Persistence of Racial and Ethnic Disparities in Mental Health Treatment a Result of Faulty Assumptions

Faulty assumptions about the best ways to address the needs of minority patients may be behind the racial and ethnic disparities that exist in the treatment of mental health and substance use disorders, say Massachusetts General Hospital researchers in a recent article in Health Affairs. Margarita Alegría, PhD, professor of psychology at Harvard Medical School and chief of the Disparities Research Unit at the hospital, and colleagues said that despite good intentions and increased attention to racial and ethnic disparities in healthcare since the early 2000s, disparities in access to mental health and substance use continue to exist. This is the case even though the Affordable Care Act expanded access to behavioral healthcare, and despite decades of research that are being ignored by many reform initiatives. “Mistaken assumptions that underlie the expansion of behavioral health care run the risk of replicating existing service disparities,” the study cautions.

“Even when minority patients enter care, the care they receive is often low quality because the current design of our healthcare system doesn’t incorporate the latest research findings on novel treatment models or engagement strategies for ethnic/racial minorities,” Alegría said. The 2014 National Health Quality and Disparities Report found that racial and ethnic disparities in access to treatment of mental health and substance use disorders had hardly changed between 2008 and 2012. Patients from minority groups were less likely to be treated for depression, and those who did enter drug or alcohol treatment programs were less likely to complete those programs.

Based on a review of the literature and many observational and field studies of minority populations, the researchers identified 3 mistaken assumptions that they believe lie behind the persistence of racial and ethnic disparities in behavioral healthcare:

• Assumptions that a universal approach to improving access to care alone will reduce disparities
• Assumptions that current planning of behavioral health services addresses minority patients’ preferences
• Assumptions that evidence-based interventions are readily adaptable to diverse populations.

To the contrary, studies have shown that the needs and preferences of patients from different minorities and ethnic groups actually vary a great deal, and different approaches are needed to how and where treatment for behavioral health needs can be delivered. The study recommends flexibility and innovation, along with an expanded, more linguistically diverse behavioral health workforce that is integrated into primary care.

Studies have also suggested that minority patients receiving behavioral health treatment may require more frequent, persistent follow-up and rescheduling from providers—which may conflict with standard clinical practice of dropping patients after too many missed appointments.

The researchers recommend that outreach to behavioral health care be expanded with such measures as mobile health clinics, mobile technologies, and social marketing campaigns that reduce stigma and inform patients of options. Better response to patients’ needs could be accomplished through collection of data on behavioral health needs and barriers encountered. Implementing research-based practices through partnerships among researchers, caregivers, and community leaders is also recommended, along with providing the many community health workers in clinics and community organizations with behavioral health training. More flexible payment structures, scheduling, and telemedicine treatment would also go a long way to helping improve implementation of innovations in behavioral healthcare.