Service utilization by black and white clientele in an urban Community Mental Health Center: Revised assessment of an old problem

Abstract

Results of a four-year evaluation project by Harborview Community Mental Health Center to assess equity of service to its black constituency are reported. Demographic, service, and psychometric data were gathered on black and white groups which were compared with each other. It was anticipated that service delivery would be proportionate to the social and psychiatric functioning of patients regardless of race or sex. The expectation was partially confirmed. Black patients were found to be somewhat less impaired than whites, yet were referred to treatment modalities and units with apparent equity. Patterns of service at one year were significantly different, reflecting earlier termination for blacks than for whites. This finding is discussed in the context of equal socio-economic class and diagnostic grouping between ethnic groups, but differing indexes of impairment.

Enhancing Interpersonal Psychotherapy for Mothers and Expectant Mothers on Low Incomes: Adaptations and Additions

“…Epidemiologic and qualitative studies (Armstrong et al 1984;Maynard et al 1997) have identified a number of practical barriers to service use by populations living on low incomes: cost; not being insured; limited time and competing priorities; loss of pay from missing work; inconvenient or inaccessible clinic locations; limited clinic hours; transportation problems; and child care difficulties. Psychological barriers to care may include the stigma of depression (Corrigan et al 2000), previous negative treatment experiences on the part of the woman with depression or members of her family and social network (McKay and Bannon 2004), and the burden of depression itself.…”

Culturally relevant treatment services for perinatal depression in socio-economically disadvantaged women: The design of the MOMCare study

“…Potential patient barriers include: 1) practical barriers (e.g.,economic problems; lack of medical insurance, transportation, or childcare; competing priorities and limited time; inaccessible clinic locations); 20,21,22 2) cultural barriers (e.g.,clinician insensitivity to cultural values, preferred ways of coping, and beliefs about depression); 15,23,24 and 3) psychological barriers (e.g.,previous negative experiences with service use; 25 stigma of depression 26 ). Another barrier appears to be an avoidant or fearful attachment style, often resulting from exposure to childhood or domestic trauma 27,28 and characterized by strong self-reliance and/or distrust of others, potentially making it difficult to engagement in treatment.…”

Ethnography's role in assisting mental health research and clinical practice

“…African American women consumer perspectives and sustained involvement are needed to understand cultural complexities and assist interventions. Sociological issues of gender, class, race, ethnicity, heritage, and identity that affect the accuracy of diagnosis, receptivity to research findings, and treatment effectiveness are detectable (Adebimpe, 1981(Adebimpe, , 1994; Agency for Healthcare Research, 2000;Alvarez et al, 1976;Armstrong et al, 1984;Autunes, Gordon, Gaitz, & Scott, 1974;Ayanian, 1994;Bailey, 1987;Baker & Bell, 1999;Baldwin, 1981;Bell & Mehta, 1980).…”