Who’s Getting the Help? Access to Mental Health Services in African American Communities

In 2001 the federal government released, “Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General,” a landmark publication that highlighted the severe disparity in mental health access and treatment between White and African Americans. Included in this report were suggestions to ameliorate these disparities via research and legislative measures. In “Health and Mental Health Policies’ Role in Better Understanding and Closing African American-White American Disparities in Treatment Access and Quality of Care,” Lonnie Snowden examines what has been learned in the decade following the 2001 Surgeon General’s Report about mental health disparities in African American communities and how the Patient Protection and Affordable Care Act (ACA) may affect mental health access and treatment for African Americans in the future.

Snowden begins by reviewing the current state of mental health access and treatment in the African American community. Findings from The National Survey of American Life (NSAL) point to unexpected heterogeneity of African Americans, with 6% of the population being foreign-born. The heterogeneity in the community results in different mental health care access and treatment rates for different groups, with foreign-born African Americans being less likely to access or receive care than their native-born counterparts. Additionally, the NSAL reaffirmed the disparities found in the Surgeon General’s Report—only 31.9% of African Americans diagnosed with mental illness received treatment in the past year compared to 41.1% of the general population with mental health illness. This is especially discouraging because some mental health illnesses, such as chronic major depressive disorder and post traumatic stress disorder, are more prevalent in African-American communities compared to white communities.

In addition to lower treatment rates and higher prevalence of certain mental health illness, evidence points to a lower quality of care in treatment for African Americans. Only 21.2% of African Americans in the NSAL survey had received minimally adequate care (defined as appropriate medication management by a physician and eight 30-minute therapy sessions with a mental health professional) as opposed to 32.7% of other Americans. Lastly, white Americans in the sample were more likely to receive Evidence Based Therapies than their African American counterparts.

Next, Snowden turns to how recent policy changes, notably the ACA, have the potential to combat some of the mental health access and treatment disparities between white Americans and African Americans. The ACA provides financial incentives for health care systems, especially federally qualified health centers (FQHCs), to use the Medical Home model, a team-based care delivery approach that emphasizes holistic health, encompassing the physical, psychological, and psychosocial. This will benefit the African American community, as safety net medical care providers (such as FQHCs) disproportionately serve African Americans. Snowden also predicts increased access to mental health treatment will result from Medicaid expansion, private insurance market subsidies, and the essential health benefits package, which ensures coverage of mental health treatment.

Despite these benefits, Snowden argues it is important to proceed with caution, as the ACA may in fact heighten health disparities if implementation is not closely monitored. In June the Supreme Court ruled that states are not mandated to expand Medicaid coverage (although there are large financial incentives to do so). If certain states elect not to expand Medicaid coverage, those left uninsured will disproportionately be African American. Lastly, Snowden notes that historically enrollment in government programs is low for African Americans, and they may not enroll in Medicaid despite expansion of the program. Therefore, Snowden believes that the ACA is a step in the right direction, but it is not a panacea that will completely eradicate disparities in mental health treatment and access.

Feature photo: cc/A Health Blog