White Adults With Mental Illness Report More Barriers To Care, Study Shows Crain’s Health Pulse February 1, 2018
In a reversal of the typical health-disparities story, a new study led by a Mount Sinai researcher found that white adults with serious psychiatric distress were more likely than their minority counterparts to report barriers to care.
Judith Weissman, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai, was the lead researcher on the study published today in the journal Psychiatric Services.
Results from the National Health Interview Survey, spanning 2006 to 2015, showed that white people with mental health issues severe enough to impede their ability to work or go to school were more likely than either black or Hispanic people to report being unable to afford their medication or mental health care. They were also more likely to experience delays in getting care in general.
"I ran the numbers over and over again, and they came out the same way," said Weissman. "White Americans are reporting worse access and utilization than other groups. It's not just a marginal or fluke finding."
Past research indicates the opposite—that racial minorities have worse access to mental health services. A 2015 report by the Substance Abuse and Mental Health Services Administration found that 16.6% of whites reported using mental health care in the past year, compared with 8.6% of blacks and 7.3% of Hispanics. The cost of care was the most frequently cited reason for not accessing services among all groups, according to that report, which was based on data from the National Survey on Drug Use and Health from 2008 to 2012.
One possible explanation for the results in the current study is that white people were more likely than black or Hispanic survey respondents to have private insurance coverage, which could fluctuate depending on employment, said Weissman.
"I went back and looked at what kind of coverage different groups had and found that whites with mental illness were going back onto private coverage after the recession, whereas other groups were disproportionately going toward Medicaid," Weissman said. "Our hypothesis would be that if you look at the trajectory of oscillation in the economy, you would probably see whites with mental illness going on and off health coverage based on the economy."
Weissman said the study didn't determine whether private insurance or Medicaid offers better mental health benefits, but she said it's worth studying in the future.
Dr. Ralph Aquila, medical director at Fountain House, a community center in Manhattan for people with serious mental illnesses, said public insurance is better for the people he serves because they don't have to worry about exorbitant out-of-pocket costs. The fact that many mental health professionals in New York don't accept any type of insurance may also narrow the gap between privately and publicly insured people with mental health problems, he noted.
The overwhelming majority of Fountain House members, regardless of race, are publicly insured. Members often worry that taking a full-time job would jeopardize their coverage, said Kenneth Dudek, president of Fountain House.
"In spite of what everybody says, Medicaid and Medicare are pretty good health plans," said Dudek. "A lot of the [employer-sponsored] plans people are on are very limited in what they offer." —C.L.
Racial, Ethnic, and Gender Disparities in Health Care Access and Use Among U.S. Adults With Serious Psychological Distress
Received: May 12, 2017
This study compared health care access and utilization among adults with serious psychological distress by race-ethnicity and gender in years surrounding implementation of the Affordable Care Act.
Data for adults ages 18 to 64 with serious psychological distress in the 2006–2015 National Health Interview Survey (N=8,940) were analyzed by race-ethnicity and gender on access and utilization indicators: health insurance coverage, insufficient money to buy medications, delay in health care, insufficient money for health care, visited a doctor more than ten times in the past 12 months, change in place of health care, change in place of health care because of insurance, saw a mental health provider in the past 12 months, and insufficient money for mental health care.
The proportions of white and black adults with serious psychological distress were largest in the South, the region with the largest proportion of persons with serious psychological distress and no health coverage. Multivariate models that adjusted for health coverage, sociodemographic characteristics, health conditions, region, and year indicated that whites were more likely than blacks to report insufficient money for medications and mental health care and delays in care. A greater proportion of whites used private coverage, compared with blacks and Hispanics, and blacks were more likely than all other racial-ethnic groups to have Medicaid.
More research is needed on health care utilization among adults with serious psychological distress. In this group, whites and those with private coverage reported poor utilization, compared with other racial-ethnic groups and those with Medicaid, respectively.