Racial-Ethnic Differences in Mental Health Service Use among Adults

2015·1.2 MB·English

CHAPTER 1 · Introduction
Racial/Ethnic
Outpatient Services
Treatment
Differences in P
r
e
Mental Health
v
Mental HealthI
n
a
Service Use
A pl
e
d a
among Adults n
t
u c
i
ee
l
Ethnicityt n
s t

S
e
r
v
S
i
c e
e r
Mental Health Care
s v
Racei
c
e
s
Acknowledgments
h
t This chartbook was prepared by the Center for Behavioral Health
al
e Statistics and Quality (CBHSQ), Substance Abuse and Mental Health
H
d Services Administration (SAMHSA), U.S. Department of Health
n
a
e and Human Services (HHS), the National Institute of Mental Health
s
U (NIMH), National Institutes of Health (NIH), and RTI International
g
u (a registered trademark and a trade name of Research Triangle Institute),
r
D
n Research Triangle Park, North Carolina. Work by RTI was performed
o
y under Contract No. HHSS283201000003C and Task Order No.
e
v HHSS283200700002I/HHS28342005T.
r
u
S
al Public Domain Notice
n
o
ati All material appearing in this publication is in the public domain and may
N
· be reproduced or copied without permission from SAMHSA. However,
n this publication may not be reproduced or distributed for a fee without the
o
ati specific, written authorization of the Office of Communications, SAMHSA,
r
st HHS. When using estimates and quotations from this publication, citation
ni
mi of the source is appreciated.
d
A Recommended Citation
s
e
c
vi Substance Abuse and Mental Health Services Administration, Racial/
r
e Ethnic Differences in Mental Health Service Use among Adults. HHS
S
h Publication No. SMA-15-4906. Rockville, MD: Substance Abuse and
t
al Mental Health Services Administration, 2015.
e
H
al Electronic Access and Copies of Publication
t
n
e
M This publication may be downloaded from http://www.samhsa.gov/data/.
d
n
a Originating Office
e
s
u Substance Abuse and Mental Health Services Administration
b
A
e Center for Behavioral Health Statistics and Quality
c
n 1 Choke Cherry Road, Room 2-1067
a
st Rockville, MD 20857
b
u
S
February 2015
ii
Contents
h
t
al
e
H
d
n
a
Highlights                                                      1 4 Differences in Mental Health Service Use among e
s
U
Adults with Any Mental Illness                            21 g
1 Introduction                                               3 u
41 Introduction                                          21 Dr
n
2 Methods                                                   5 42 Racial/Ethnic Differences in Past Year Mental Health o
y
e
21 Data Sources                                           5 Service Use among Adults with Any Mental Illness      23 v
r
u
S
22 Chartbook Methodology                               6 43 Racial/Ethnic Differences in Reasons for Not Using al
n
Sample                                                 6 Mental Health Services among Adults with Any Mental tio
Illness Who Reported an Unmet Need for Services       28 Na
Measures                                               7
·
44 Summary                                             29 n
Analyses                                               9 o
ti
5 Differences in Mental Health Service Use among a
r
3 Racial/Ethnic Differences in Mental Health Service Use t
s
Adults with Serious Mental Illness                        31 ni
among Adults                                             11 mi
51 Introduction                                          31 d
31 Introduction                                          11 A
52 Racial/Ethnic Differences in Past Year Mental Health s
32 Racial/Ethnic Differences in Past Year Mental Health ec
Service Use among Adults with Serious Mental Illness  33 vi
Service Utilization among Adults                       12 r
e
53 Racial/Ethnic Differences in Reasons for Not Using S
33 Racial/Ethnic Differences in Reasons for Not Using h
Mental Health Services among Adults Who Reported Mental Health Services among Adults with Serious alt
e
Mental Illness Who Reported an Unmet Need for H
an Unmet Need for Services                           18 Services                                               38 al
t
34 Summary                                             19 n
e
54 Summary                                             39 M
d
n
End Notes                                                      41 a
e
s
u
List of Figures                                                  43 b
A
e
c
List of Tables                                                   44 n
a
t
s
b
u
S
iii
Contents
h (continued)
t
al
e
H
d
n
a
e
s Appendix
U
g
u
r A Mental Health Service Use among Adults:
D
n Detailed Tables                                      A-1
o
y
e
v
r B Mental Health Service Use among Adults with
u
S
al Any Mental Illness: Detailed Tables                  B-1
n
o
ati C Mental Health Service Use among Adults with
N
· Serious Mental Illness: Detailed Tables              C-1
n
o
ti D List of Contributors                                  D-1
a
r
t
s
ni
mi
d
A
s
e
c
vi
r
e
S
h
t
al
e
H
al
t
n
e
M
d
n
a
e
s
u
b
A
e
c
n
a
t
s
b
u
S
iv
Highlights
This chartbook uses combined 2008 to 2012 data from the National Survey on Drug Use and Health (NSDUH) to present
nationally representative estimates of mental health service utilization among adults aged 18 or older within different racial/ethnic
groups in the United States. The percentages are annual averages.
● The highest estimates of past year mental health ● Racial/ethnic differences in the estimates of any past year
service use were for adults reporting two or more races mental health service use were similar among all adults,
(17.1 percent), white adults (16.6 percent), and American adults with any mental illness (AMI), and adults with
Indian or Alaska Native adults (15.6 percent), followed serious mental illness (SMI).
by black (8.6 percent), Hispanic (7.3 percent), and Asian
(4.9 percent) adults. ● Estimates of past year mental health service use increased
with the severity of mental illness across all racial/ethnic
● Estimates of prescription psychiatric medication use in groups.
the past year were highest for white adults (14.4 percent),
adults reporting two or more races (14.1 percent), and ● Few racial/ethnic differences were found among the reasons
for not using mental health services among all adults, adults
American Indian or Alaska Native adults (13.6 percent),
with AMI, and adults with SMI.
followed by black (6.5 percent), Hispanic (5.7 percent),
and Asian (3.1 percent) adults.
● Service cost or lack of insurance coverage was the most
frequently cited reason for not using mental health services
● Outpatient mental health service use in the past year was
across all racial/ethnic groups. The belief that use of mental
highest for adults reporting two or more races (8.8 percent),
health services would not help was the least frequently cited
white adults (7.8 percent), and American Indian or Alaska
reason for not using mental health services across all racial/
Native adults (7.7 percent), followed by black (4.7 percent),
ethnic groups. Among all adults and adults with AMI or
Hispanic (3.8 percent), and Asian (2.5 percent) adults.
SMI, white adults were generally the most likely to cite cost
● Past year inpatient mental health service use was more or insurance and believing that services would not help as
prevalent among black adults (1.4 percent) than white reasons for not using mental health services compared with
adults (0.7 percent). other racial/ethnic groups.
1
This page intentionally left blank
2
CHAPTER 1 · Introduction
1
1 Introduction
h
t
al
e
H
d
n
a
e
s
U
g
u
r
D
n
o
y
e
v
r
u
S
al
In 2001, the U.S. Surgeon General released a seminal report, Mental Health: Culture, n
o
ti
Race, and Ethnicity, that documented substantial differences in mental health service Na
utilization between non-Hispanic white adults and other racial/ethnic groups.1 ·
n
o
The report also noted racial/ethnic differences in the types of services that are used. ti
a
r
Moreover, the Surgeon General determined that not all differences in mental health st
ni
service utilization resulted from personal preference. Rather, many of the racial/ethnic mi
d
differences in mental health service utilization resulted from structural barriers, such as A
s
e
lack of transportation, low availability of care providers, cost, and insurance barriers. c
vi
r
e
S
At the same time, the Surgeon General identified an acute need for additional h
t
information on racial/ethnic differences in mental health care delivery, as well as ongoing al
e
H
national surveillance of mental health service utilization.1 Currently, most national al
t
n
estimates of mental health service use among racial/ethnic groups are based on data e
M
nearing or more than a decade old.1,2,3,4,5,6,7,8,9,10,11 Since the release of the Surgeon d
n
a
General’s report, significant policy changes have occurred, such as the Mental Health e
s
u
Parity and Addiction Equity Act of 2008.12 These policy changes have affected insurance b
A
coverage for mental health care and access to care.13 Moreover, with the passage of the e
c
n
Affordable Care Act of 2010,14 further changes in access to care are expected.15 ta
s
b
u
S
3
CHAPTER 1 · Introduction
The purpose of this chartbook is to provide more recent, Methods for this chartbook are presented in Section 2.
h nationally representative estimates of mental health service The chartbook presents information on racial/ethnic
t
al
e
H utilization among adults aged 18 or older across different differences in mental health service utilization among
d
n racial/ethnic groups in the United States. These data may all adults (Section 3), among adults with any mental
a
e
Us serve as a benchmark for examining future national-level illness (AMI) (Section 4), and among adults with serious
g
u changes in mental health service utilization among adults mental illness (i.e., mental illness with serious functional
r
D
n in different racial/ethnic groups in the United States, impairment; SMI) (Section 5). Data on racial/ethnic
o
y
e particularly in the context of relevant policy changes. differences in mental health service utilization also are
v
r
u
S examined in the context of other characteristics, such as
al This chartbook uses combined 2008 to 2012 data from
n age, gender, and education. Sections 3 to 5 are organized
o
ti the National Survey on Drug Use and Health (NSDUH).
Na uniformly, each with an introduction that describes
· NSDUH is the primary source of statistical information
n relevant points for interpreting the data presented and
o on the use of illegal drugs, alcohol, and tobacco by the
ti a variety of figures showing racial/ethnic differences in
a
r civilian, noninstitutionalized population of the United
st mental health service utilization. All of the figures present
ni States aged 12 years old or older. The survey also includes
mi annual average percentages for the 2008 to 2012 period
d several modules of questions that focus on mental health
A and 95 percent confidence intervals (CIs) to show the
s
e issues. Conducted by the Federal Government since 1971,
c precision of the estimates. Because of small sample sizes
vi
r the survey collects data through face-to-face interviews
e for some racial/ethnic groups even with 5 years of data,
S
h with a representative sample of the population at the
t some estimates may be imprecise, as indicated by the
eal respondent’s place of residence. The survey is sponsored
H wide CIs. In these situations, large apparent differences
al by the Substance Abuse and Mental Health Services
t between groups may not be statistically significant. In
n
e Administration (SAMHSA), U.S. Department of Health
M cases where the estimates are too imprecise, statistical
d and Human Services, and is planned and managed by
n comparisons may not be conducted and/or estimates may
a
e SAMHSA’s Center for Behavioral Health Statistics and
s be suppressed. All unsuppressed estimates are available
u
b Quality (CBHSQ). Data collection and analysis are
A in Appendix A (estimates among all adults), Appendix B
ce conducted under contract with RTI International.
n (estimates among adults with AMI), and Appendix C
a
t
bs (estimates among adults with SMI).
u
S
4
2
2 Methods
h
t
al
e
H
d
n
a
e
s
U
g
u
r
D
n
o
y
e
v
r
u
S
al
2.1 Data Sources n
o
ti
a
N
Data in this chartbook come from the 2008 to 2012 National Surveys on Drug Use ·
n
and Health (NSDUHs). Each annual survey is administered to a sample of the civilian, o
ti
a
noninstitutionalized population of the United States aged 12 or older. Respondents tr
s
ni
include residents of households and noninstitutional group quarters (e.g., shelters, mi
d
rooming houses, dormitories) and civilians living on military bases. The survey excludes A
s
homeless people who do not use shelters, military personnel on active duty, and residents e
c
vi
of institutional group quarters, such as jails and hospitals. r
e
S
h
t
NSDUH collects data from a probability sample of the population aged 12 or older in al
e
H
all 50 States and the District of Columbia using a multistage design. For the 2008 to al
t
2012 NSDUHs, States were first stratified into State sampling regions (SSRs). Within n
e
M
each SSR, the first stage of selection was census tracts. Within sampled census tracts, d
n
adjacent census blocks were combined to form the second-stage sampling units, or area a
e
s
segments. In each of the area segments, a listing of all addresses was made from which u
b
A
national samples of addresses were selected. If a sampled address was determined to be e
c
n
an eligible dwelling unit, sample individuals were randomly selected using an automated a
t
s
b
screening procedure programmed in a handheld computer carried by the interviewers. u
S
Up to two eligible individuals from a dwelling unit could be selected for the interview.
Adolescents aged 12 to 17 and adults aged 18 to 25 are oversampled at this stage.
5
CHAPTER 2 · Methods
The NSDUH interview can be completed in English or 2.2 Chartbook Methodology
h Spanish, and both versions have the same content. If the
alt Sample
e
H sample individual prefers to complete the interview in
d This chartbook presents data on adults aged 18 or older
n Spanish, a certified bilingual interviewer is sent to the
a
e (henceforth referred to as “adults”). Data collection for any
Us address to conduct the interview. Because the interview
g mental illness (AMI) and serious mental illness (SMI) began
u is not translated into any other language, if a sample
r
D
n individual does not speak English or Spanish, the interview in 2008; therefore, this chartbook combines 2008 through
o
y 2012 NSDUH data. From 2008 to 2012, approximately
e is not conducted.
v
ur 45,900 adults were surveyed annually.
S
al Immediately after completion of the household screening,
n
o Data are presented for racial/ethnic groups based on Federal
ti interviewers attempt to conduct the NSDUH interview
a
N guidelines for collecting and reporting race/ethnicity data.21
· with each sample individual in the household. The
n Because respondents could choose more than one racial
o interviewer requests the selected respondent to identify a
ti
a group, a “two or more races” category is included for those
r private area in the home to conduct the interview away from
t
s
ni other household members. The interview averages about an who reported more than one category (i.e., white, black
mi
or African American, American Indian or Alaska Native,
d hour and collects data on a variety of topics, including drug
A
s Native Hawaiian, Other Pacific Islander, Asian, Other).
e and alcohol use, mental illness, substance use disorders,
c
vi Respondents choosing both Native Hawaiian and Other
r and the use of services for mental disorders and substance
e
S Pacific Islander but no other categories are classified as being
h use disorders. Questions about less sensitive topics, such as
t
eal demographic characteristics, are interviewer administered. in the “Native Hawaiian or Other Pacific Islander” category
H
al Questions about sensitive topics—including criminal instead of the “two or more races” category. Except for the
t
n “Hispanic or Latino” group, the racial/ethnic groups include
e justice contact, substance use, and mental health issues—are
M
d administered via audio computer-assisted self-interviewing only non-Hispanics. The category “Hispanic or Latino”
n
a includes Hispanics of any race.
e (ACASI). ACASI provides maximum privacy for
s
u
b respondents in the household setting to promote accurate
A Of the total sample of adults in the 2008 through 2012
nce reporting of data on sensitive topics. More information NSDUH data, 65.4 percent were white, 11.9 percent were
a
t on the study design of NSDUH can be found in the 2008
s black, 1.3 percent were American Indian or Alaska Native,
b
u national findings report and the 2009 to 2012 mental health
S 3.6 percent were Asian, 2.6 percent reported two or more
findings reports.16,17,18,19,20
races, and 15.1 percent were Hispanic. Because of the low
6