Disparities within the Behavioral Health System

dis•par•i•ty
noun, plural -ties
.
lack of similarity or equality; inequality; difference: a disparity in age; disparity in rank

What are the disparities that exist in the behavioral health system?

Disparities in the behavioral health system exist when unjust inequities in access to and quality of treatment exist.  For example, Native Americans disproportionately experience PTSD and alcoholism and are thus overrepresented in these areas.  African Americans are less likely to receive psychiatric services and are thus underserved in this area.  Female veterans disproportionately experience PTSD (overrepresented) yet appropriate services and practices are not fully in place to address this gender-specific PTSD (underserved).

Disparities in quality of treatment are often associated with class and socioeconomic standards, and illustrate how certain groups of people may receive poor treatment or no treatment at all due to lack of insurance, inability to pay, or lack of accessible service providers.

Why do disparities matter?

The existence of disparities is contradictory to the work that is being done to increase access to behavioral health treatment, to increase the quality of treatment, and to make sure that all people, regardless of race, sex, gender, sexual orientation, ethnicity, employment status, socioeconomic status, veteran status, or disability have access to the services they deserve.  Once we recognize where these disparities are in our communities, we can actualize change and work to ensure that all people have equal access to services that are high quality and effective.

Here are a few examples of the realities of behavioral health disparities and their impact on the people in our communities:

People with Behavioral Health Challenges

Adults living with severe mental illness (SMI) die 25 years earlier than their peers, largely due to preventable disease and treatable medical conditions (1).

Native Americans

According to the CDC (2), although American Indians/Alaska Natives represent the smallest proportion of suicides of all racial/ethnic groups, they share the highest rates with whites.  In general, the suicide rate for males is nearly four times the rate for females.

Lesbian, Gay, Bisexual, and Transgender Individuals

An article published by the New York Times reports that “Older gay and bisexual men — ages 50 to 70 — reported higher rates of high blood pressure, diabetes and physical disability than similar heterosexual men. Older gay and bisexual men also were 45 percent more likely to report psychological distress and 50 percent more likely to rate their health as fair or poor.”  Among young adults, according to Science Daily, the stigma that surrounds lesbian, gay, bisexual, and transgender (LGBT) teens leads to a variety of health risks such as “substance use, risky sexual behaviors, eating disorders, suicidal ideation, and victimization.”

African Americans

As reported in Medical News Today, “According to the 2008 National Healthcare Disparities Report, 8.3 percent of non-Hispanic black women under the age of 18 received mental health treatment in 2006, compared to 20 percent of non-Hispanic white women.”

Hispanics/Latinos

An American Psychological Association (APA) fact sheet states that, nationally, 33% of Hispanics are uninsured, compared to 16% percent of all Americans. Hispanic/Latino youth are more likely than their white peers to experience sadness and hopelessness (36% versus 26%) and are more likely to attempt suicide (10% versus 6% of whites).  Across age groups, Hispanics/Latinos with a behavioral health condition are less likely than their counterparts to contact a mental health provider for support – fewer than 1 in 11 members of this population will reach out to a mental health specialist.

We see, then, that disparities matter because they directly, and negatively, impact the health and well-being of the people service providers strive to assist.  However, once we evaluate our own communities and assess where these disparities exist, we have the power to create positive change and help to reduce, or even eliminate, these inequities.

A large component of successful work against disparities is communication – talking with and interacting with the populations of people who experience these inequities and who are disproportionately represented in behavioral health systems.  For example, bringing youth together for a focus group or discussion about what helps and what harms is a simple and effective way that service providers can obtain the information needed to better adapt to meet the needs of this at-risk population.

Part of why we engage in innovative service delivery projects, such as those funded by the Mental Health Transformation Grant, is to generate change and enhancements to service provision that can assist with the creation of larger system transformation – and provide quality services to those members of our community who need them most.  As we seek to transform systems, including behavioral health systems, we are also seeking to promote social justice, equity, and equality.  Disparities, however, create the opposite – and are responsible for preventable and treatable illnesses going untreated, and expensive and unnecessary hospitalization, for example.  Recognizing where these disparities are in our own communities can help us address these issues and provide the best care and service we can for all people.

Disparities Resources

Behavioral health