Mental Health Disparities by Race and Ethnicity of Adults

June 2019

The 2001 landmark Surgeon General’s report, Mental Health: Culture, Race, and Ethnicity, underscored significant disparities in initiation of and engagement in mental health care among persons from racial-ethnic minority groups. Now, almost 20 years later, these disparities persist, with higher rates of morbidity from decreased engagement in high-quality care, including use of evidence-based medications and psychotherapies. Reasons for lower treatment engagement are multifactorial and range from a lack of culturally informed treatment options to absence of a diverse mental health workforce, racism, mistrust of health care systems, variance in the quality of mental health treatment offered, and lack of attention to the social determinants of health. This collection highlights the severity of the problem among adults from racial and ethnic minority groups, with consideration of cultural issues related to higher attrition rates and structural challenges associated with access to care. It also highlights the importance of addressing key issues, such as stigma, and the value of including the patient in the decision-making process to improve mental health outcomes. We include possible solutions to these ongoing disparities, including integrated health care services, culturally informed evidence-based treatment interventions, partnership with faith-based organizations, and the need for a more diverse addiction workforce.

Ayana Jordan, M.D., Ph.D.
Lisa B. Dixon, M.D., M.P.H.

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Characterizing the Problem

Inequalities in Use of Specialty Mental Health Services Among Latinos, African Americans, and Non-Latino Whites
Margarita Alegría, Ph.D., Glorisa Canino, Ph.D., Ruth Ríos, Ph.D., Mildred Vera, Ph.D., José Calderón, M.S., Dana Rusch, B.A., and Alexander N. Ortega, Ph.D.
2002, Volume 53, Issue 12, pp. 1547–1555


Disparities in the Adequacy of Depression Treatment in the United States
Jeffrey S. Harman, Ph.D., Mark J. Edlund, M.D., Ph.D., and John C. Fortney, Ph.D.
2004, Volume 55, Issue 12, pp. 1379–1385


Measuring Trends in Mental Health Care Disparities, 2000–2004
Benjamin L. Cook, Ph.D., M.P.H., Thomas McGuire, Ph.D., Jeanne Miranda, Ph.D.
2007, Volume 58, Issue 12, pp. 1533–1540


Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services
Mario Hernandez, Ph.D., Teresa Nesman, Ph.D., Debra Mowery, Ph.D., Ignacio D. Acevedo-Polakovich, Ph.D., Linda M. Callejas, M.A.
2009, Volume 60, Issue 8, pp. 1046–1050


Racial and Ethnic Disparities in Use of Psychotherapy: Evidence From U.S. National Survey Data
Jie Chen, Ph.D., John Rizzo, Ph.D.
2010, Volume 61, Issue 4, pp. 364–372


Psychiatrists’ Attitudes Toward and Awareness About Racial Disparities in Mental Health Care
Julie B. Mallinger, M.P.H., J. Steven Lamberti, M.D.
2010, Volume 61, Issue 2, pp. 173–179


Racial-Ethnic Disparities in Outpatient Mental Health Visits to U.S. Physicians, 1993–2008
Marc Manseau, M.D., M.P.H., and Brady G. Case, M.D.
2014, Volume 65, Issue 1, pp. 59–67


A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic
Michael A. Gara, Ph.D., Shula Minsky, Ed.D., Steven M Silverstein, Ph.D., Theresa Miskimen, M.D., Stephen M. Strakowski, M.D.
2019, Volume 70, Issue 2, pp. 130–134

Financial Considerations

The Costs and Benefits of Reducing Racial-Ethnic Disparities in Mental Health Care
Benjamin Lê Cook, Ph.D., M.P.H., Zimin Liu, M.A., Anna Sophia Lessios, B.A., Stephen Loder, B.A., Thomas McGuire, Ph.D.
2015, Volume 66, Issue 4, pp. 389–396


Racial, Ethnic, and Gender Disparities in Health Care Access and Use Among U.S. Adults With Serious Psychological Distress
Judith Weissman, Ph.D., J.D., David Russell, Ph.D., Melanie Jay, M.D., M.S., Dolores Malaspina, M.D., M.P.H.
2018, Volume 69, Issue 5, pp. 517–522


Disparities in Access to Mental Health Services Among Patients Hospitalized for Deliberate Drug Overdose
Elizabeth Charron, M.P.H., Ellen C. Francis, M.S., Smith F. Heavner-Sullivan, M.S., R.N., Khoa D. Truong, Ph.D., M.Phil.
2019, Volume 70, Issue 9, pp. 758–764

Quality of Care Received

Changes in Racial-Ethnic Disparities in Use and Adequacy of Mental Health Care in the United States, 1990–2003
Andrea Alexis Ault-Brutus, Ph.D., M.P.A.
2012, Volume 63, Issue 6, pp. 531–540


Racial-Ethnic Variation in U.S. Mental Health Service Use Among Latino and Asian Non-U.S. Citizens
Sungkyu Lee, Ph.D., Laurel Laiewski, M.S.S.W., and Sunha Choi, Ph.D.
2014, Volume 65, Issue 1, pp. 68–74

Proposed Solutions

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders
William Armando Vega, Ph.D., Marvin Karno, M.D., Margerita Alegria, Ph.D., Jennifer Alvidrez, Ph.D., Guillermo Bernal, Ph.D., Michael Escamilla, M.D., Javier Escobar, M.D., Peter Guarnaccia, Ph.D., Janis Jenkins, Ph.D., Alex Kopelowicz, M.D., Isabel T. Lagomasino, M.D., M.S.H.S., Roberto Lewis-Fernandez, M.D., Humberto Marin, M.D., Steven Lopez, Ph.D., Sana Loue J.D., Ph.D.
2007, Volume 58, Issue 3, pp. 385–394


Church-Based Health Programs for Mental Disorders Among African Americans: A Review
Sidney H. Hankerson, M.D., M.B.A., and Myrna M. Weissman, Ph.D.
2012, Volume 63, Issue 3, pp. 243–249


Improving Treatment Engagement of Underserved U.S. Racial-Ethnic Groups: A Review of Recent Interventions
Alejandro Interian, Ph.D., Roberto Lewis-Fernández, M.D., Lisa B. Dixon, M.D., M.P.H.
2013, Volume 64, Issue 3, pp. 212–222


Eliminating Behavioral Health Disparities and Improving Outcomes for Racial and Ethnic Minority Populations
Katherine Sanchez, Ph.D., L.C.S.W., Rick Ybarra, M.A., Teresa Chapa, Ph.D., M.P.A., Octavio N. Martinez, M.D., M.P.H.
2016, Volume 67, Issue 1, pp. 13–15

Also featured in Integrated Care collection.

Change in Patient Activation and Mental Illness Symptoms After Communication Training: A Multisite Study With a Diverse Patient Sample
Mengchun Chiang, Ph.D., Janet Chang, Ph.D., Ora Nakash, Ph.D., Mario Cruz-Gonzalez, Ph.D., Mirko K. Fillbrunn, Ph.D., Margarita Alegría, Ph.D.
2019, Volume 70, Issue 8, pp. 696–702

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