Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care

http://ajp.psychiatryonline.org/cgi/content/full/158/12/2027

Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care  Am J Psychiatry 158:2027-2032, December 2001

Kenneth Wells, M.D., M.P.H., Ruth Klap, Ph.D., Alan Koike, M.D., and Cathy Sherbourne, Ph.D.

Abstract

 
OBJECTIVE: Recent policy has focused on documenting and reducing ethnic disparities in availability and quality of health care.The authors examined differences by ethnic status in unmet need for alcoholism, drug abuse, and mental health treatment.METHOD: Data were from a follow-up survey of adult respondents to a 1996–1997 national survey. Non-Hispanic whites, African Americans, and Hispanics were compared in access to alcoholism and drug abuse treatment and mental health care (primary or specialty), unmet need for care, satisfaction with care, and use of active treatment for alcoholism, drug abuse, and mental health problems in the prior 12 months. RESULTS: A total of 31.9% of whites, 28.1% of African Americans, and 30.1% of Hispanicshad some alcoholism, drug abuse, and mental health care, mostly in primary care. Among those with perceived need, compared to whites, African Americans were more likely to have no access to alcoholism, drug abuse, or mental health care (25.4% versus 12.5%), and Hispanics were more likely to have less care than needed or delayed care (22.7% versus 10.7%). Among those with need, whites were more likely than Hispanics or African Americansto be receiving active alcoholism, drug abuse, or mental health treatment (37.6% versus 22.4%–25.0%). CONCLUSIONS: The authors document greater unmet need for alcoholism and drug abuse treatment and mental health care among African American and Hispanics relative to whites. New policies are needed to improve access to and quality of alcoholism, drug abuse, and mental health treatment across diverse populations.

Introduction

 
Reducing ethnic disparities in access to and quality of health care is a goal of recent federal initiatives (1–5). The Surgeon General’s report on minority mental health (6) emphasized the overall high levels of unmet need for mental health care nationally across diverse subpopulations. While major psychiatric disorders are common across major ethnic groups in the United States (7–10), rates of some disorders may differ across groups, e.g., major depression may be less prevalent among African Americans than among non-Hispanic whites (8).

Among those with similar need, there may be ethnic differences in access to or quality of care for psychiatric disorders. InsuredAfrican Americans and Hispanics may be less likely than whites to use outpatient mental health services, while African Americans in the public sector may be more likely than whites to use mental health services (10–14). Less acculturated Mexican Americans may have much lower rates of use of mental health care and substance abuse treatment, especially specialty care, than more acculturated groups (15). Young et al. (16) found that among U.S. adults with probable depressive or anxiety disorders, African Americans had lower rates of appropriate care than did whites. But prior studies have not compared ethnic groups on multiple domains of access to and quality of care for alcoholism, drug abuse, and mental health conditions.

In this study we compared adult non-Hispanic whites, African Americans, and Hispanics in access to and quality of care for alcoholism, drug abuse, and mental health conditions. The study group contained too few data regarding Asian American/Pacific Islanders and Native Americans for separate study. We evaluated care from a consumer perspective, which includes perceptions of unmet need, and from a clinical perspective, which evaluates use of active treatments for alcoholism, drug abuse, and mental health conditions rather than assessing numbers of visits only. We hypothesized that minorities would have more unmet need for alcoholism, drug abuse, and mental health treatment.

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