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Kennedy-Satcher Center for Mental Health Equity

The Need for Mental Health Equity

There is a critical need to implement effective strategies that address policies surrounding equitable access to treatment for behavioral health disorders, specifically targeting health disparities at the community level and in community settings. According to surveillance data from the Centers for Disease Control and Prevention (CDC), mental illness contributes to significant morbidity and mortality due, in part, to the strong association with poorer treatment adherence for concurrent chronic diseases, lower use of appropriate medical care, and negative health behaviors[1].  Recent studies show that disparities in access to medical and behavioral health care continue to plague racial-ethnic minorities, along with disproportionately higher rates of obesity and other chronic diseases[2].  Engagement in mental health care can be difficult due to stigma, poor accessibility, and cultural factors[3]. Even when mental health symptoms are identified as a problem, unmet social concerns (e.g., financial stress, housing insecurity) may contribute to an individual’s difficulty in prioritizing symptoms for intervention[4].  Healthy People 2020 called for improved mental health screening and expanded treatment for mental illness[5]. Yet, at baseline, only 2.2% of adult primary care physician office visits included screening for depression[6].  A public health approach to addressing mental illness that applies an integrative, multi-level model of influence recognizes systems level factors as either sustaining health inequities or by extension potentially being the main driver of health equity. This approach is often lacking in traditional health settings, even in public health agencies, because of the persistent predominance of the Medical Model of Illness that emphasizes individual factors. This is important because the “network” where individuals are embedded is highly influential in determining whether they will seek and receive care during a mental illness episode[7].  Measurement Based Care (MBC) involves the systematic administration of symptom rating scales and use of the results to drive clinical decision-making at the level of the individual patient[8].  Racial/ethnic minorities face additional barriers such as distrust of the health system and cultural factors that deter them from mental health help seeking[9].  Major depression is among the most common mental disorders in the United States, and, of all mental and behavioral disorders, it carries the heaviest burden of disability.  In 2015, 4.3% of adults in the U.S. experienced a major depressive episode that caused severe impairment[10].  In 2010, the economic burden of depression in the United States was $210.5 billion, inclusive of direct costs, suicide-related costs, workplace costs, and costs associated with depression and comorbid conditions[11].  Legislative changes in health care (e.g., Patient Protection and Affordable Care Act, Mental Health Parity and Addiction Equity Act, 21st Century Cures Act) and growing emphasis on care coordination have catalyzed efforts to integrate behavioral health and primary care services across the United States[12].

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[1] Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis [serial online] 2005 Jan [date cited]. Available from: URL: http://www.cdc.gov/pcd/issues/2005/
jan/04_0066.htm.

[2] KA Phillips, M L Mayer and L A Aday. Barriers to care among racial/ethnic groups under managed care Health Affairs 19, no.4 (2000):65-75 doi: 10.1377/hlthaff.19.4.65

[3] Holden K, McGregor B, Thandi P, et al. Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities among Ethnic Minorities. Psychological services. 2014;11(4):357-368. doi:10.1037/a0038122.

[4] Wrenn G, Kasiah F, Belton A, et al. Patient and Practitioner Perspectives on Culturally Centered Integrated Care to Address Health Disparities in Primary Care. The Permanente Journal. 2017;21:16-018. doi:10.7812/TPP/16-018.

[5] U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2010). Healthy People 2020 Framework. Retrieved from https://www.healthypeople.gov/sites/default/files/HP2020Framework.pdf.

[6] Centers for Disease Control and Prevention, National Center for Health Statistics (2007).  National Ambulatory Medical Care Survey.  Retrieved from https://www.healthypeople.gov/node/4807/data_details.

[7] Pescosolido, B. A. et al. “How People Get into Mental Health Services: Stories of Choice, Coercion and “Muddling through” from “First-Timers”.” Soc Sci Med, vol. 46, no. 2, 1998, pp. 275-286.

[8] Fortney, J., Unützer, J., Wrenn, G., Pyne, J., Smith, R., Schoenbaum, M., Harbin, H. “A Tipping Point for Measurement Based Care” Psychiatric Services PMID: 27582237

[9] Wrenn, G. , Muzere, J. , Hall, M. , Belton, A. , Holden, K. , Hughes-Halbert, C. , Kent, M. , Bradley, B. (2017). ‘Understanding Help Seeking among Black Women with Clinically Significant Posttraumatic Stress Symptoms” WASET, International Science Index 122, International Journal of Social, Behavioral, Educational, Economic, Business and Industrial Engineering, 11(2), 213 – 217.

[10] National Institute of Mental Health (n.d.)  NIMH>>Major Depression with Severe Impairment Among Adults.  Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-with-severe-impairment-among-adults.shtml

[11] Greenberg, PE, Fournier, AA, Sisitsky, T, Pike, CT, & Kessler, RC (2015).  The economic burden of adults with major depressive disorder in the United States (2005 and 2010).  J Clin Psychiatry. 2015 Feb;76(2):155-62. doi: 10.4088/JCP.14m09298.

[12] Peikes, D., Zutshi, A., Genevro, J. L., Parchman, M. L., & Meyers, D. S. (2012). Early evaluations of the medical home: Building on a promising start. The American Journal of Managed Care, 18,105-16.

 

 

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