Minority Mental Health Needs & Treatment in Virginia SJR 46 (2008) Patron: Senator Marsh Virginia...
-
Upload
juniper-underwood -
Category
Documents
-
view
212 -
download
0
Transcript of Minority Mental Health Needs & Treatment in Virginia SJR 46 (2008) Patron: Senator Marsh Virginia...
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
2
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)
3
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.
4
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
5
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%
6
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.
7
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.
8
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.
9
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.
10
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)
11
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
12
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.
13
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.
14
Prescriptions for Change
Anti-stigma campaigns in minority communities
Continued cultural competency training for mental health practitioners
15
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.
16
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
17
Integrated Community Collaborative Care
PrimaryCare
Mental Health Care
CommunityCare
Education /SchoolHealth
Justice/Courts
Housing/Employment
Transportation