Report finds racial disparities in behavioral health services

Many fear the stigma of mental health treatment.

BOSTON, Mass.(State House News Service)-Latinos in Massachusetts are significantly less likely to access mental health treatment than blacks, whites and Asians, according to researchers who suggest underlying factors could contribute to racial disparities in behavioral health treatment.

Speaking Thursday to health care professionals at the Omni Parker House, Margarita Alegria, director of the Center on Multicultural Mental Health Research at Cambridge Health Alliance and co-author of a new report, recommended increasing the amount of substance abuse treatment, encouraging psychiatrists to accept Medicaid patients and allowing interstate professional licensure to increase competition.

Non-English speakers encounter language barriers when they attempt to seek treatment, said Alegria, who said she had heard of people driving out-of-state because of the stigma of seeking mental health services.

“We have a lot of segregation in Massachusetts, and it sometimes concentrates risk factors,” said Alegria.

The report, presented by the Massachusetts Health Policy Forum, found that 29.2 percent of Latino adults with mental illness received treatment compared to 51.5 percent of whites. Blacks and Asians had slightly lower rates of treatment than whites. The disparities are greater in the United States as a whole.

“Racial and ethnic minority populations are much more likely to be concentrated in high-poverty neighborhoods with low resources and few opportunities, which can contribute to behavioral health disparities,” said the report, a 53-page document assembled with support from Blue Cross Blue Shield Foundation of Massachusetts and the Harvard Pilgrim Health Care Foundation.

The report also noted the proportion of blacks and Latinos in the Massachusetts prison population is two to three times higher than their proportion of the population as a whole. Massachusetts Health Policy Forum Chairman Philip Johnston said, “The jails have become the sort of successors to what the state hospitals used to be.”

The report recommended increasing the premium payments to providers who treat Medicaid patients and suggested “a system of feedback” for both patients and their health care providers.

Department of Mental Health Commissioner Marcia Fowler said a black man and a white man could go to the same clinic and each receive a “different diagnosis, different course of treatment.”

Fowler said there are “gaps in our insurance coverage,” including among immigrants, and she recommended pediatricians and primary care doctors screen for behavioral health, and advocated for more “diversion” programs in the justice system, steering people away from prison. Fowler said the majority of people participating in special drug and mental health courts are white.

Dr. David Takeuchi, a professor at Boston College School of Social Work, said that immigrants generally have lower rates of behavioral health problems, but subsequent generations have higher rates more on par with U.S.-born whites. Takeuchi also said even though mental health treatment outcomes for whites are better “their outcomes are also poor.”

Takeuchi also said Marylou Sudders would have been at the forum if not for her recent selection as Governor-elect Charlie Baker’s secretary of Health and Human Services. Sudders, the former commissioner of DMH, frequently discusses the need for better behavioral health treatment.

Alegria also said community health clinics are “missing a lot of the population,” including young men, and also said health providers should recognize their “bias blind spot.”

Benjamin Cook, who worked on the paper with Alegria, said whites use cocaine, hallucinogens and marijuana at higher rates than other racial groups, and across the country white people have a higher incidence of mental illness.

The report found white and black people in Massachusetts have a similar rate of depression diagnosis, about 20 percent, while the rate for Latinos was 26.3 percent in 2012, and the rate for Asians was only 5.4 percent. Blacks and Latinos had higher reports of “poor” mental health.

Massachusetts Behavioral Health Partnership Medical Director of Integration Nancy Norman said that data can be interpreted in various ways by different people, and said people should be educated by their own experiences.

“It is really important to listen to anecdotes, and they do matter,” Norman said.


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