Minority Mental Health Needs & Treatment in Virginia

SJR 46 (2008) Patron: Senator Marsh

Virginia Health Care Foundation’s

Mental Health Roundtable

May 15, 2009

Michele Chesser, PhDSenior Health Policy AnalystJoint Commission on Health Care

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Prevalence of Mental Illness among Minority Populations Overall, Blacks, Hispanics, and Asians have

lower rates of lifetime mental disorders than Whites.

Compared to Whites, Blacks and Hispanics are more likely to have mental disorders that are persistent and severe.

Source: 4 studies funded by the National Institute of Mental Health, Consortium on Psychiatric Epidemiology Studies (2004)

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Prevalence of Mental Illness among Minority Populations Native Americans have lower levels of risk for

major depression than Whites, but are at higher risk for PTSD and alcohol dependence.

Finally, minorities are more likely to be in high-need sub-populations (e.g. homeless or residing in an institution) whose rates of mental illness are higher and much less likely to be treated.

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Race/Ethnic Mental Health Disparities

Key Disparities: Access to quality services Help seeking and help utilization Negative experiences within the system Pervasiveness of stigma Lack of language and cultural competency

among practitioners Lack of inclusion in research and clinical trials

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Percentages of Adults Aged 18 or Older Reporting Receipt of Past Year Mental Health Treatment/Counseling Among

Those with Serious Mental Illness, by Race/Ethnicity: 2001

0

10

20

30

40

50

60

White Black Hispanic

Source: SAMHSA, 2001 National Survey on Drug Use and Health (NSDUH).

51.4%

38.4%

26.6%

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Percentage of Adults Receiving Outpatient Mental Health Treatment in Past Year, by Race

and Treatment Facility: 2000-2001

0

10

20

30

40

50

60

White Black Hispanic

Outpatient MH Center Private Therapist's Office Doctor's Office Other

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.

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Percentage of Adults Receiving Outpatient Mental Health Treatment in Past Year, by Income and Treatment Facility: 2000-2001

0

10

20

30

40

50

60

70

80

<$20K $20K-$49,999 $50K-$74,999 $75K or >

Outpatient MH Center Private Therapist's Office Doctor's Office Other

Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.

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Summary of Mental Health Disparities

Racial/ethnic minorities are less likely to receive mental health treatment than Whites.

Whites are more likely to receive outpatient treatment at a private therapist’s office whereas Blacks and Hispanics are more likely to receive care from a state mental health agency.

Blacks are more likely to be hospitalized for mental illness than other racial/ethnic groups.

Many racial/ethnic differences in mental health care are confounded by income differences.

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Social Mechanisms Contributing to Mental Health Disparities

Provider Bias and Stereotyping Provider Statistical Discrimination Provider and Geographic Differences Health Insurance Differences

Source: McGuire, Thomas G. and Jeanne Miranda. 2008. “New Evidence Regarding Racial and EthnicDisparities in Mental Health: Policy Implications.” Health Affairs, Vol. 27, No. 2, pgs 393-403.

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Factors Influencing Consumer Treatment Decisions

FearEmbarrassmentLanguageTrustIncomeMH LiteracyNegative ExperienceConfidentialityBeliefs

Use of Pastoral CareUse of Native HealersUse of Emergency RoomsUse of Primary CareFamily SupportDelay of Treatment

Source: Adapted (with revisions) from Snowden (2004) and Neighbors (2007)

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Implications of Treatment Decisions & System Characteristics

Source: Surgeon General (1999) and New Freedom Commission (2003)

>Acute EpisodesChronic Conditions

>Risk of Death>Uneven Utilization

<Access & Availability<Quality of Care

>Risk of Misdiagnosis>Inpatient Treatment

>Use of Courts

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Prescriptions for Change

Interface of mental health care and general medicine The U.S. has “had a ‘system’ of care in which mental

health has been set apart, separate from primary or general health care. Now that it is understood that mental and general health are inextricably linked, the two disciplines must be brought together.” (New Freedom Commission on Mental Health, 2003, p.v)

Equalizing insurance coverage for mental and physical care

Federal law takes effect January 1, 2010. Primary care providers need to be able to recognize

mental illness and either treat or refer individuals to more specialized care.

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Prescriptions for Change

Support initiatives designed to address access and quality issues for all Virginians The Virginia Health Care Foundation’s New

Mental Health Initiative: “A New Lease on Life: Health for Virginians with Mental Illness.”

Grants will be awarded to health safety net organizations in the fall of this year to establish or expand:

Basic mental health services and access to prescription medicines for uninsured patients.

Primary medical care and access to prescription medicines for CSB clients with serious mental illness.

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Prescriptions for Change

Anti-stigma campaigns in minority communities

Continued cultural competency training for mental health practitioners

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Methods of Teaching Cultural Competency Material

0

5

10

15

20

25

30

35

40

45

None Course Imbedded

4-year

2-year

Private

N=183 health profession degree programs at 44 institutions. Source: SCHEV report.

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Prescriptions for Change

Foster greater interest in the mental health care field among minority high school students

Address social determinants of health inequities: poverty, shortage of affordable housing, lack of transportation in rural areas, and employment issues

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Integrated Community Collaborative Care

PrimaryCare

Mental Health Care

CommunityCare

Education /SchoolHealth

Justice/Courts

Housing/Employment

Transportation