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How Do We Reduce Mental Health Disparities?

Posted on December 5, 2011

Benjamin Cook examines the difficulty of reducing mental health disparities for ethnic minorities, particularly Latinos.

 

What we can see from surveys is whether they've made it to the mental health care side or not, whether they've seen a PCP for a mental health reason or whether they've seen a specialist for a mental health reason.

We can't see all the steps before. So what we end up with is a zero-one variable. And if you're in care, then we can see what kind of care you've had, how much money you've spent on mental health care, those sorts of things.

But what we don't see, which I think you might be getting at, is all of that decision making that happens beforehand. We can start to think about that stuff by looking at how they've accessed physical health care. And I think that's one way to see some of the things that happen before they hit the mental health care visit. You can see how they've interacted with primary care physicians for their diabetes, for example.

If they're likely to hit -- we just wrote a paper that found if they have -- if individuals with mental health problems have physical health comorbidities, then over time, they're more likely to see a mental health care provider, to be recognized as having a mental health problem, than those who don't have all of those comorbidities but are just as mentally ill.

So there is something about the kind of things that happen before someone hits the mental health care system that can be tracked but not the things that I think might be more important. And this is maybe where qualitative research will help a lot, which are: "I'm not feeling very well. I want to go see someone, but I don't know where to go," or, "I'm not feeling very well, but I don't want people to think I'm crazy, so what should I do? Maybe I'll just not do anything." "My friend went to a psychologist. Maybe I need to go to a psychologist, but she had a terrible experience at the psychologist's. So I'm not going to go there."

So I think those sorts of things are really the way that you're going to shrink disparities. The one story that I have about that is my wife is... her mother's Colombian, and I was waiting for her at her hairdresser's one time in Virginia. And her hairdresser is... there were probably 20 Colombians all getting their hair done at the same time.

And one of the hairdressers was saying... was cutting someone's hair, and everybody was listening. And she said, "My daughter's not feeling well, and I took her to a primary care provider, and I wanted some help because she's been really depressed. And the primary care provider said that she's suicidal. I am never taking her back there again. My daughter's not suicidal. It was wrong of him to say that, and I was insulted. My daughter was insulted, and so we're not taking her back."

There were 20 people in that room who heard that story, all Latinos, and they're not going to... they're going to be more reticent to go back to mental health care providers. So I think it's that stuff that will help us find levers for reducing disparities. You don't find that much in nationally representative data sets.

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Excerpted from an interview with the researcher conducted at the 2011 NHSN Conference held in Miami, FL.

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