As part of the Affordable Health Care Act, the Department of Health and Human Services (HHS) must develop and evaluate an action plan to reduce racial/ethnic health disparities, including increased preventive care and investments in community health teams that can benefit minority communities. But for such a plan to be effective, thoughtful targeting is needed. The proposed research has the potential to build a solid research foundation for developing interventions to achieve mental health equity that could be implemented as part of the HHS agenda to reduce disparities. Nearly 40% of the US population develops a mental disorder in their lifetime, with racial/ethnic minority groups at particularly high risk of severe-persistent mental disorders and untreated mental illness. But fundamental questions remain unanswered given that few studies investigate the mechanisms that underlie these disparities. The research proposed here aims to attend to this knowledge gap by examining four sets of mechanisms hypothesized to play important roles in causing racial/ethnic disparities in mental disorders: (1) low socio-economic status (SES); 2) childhood adversities (e.g., maltreatment, family violence); (3) disadvantaged role constellations (e.g., early child-bearing, divorce); and (4) disadvantaged neighborhood context (e.g., residential segregation, concentrated disadvantage). We propose to study four mechanisms by carrying out secondary analysis of community epidemiological data across five surveys that provide unparalleled information about the lifetime onset of a wide range of these lifetime disorders, and disparities in the persistence and severity of these disorders once they occur. We also examine barriers to mental health care since untreated mental illness has devastating effect on minority communities. But because empirical findings typically do not bridge the distance between the people who produce the information and the people who could use the information, our last aim identifies how best to frame and use our research results as actionable targets for Intervention and/or policy change. We will work with community, consumer, and policy groups to generate recommendations for prevention, service, and policy interventions aimed at reducing racial/ethnic disparities in mental health outcomes and services.
The proposed study investigates differential mechanisms that might help explain ethnic/racial disparities in mental health outcomes and in service delivery and to integrate these findings with processes for generating projected solutions. We propose to work iteratively with community; consumer and policymaker partners to interpret; further integrate; and generate potential recommendations for interventions and/or policy proposals that can address the identified disparities.
