Understanding Mechanisms of Mental Health Care Disparities

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DESCRIPTION (provided by applicant): Racial/ethnic disparities in mental health care, in relative terms, exceed disparities in many other areas of health care services, with African-Americans and Hispanics accessing mental health care at only half the rate of non-Hispanic Whites, even after accounting for mental health status. These disparities in service use likely contribute to the greater persistence, severity, and disease burden of mental disorder among African- Americans and Latinos. In this proposed study, we fulfill a need for direct, easily understandable information about the mechanisms underlying disparities in mental health care services. We improve upon previous research by assessing racial/ethnic disparities in episodes of care rather than cross-sectional data, allowing us to understand factors related to initiation, duration, intensity, and quality of care that are more closely linked with the actual behaviors of patients and providers. In addition, we propose the first comprehensive look at the contribution of geographic disparities to racial/ethnic disparities in mental health care, distinguishing disparities due to the state and neighborhood where an individual lives from disparities due to individual characteristics and identifying area-level characteristics that are amenable to policy change. Finally, we develop, in collaboration with policymakers, a mental health care disparities index that provides an easy to understand state-by-state comparison of mental health care disparities to directly inform policymakers' disparities reduction interventions. Our specific aims are to: 1. Assess disparities in initiation, intensity, duration, and quality of mental health care episodes 2. Assess role of geography in disparities identifying area-level correlates of mental health service use 3. Develop indices of disparities in states' mental health care expenditure and quality. PUBLIC HEALTH RELEVANCE: In this project, we attempt to identify and understand the underlying mechanisms driving racial/ethnic disparities in mental health care episodes. Our focus in this project is to use state-of-the-art methods of disparity research, improving upon previous studies by incorporating longitudinal and neighborhood-level data on mental health care treatment. We aim to translate our findings to provide directly useable information to policymakers on how to reduce mental health care disparities, including the development of a mental health care disparities index, a state-by-state comparison of disparities in mental health care expenditures and quality.