).
Stranges, E. (Thomson Reuters), Ryan, K. (Thomson Reuters), and Elixhauser, A. (AHRQ). Medicaid Hospitalizations, 2008. HCUP Statistical Brief #104. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb104.pdf
Owens PL, Mutter R, Stocks C. Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007: Statistical Brief #92. 2010 Jul. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006 Feb-. Available from
Health Care Accessibility of Minority and
Indigent Patients
• 2008: 46 million individuals in the U.S. have no health
insurance coverage.
• 2010:
52 million Americans went without health
insurance, compared to 38 million in 2001.
• The uninsured more frequently go without needed
medical care; receive lower quality care & have the worst
health.
• Approximately 19% of all US adults are without a usual
source of care (USC), & 53% of uninsured adults have no
USC.
Kirby JB, Kaneda T. Unhealthy and uninsured: exploring racial differences in health and health insurance coverage using a life table approach. Demography. 2010 Nov;47(4):1035-51. PubMed PMID: 21308569.
DeNavas-Walt, C., B.D. Proctor, and J. Smith. 2009. “Income, Poverty, and Health Insuracne Coverage in the United States: 2008.” Current Population Reports, P60-236 (RV). U.S.Census Bureau, Washington, DC
On Average, Blacks Spend Proportionally More Time Without Health Insurance Coverage
James B. Kirby and Toshiko Kaneda, "Unhealthy and Uninsured: Exploring Racial Differences in Health and Health Insurance Coverage Using a Life Table Approach," Demography 47, no. 4 (2010): 1035-51.
Health Care Disparities in African
Americans
•Disproportionate use of emergency services: one of many disparities in
health and mental health care.
• African Americans use psychiatric emergency services much more
frequently than whites.
• African Americans who receive mental health services tend to receive
lower quality of care than do whites.
• AA are more likely to receive older forms of medications that have more
side effects and are associated with lower rates of adherence.
Possible Reasons for Overrepresentation Psychiatric Emergency Services in
African Americans:
• Personal, family and network stress distress in disadvantaged
neighborhoods
• Countervailing prosocial trends in disadvantaged neighborhoods
• Lower tolerance for African Americans disruptive behavior
• African American communities greater stigmatizing attitudes
• African Americans may be more likely than whites to experience mental
health crises that necessitate emergency visits.
Snowden LR, Catalano R, Shumway M. Disproportionate use of psychiatric emergency services by african americans. Psychiatr Serv. 2009 Dec;60(12):1664-71. PubMed PMID: 19952158. Chen J, Rizzo J. Racial and ethnic disparities in use of psychotherapy: evidence from U.S. national survey data. Psychiatr Serv. 2010 Apr;61(4):364-72. PubMed PMID: 20360275
.
• Latinos and African Americans are significantly less
likely than Caucasians to take antidepressants.
Asian Culture: Mental health issues are considered as a
“taboo” to openly discuss.
– Deterrents for mental health seeking behavior:
• Lack of insurance coverage
• Lack of mental health professional who can offer
linguistically and culturally appropriate care
• Lack of awareness
• Lack of parent’s knowledge on how to identify and
address mental health issues.
ee S, Ma GX, Juon HS, Martinez G, Hsu CE, Bawa J. Assessing the needs and guiding the future: findings from the health needs assessment in 13 asian american communities of Maryland in the United States. J Immigr Minor Health. 2011 Apr;13(2):395-401. PubMed PMID: 20012202.
Mental Health Care in Adolescents
• One is five youth is suffering from a mental illness.
• < 30% White adolescents were not receiving needed mental
health care.
• 50% of minority adolescents were not receiving needed care.
• Adolescents of color have lower-income disproportionately
and are less likely to be insured than white peers.
• Shame and stigma associated with psychological treatment:
Strong impediment to minority youth than White youth in
receiving needed care.
Thomas JF, Temple JR, Perez N, Rupp R. Ethnic and gender disparities in needed adolescent mental health care. J Health Care Poor Underserved. 2011;22(1):101-10. PubMed PMID: 21317509.
Disparities in access to Health Care
• Ethnic minorities receive less preventative care,
are seen less by specialists, and have fewer
expensive and technical procedures than
non-ethnic minorities
• Reasons for disparities to health care access:
– Lack of insurance coverage
– Lack of regular source of care
– Lack of financial resources
– Structural barriers: poor transportation.
– Health literacy
– Age
Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. JAMA: The Journal of the American Medical Association, 283(19), 2579-2584.
Kaiser Commission on Medicaid and the Uninsured (KCMU), "The Uninsured and Their Access to Health Care" (December 2003). G. E. Fryer, S. M. Dovey, and L. A. Green, "The Importance of Having a Usual Source of Health Care," American Family Physician 62 (2000): 477. Agency for Healthcare Research and Quality (AHRQ), "National Healthcare Disparities Report," U.S. Department of Health and Human Services (July 2003).
Landmark Surgeon General’s Report
•2001: Mental Health: Culture, Race and Ethnicity.
Three Issues of Mental Health Care and Treatment Disparities:
A. People from racial and ethnic minority groups have less
access to health care than do non-Hispanic whites.
A. Individuals from minority groups are less likely than
individuals from nonminority groups to receive treatment
for mental illness.
B.
When minority people do receive treatment, the care is
likely to be of poor quality.
Chen J, Rizzo J. Racial and ethnic disparities in use of psychotherapy: evidence from U.S. national survey data. Psychiatr Serv. 2010 Apr;61(4):364-72. PubMed PMID: 20360275.
Consequences of Being Uninsured
• Most likely to miss preventive and routine care for
chronic conditions.
• Incur risk to their finances
• More frequently hospitalized for conditions that are
potentially avoidable.
• Communities pay a price for gaps in health insurance
coverage of their residents
Kirby JB, Kaneda T. Unhealthy and uninsured: exploring racial differences in health and health insurance coverage using a life table approach. Demography. 2010 Nov;47(4):1035-51. PubMed PMID: 21308569.
