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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, PhD Senior Health Policy Analyst Joint Commission on Health Care 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) 2 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. 3 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 4 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 60 51.4% 50 38.4% 40 26.6% 30 20 10 0 White Black Source: SAMHSA, 2001 National Survey on Drug Use and Health (NSDUH). Hispanic 5 Percentage of Adults Receiving Outpatient Mental Health Treatment in Past Year, by Race and Treatment Facility: 2000-2001 60 50 40 30 20 10 0 White Outpatient MH Center Black Private Therapist's Office Hispanic Doctor's Office Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001. Other 6 Percentage of Adults Receiving Outpatient Mental Health Treatment in Past Year, by Income and Treatment Facility: 2000-2001 80 70 60 50 40 30 20 10 0 <$20K Outpatient MH Center $20K-$49,999 $50K-$74,999 Private Therapist's Office $75K or > Doctor's Office Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001. Other 7 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. 8 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 Ethnic Disparities in Mental Health: Policy Implications.” Health Affairs, Vol. 27, No. 2, pgs 393-403. 9 Factors Influencing Consumer Treatment Decisions Fear Embarrassment Language Trust Income MH Literacy Negative Experience Confidentiality Beliefs Use of Pastoral Care Use of Native Healers Use of Emergency Rooms Use of Primary Care Family Support Delay of Treatment Source: Adapted (with revisions) from Snowden (2004) and Neighbors (2007) 10 Implications of Treatment Decisions & System Characteristics >Acute Episodes Chronic Conditions >Risk of Death >Uneven Utilization <Access & Availability <Quality of Care >Risk of Misdiagnosis >Inpatient Treatment >Use of Courts Source: Surgeon General (1999) and New Freedom Commission (2003) 11 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. 12 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. 13 Prescriptions for Change Anti-stigma campaigns in minority communities Continued cultural competency training for mental health practitioners 14 Methods of Teaching Cultural Competency Material 45 40 35 30 25 4-year 2-year Private 20 15 10 5 0 None Course Imbedded N=183 health profession degree programs at 44 institutions. Source: SCHEV report.15 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 16 Integrated Community Collaborative Care Primary Care Education / School Health Mental Health Care Community Care Housing/ Employment Transportation Justice/Courts 17