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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Mental Health Services in MH Specialty Settings (SRSP)
Program Officer
Rupp, Agnes
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Cambridge Health Alliance
United States
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Valentine, Anne; DeAngelo, Darcie; Alegría, Margarita et al. (2014) Translating disparities research to policy: a qualitative study of state mental health policymakers' perceptions of mental health care disparities report cards. Psychol Serv 11:377-87
Carson, Nicholas J; Vesper, Andrew; Chen, Chih-Nan et al. (2014) Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups. Psychiatr Serv 65:888-96
Cook, Benjamin Le; Zuvekas, Samuel H; Carson, Nicholas et al. (2014) Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Serv Res 49:206-29
Cook, Benjamin Lê; Wayne, Geoff Ferris; Kafali, E Nilay et al. (2014) Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation. JAMA 311:172-82
Saloner, Brendan; Carson, Nicholas; Cook, Benjamin Lê (2014) Episodes of mental health treatment among a nationally representative sample of children and adolescents. Med Care Res Rev 71:261-79
Saloner, Brendan; Carson, Nicholas; Lê Cook, Benjamin (2014) Explaining racial/ethnic differences in adolescent substance abuse treatment completion in the United States: a decomposition analysis. J Adolesc Health 54:646-53
Lê Cook, Benjamin; Brown, Jonathan D; Loder, Stephen et al. (2014) Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 16:1093-102
Le Cook, Benjamin; Barry, Colleen L; Busch, Susan H (2013) Racial/ethnic disparity trends in children's mental health care access and expenditures from 2002 to 2007. Health Serv Res 48:129-49
Le Cook, Benjamin; Manning, Willard; Alegria, Margarita (2013) Measuring disparities across the distribution of mental health care expenditures. J Ment Health Policy Econ 16:3-12
Cook, Benjamin Le; Doksum, Teresa; Chen, Chih-Nan et al. (2013) The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S. Soc Sci Med 84:102-9

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