Study finds disparities in mental health care for minority children and young adults

Black children and young adults are about half as likely as their white counterparts to get mental health care despite having similar rates of mental health problems, according to a study published today [Friday, Aug. 12] in the International Journal of Health Services. Hispanic youth also get only half as much mental health care as whites.

The study used data on children under 18 and young adults 18-34 from the Medical Expenditure Panel Survey covering all 50 states for the years 2006-2012. It found that minorities received much less of virtually all types of mental health care, including visits to psychiatrists, social workers and psychologists, as well as substance abuse counseling and mental health counseling by pediatricians and other doctors.

The research was led by Dr. Lyndonna Marrast, who was a fellow at Harvard Medical School and Cambridge Health Alliance when she initiated the study. Marrast is currently assistant professor of medicine at the Hofstra Northwell School of Medicine in New York. The study's co-authors are Drs. Steffie Woolhandler and David Himmelstein, professors at the City University of New York at Hunter College and lecturers at Harvard Medical School.

Their findings include the following:

• Black and Latino children made, respectively, 37 percent and 49 percent fewer visits to psychiatrists, and 47 percent and 58 percent fewer visits to any mental health professional, than white children.
• Black children's low use of services was not due to lesser need. Black and white children had similar rates of mental health problems, and similar rates of severe episodes that resulted in psychiatric hospitalization or emergency visits.
• Hispanic parents reported less mental health impairment among their children, but analyses that controlled for this lesser need for care continued to show underuse compared to non-Hispanic whites.
• Racial/ethnic disparities were even larger among young adults. Whites received about three times more outpatient mental health services than blacks and Hispanics in this age group. The substance abuse counseling rate for black young adults was strikingly low, about one-seventh that for whites.
• While poor children and young adults had lower rates of care, differences in income and insurance did not account for the racial/ethnic disparities in care.
• Among children, girls got less mental health care than boys. The gender difference was reversed among young adults, with women having more visits.
• Groups at highest risk for incarceration - black and Hispanic young men - had particularly low mental health visit rates. According to Department of Justice data, at least half of inmates suffer from mental illness, most of which had been untreated when they were arrested.

The authors write: "The under-provision of mental health care for minority children contrasts starkly with the high frequency of punitive sanctions that their behaviors elicit. Black children suffer excessive rates of school discipline such as suspensions and expulsions starting at preschool ages. Minority teens also have disproportionate contact with the juvenile justice system, with higher arrest rates for nonviolent, low-level offenses such as drug possession, as well as for non-criminal misbehaviors such as truancy and curfew violations. Youthful transgressions that might result in referral for treatment among non-minority children more often incur criminal sanctions for minorities."

The authors also observe that minorities' very low substance abuse treatment rates contrast with their high rates of arrest for substance abuse.

Dr. Marrast commented: "It has become increasingly clear that minorities are overrepresented in the criminal justice system and underrepresented in the receipt of mental health care. We need to look closely at how equitably our health care institutions are serving all segments of society."

According to Dr. Woolhandler: "Minority kids don't get help when they're in trouble. Instead they get expelled or jailed. But punishing people for mental illness or addiction is both inhumane and ineffective. The lack of care for minority youth is the real crime."

Drs. Woolhandler and Himmelstein co-founded Physicians for a National Health Program, a nonprofit group that advocates for universal, comprehensive health coverage through a single-payer plan. PNHP played no role in financing or otherwise supporting the study.