1 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 million people paid for mental health services totaling $57.5 billion in : 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, HCUP Statistical Brief #104. January Agency for Healthcare Research and Quality, Rockville, MD. Owens PL, Mutter R, Stocks C. Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007: Statistical Brief # Jul. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006 Feb-. Available from PubMed PMID:
2 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 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 Nov;47(4): PubMed PMID: DeNavas-Walt, C., B.D. Proctor, and J. Smith Income, Poverty, and Health Insuracne Coverage in the United States: Current Population Reports, P (RV). U.S.Census Bureau, Washington, DC
3 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): 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. Snowden LR, Catalano R, Shumway M. Disproportionate use of psychiatric emergency services by african americans. Psychiatr Serv Dec;60(12): PubMed PMID:
4 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 Dec;60(12): PubMed PMID: 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): PubMed PMID: 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 Apr;13(2): PubMed PMID:
5 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 PoorUnderserved. 2011;22(1): PubMed PMID: 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 nonethnic 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 AmericanMedical Association, 283(19), 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 HumanServices (July 2003).
6 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): PubMed PMID: 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 Nov;47(4): PubMed PMID: Kozak, L.J., M.J. Hall, and M.F. Owings Trends in Avoidable Hospitalizations, Health Affairs 20(2):