Children’s Mental Health Care: Differences by Race/Ethnicity in Urban/Rural Areas

Abstract

This study examines racial/ethnic disparities in children's mental health and the receipt of mental health services, and whether those disparities differ between urban and rural areas. We find no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas. However, there are disparities in the use of mental health services. Hispanic children and Black children in urban areas receive less mental health care than their White counterparts, and the disparity persists for Hispanic children in rural areas, even after controlling for other relevant factors. Initiatives to improve access to mental health care for racial/ethnic minorities should recognize these disparities, and address the lack of culturally appropriate services in both urban and rural areas. In addition, outreach should raise awareness among parents, teachers, and other community members concerning the need for mental health services for minority children.

Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting

“…White children in rural areas are significantly less likely to receive mental health services than their counterparts in urban areas. 4 These findings remain statistically significant even after income, family composition, and health insurance status are controlled for, and they suggest that there may be other determinants, such as communication, bias and discrimination, and practical barriers that may affect access to mental health services.…”

“…5,6 Although there is no significant difference in the prevalence of mental health problems among children residing in poverty by race or ethnicity or geographic residence, after demographic and family variables are controlled for, there are statistically significant disparities in mental health service utilization across racial and ethnic groups and between children residing in urban and rural areas. 4 Studies have generally found lower mental health service utilization among African American and Hispanic children, compared with white children. 5,26 Native American children in urban areas are more likely to have received mental health care than white children, whereas African American children residing in urban areas and Latino children residing in both rural and urban areas are less likely to be connected to mental health care than white children.…”

“…Families in rural areas, in particular, often have to travel long distances to access mental health services. 4,7 Additionally, lack of insurance or type of "carve out" and quantity of mental health services provided under managed care plans can prevent children and families from accessing needed mental health care services. 27 The conventional practice of most mental health agencies also contributes to disparities in access to mental health care.…”

“…1 -3 Despite the mental health needs of families living in poverty, few gain access to high-quality mental health services. [4][5][6] There is a growing urgency to develop models of mental health care that are tailored to the needs of these vulnerable children and their families. Pediatric primary care providers (PCPs) are in a unique position to take a leading role in this effort because families often turn to them first for help with mental health concerns.…”

Screening for Behavioral Health Issues in Children Enrolled in Massachusetts Medicaid

“…This supports the benefits of screening both for identifying children among those who have historically received fewer services and for early identification. [24][25][26] The fact that more than half of the children identified by the screens had a recent BH history may suggest that screening was not necessary for these children. However, we argue that even for children who have received or are receiving services, a positive screen can provide an opportunity to revisit issues, reconnect children to BH care, assess current regimens and communicate with mental health providers.…”