Racial Disparities Persist in Mental Health Services Use

NEW YORK (Reuters Health) - Young African Americans and Asian American/Pacific Islanders are half as likely to receive psychiatric treatment or other mental health services as their non-Hispanic white peers, new study findings show.

While such disparities in mental health service use between minorities and whites have been previously reported, the researchers in the current study examined racial and ethnic differences in the use of such services among high-risk youth, in particular. The authors also investigated whether such differences may be explained by socioeconomic status or other variables known to be associated with the use of mental health services.

"Our study is consistent with many other studies demonstrating racial/ethnic differences in use of formal mental health services for children," study author Dr. Ann F. Garland, associate director of the Child and Adolescent Services Research Center at the University of California, San Diego, told Reuters Health.

Yet, she added, the racial and ethnic "differences in formal service use are not explained by accounting for a variety of potential confounding factors," such as family income or functional impairment.

Garland and her co-authors interviewed 1,256 children and teenagers, ages 6 to 18, who received child welfare services, special education services, alcohol and drug abuse services or were otherwise "active" in one or more of five publicly funded sectors of care in San Diego County.

Over 70 percent of the mostly male study participants reported using some type of mental health service during the previous 12 months, the researchers report in the American Journal of Psychiatry. Most (64 percent) used professional outpatient services but 20 percent used self-help groups or other informal services and 13 percent used inpatient or residential treatment services.

The highest utilization rates for any mental health services were reported among non-Hispanic whites, who also had the highest rates of outpatient services. For example, more than two thirds of whites reported visiting a psychologist or counselor, visiting a day treatment center or otherwise receiving specialty outpatient mental health services, compared with slightly more than half of Latino Americans and African Americans and about one third of Asian American/Pacific Islanders, the report indicates.

The lowest utilization rates for mental health services were reported among African Americans and Asian American/Pacific Islanders. Also, while more than 20 percent of Latino Americans, Asian American/Pacific Islanders and non-Hispanic whites reported using informal services, the same was true of just 11 percent of African Americans.

Overall, African Americans and Asian American/Pacific Islanders were about half as likely as whites to receive any type of mental health service and half as likely as whites to use any outpatient mental health services, the researchers note.

Girls were more likely to use outpatient services and 24-hour care services than were boys. Also, children whose parents or guardians reported a higher level of caregiver strain were more likely to use mental health services, as were those who had received a non-substance abuse-related psychiatric diagnosis and those with some type of functional impairment. Young people who had received alcohol and drug abuse or mental health services in the year prior to the study were also more likely to use mental health services during the study period, the report indicates.

Overall, the findings imply that "we need to address stigma and gain understanding of culturally driven beliefs about mental illness and mental health problems as they may affect recognition of mental health problems and use of services," Garland told Reuters Health.

Further, she added, "we need to improve access to mental health services and educate potential 'gatekeepers'... such as social workers, educators, (and) probation officers who work with kids with high-risk for mental health problems."

SOURCE: American Journal of Psychiatry, July 2005.