Health and mental health policies' role in better understanding and closing African American–White American disparities in treatment access and quality of care.

Abstract

Since publication of the U.S. Surgeon General's report Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001), several federal initiatives signal a sustained focus on addressing African American-White American disparities in mental health treatment access and quality and open the way to unprecedented disparity reduction. These initiatives include institutional commitments to (a) research by the National Center for Minority Health and Health Disparities; (b) disparities monitoring by the Agency for Healthcare Research and Quality; (c) new epidemiologic and service delivery information on African American populations from the National Survey of American Life sponsored by the National Institute of Mental Health; as well as (d) opportunities inherent in the World Health Organization's interest in disease burden for making it possible to view African Americans' likely greater disease burden from mental illness as a legitimate source of concern. The Patient Protection and Affordable Care Act affords unprecedented opportunities for increasing African Americans' treatment access and quality of care nationwide. By familiarizing themselves with these initiatives, and taking advantage of possibilities they offer, those committed to reducing African American-White American disparities in mental illness, and treatment access and quality, can make inroads toward improving African Americans' mental health and facilitating their successful functioning in all spheres of community living.

Racial Disparities in Community Outcomes Among Individuals with Schizophrenia and Cooccurring Substance Use Disorders

“…In general, people with comorbid conditions experience higher rates of service utilization than those with one condition (Wu, Ringwalt, & Williams, 2003), and most do not receive adequate treatment for either or both conditions (Wu, Kouzis, & Leaf, 1999). Such challenges are very problematic for Black individuals with cooccurring conditions, as they are even less likely to receive adequate treatment (Snowden, 2012), and experience less functional improvement compared to Whites (Grella & Stein, 2006). It is likely that unmeasured contextual factors influenced our finding that Black participants were less likely to have used antipsychotic treatment than Whites.…”

“…Indeed, subsequent initiatives were launched to integrate mental health and addiction systems for persons with comorbid conditions (Minkoff & Drake, 1991;Mueser, Noordsy, Drake, & Fox, 2003). Although such initiatives sought to reduce treatment barriers (Mueser et al, 2003), recent evidence indicates that Black persons with comorbid SUD and schizophrenia continue to receive inadequate treatment and experience lower rates of functional improvement compared to Whites with these conditions (Grella & Stein, 2006; see also Snowden, 2012). Although the Affordable Care Act of 2010 has the potential to improve service access across diverse populations and reduce disparities, such outcomes have yet to be realized (Pincus, Spaeth-Rublee, & Watkins, 2011).…”

“…These barriers intersect with Black racial status, which calls for social workers to consider social inequalities and the strengths of the larger Black community when engaging Black persons in community-based mental health and addiction programs. Practicing from a strengths-based approach requires social workers to work with clients to identify both personal and community-based resilience factors, acknowledge structural barriers to treatment access and quality of care, and share in decision making about the best-fitting treatment approaches given one's diagnosis and social and cultural conditions (Snowden, 2012). Using evidence-based practices in treatment with Black persons with schizophrenia is vital to reducing disparities in the quality of care between Blacks and Whites, but social workers must also assist clients in addressing the needs and challenges that fall outside the spectrum of "treatment," such as low individual or family income (Rapp, Saleebey, & Sullivan, 2005).…”

Impact of lifetime evaluated need on mental health service use among African American emerging adults.

“…This gap in the literature is particularly concerning considering that African-American emerging adults are especially at-risk due to the cumulative influences of disproportionate burden of mental illness experienced by African Americans in general (Myers, 2009; Snowden, 2012; US DHHS, 2001) as well as their greater likelihood of experiencing persistent illness once diagnosed (Breslau, Kendler, Su, Gaxiola-Aguilar, & Kessler, 2005; Snowden, 2012; Williams et al, 2007). Additionally, emerging adults of any race/ethnicity are at increased risk for the onset of severe mental illness (Hunt & Eisenberg, 2010; Tanner & Arnett, 2009; Eisenberg, Golberstein, & Gollust, 2007; Mowbray et al, 2006; Viner & Tanner, 2009), with 75% of all lifetime cases of mental illness beginning by age 24 (Kessler et al, 2005a).…”

Integrating Culture and Biology in Psychological Research: Conceptual Clarifications and Recommendations

“…Moreover, given the historical factors and power dynamics, research on culture and biology may be received differently within these different approaches, both by researchers and the communities they study. For example, studying genetic factors underlying mental health among African Americans may call for different conceptualizations and safeguards then when studying the same topic among White Americans (see Snowden, 2012). The need to think about how research might be differentially executed with different groups raises the vexing issue of how to conceptualize groups, an issue to which we now turn.…”