Health Equity Research Lab

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Cambridge, MA 02141

phone: 617-806-8741

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A study by Health Equity Research Lab Director Ben Cook and researcher Timothy Creedon was recently featured in an article in The Atlantic. The study, conducted in 2014 evaluated the impact of the ACA on mental health care disparities in the United States. It found evidence that mental health care access increased for those with psychological distress, but found no reduction in mental health disparities, and no improvements in substance abuse treatment access.

Important highlights of the study are shared below

The 2003 Institute of Medicine publication Unequal Treatment elevated to national priority the elimination of health care disparities, and this concern continues to be echoed as an overarching goal in Healthy People 2010 and 2020. Mental health care disparities remain particularly large compared to other health disparities, and pose an undue burden on minorities. Our Psychiatric Services study used nationally representative data from the Medical Expenditure Panel Survey to examine trends in racial and ethnic disparities in access to mental health care between 2004-2012.

We found that despite many calls to reduce disparities over the years, racial and ethnic disparities in mental health care were not reduced over this time period for black, Hispanic, or Asian populations as compared to whites. Even more concerning was our finding that for black-white and Hispanic-white disparities in any mental health care and the use of any psychotropic medications actually increased. Our models adjust for clinical need using mental health status. These findings indicate that black and Hispanic individuals, with similar levels of mental health need, are not getting care at the same rate as whites and that this gap is growing. 

There is hope that the ACA will be able to reduce the magnitude of mental health care disparities by increasing access to health insurance for those in need (through the health insurance exchanges and Medicaid expansions). The ACA also strengthens implementation of the Wellstone and Domenici Act of 2008 that mandated parity between behavioral health and general medical insurance benefits for most insurers. In our Health Affairs study, Timothy Creedon and I analyzed data from the National Survey on Drug Use and Health and found that mental health care access increased for those with psychological distress. However, we found no evidence for reductions in racial and ethnic disparities in access. Furthermore, we found no difference in substance use treatment in 2014 when the ACA features kicked in. 

This pair of studies underscores the persistence of racial and ethnic disparities in mental health care and the low rates of substance use treatment among those in need of care in the U.S. These studies reinforce the need for generating and testing clinical and policy solutions to improve the reach of our health care systems to reach racial and ethnic minorities. They also demonstrate the importance of renewing our efforts at improving screening of mental illness and substance use among our racial and ethnic minority patients, and engaging those in need with evidence-based and culturally appropriate behavioral health treatment.

Complete Atlantic article

Full study published in Health Affairs