There hasn't been a comprehensive look at whether disparities in mental health services have improved since 2001, when a U.S. surgeon general's report warned that racial and ethnic minority populations were underserved.
Now a 2015 APA book called "Foundations of Multicultural Psychology: Research to Inform Effective Practice" fills that gap, with a series of meta-analyses drawing on data from more than 4.7 million clients in 130 research studies.
"If there's a larger meta-analysis in psychotherapy in terms of numbers of clients, we're not aware of it," says Timothy B. Smith, PhD, of Brigham Young University, who co-authored the book with Joseph E. Trimble, PhD, of Western Washington University. The book also includes meta-analyses on treatment completion, therapist characteristics, culturally adapted services and other areas.
The meta-analyses revealed that racial and ethnic discrepancies have decreased somewhat, but are still substantial, says Smith. African-Americans are 21 percent less likely than white European-Americans to use mental health services, for example. Hispanics and Latinos are 25 percent less likely. And it's not just a matter of socioeconomic status, adds Smith, explaining that people have long assumed that differences in income and health insurance access account for disparities. "Our data show that race is an equally independent predictor of mental health utilization," he says.
The problem of underutilization is especially severe for Asian-Americans, who are 51 percent less likely to take advantage of mental health services than their white European-American counterparts. "Across the studies, Asian-Americans were by far the racial group that was most likely to underutilize mental health services given their percentage in the population," says Smith.
The type of mental health services provided makes a difference. Disparities among African-Americans disappeared when they sought services in public, rather than private, service settings, for example. "The obvious implication is that there's great benefit to public mental health services," says Smith. "Every effort should be made to maintain access to public services."
The research also points to the need for greater specificity in analyzing disparities, says Trimble. "If we're setting up services for African-Americans, who are we talking about — African-Americans from Haiti, from Boston, from Guatemala?" he says. "There has to be more precision in how these labels are used in the context of unscrambling the deep meaning of culture and tailoring programs in ways that really reflect the deep cultural meaning of who a person is."
— Rebecca A. Clay
