Black children and young adults are only about half as likely as their white peers to get mental health care despite having similar rates of mental health problems, according to a new study published in the International Journal of Health Services.
The researchers analyzed data on children under 18 and young adults 18-34 from the Medical Expenditure Panel Survey covering all 50 states for the years 2006-2012. They found that minorities receive much less of all types of mental health care, including visits to psychiatrists, social workers, and psychologists, as well as substance abuse counseling and mental health counseling by pediatricians and other doctors.
Black children’s low use of services was not due to lesser need. Black and white children had similar rates of mental health problems, and similar rates of severe episodes that resulted in psychiatric hospitalization or emergency visits.
Hispanic parents reported less mental health impairment among their children, but analyses that controlled for this lesser need for care still show underuse compared to non-Hispanic whites.
Overall, the findings reveal that black and Latino children made, respectively, 37 percent and 49 percent fewer visits to psychiatrists, and 47 percent and 58 percent fewer visits to any mental health professional, than white children.
These disparities were even greater among young adults with whites receiving about three times more outpatient mental health services than blacks and Hispanics. The substance abuse counseling rate for black young adults was particularly low, about one-seventh of the rate for whites.
Among children, girls received less mental health care than boys. The gender difference was reversed among young adults, however, with women having more visits.
Black and hispanic young men, who were at the highest risk for incarceration, had particularly low mental health visit rates. According to Department of Justice data, at least half of inmates suffer from mental illness, most of whom had been untreated at the time of arrest.
“The under-provision of mental health care for minority children contrasts starkly with the high frequency of punitive sanctions that their behaviors elicit,” write the authors.
“Black children suffer excessive rates of school discipline such as suspensions and expulsions starting at preschool ages. Minority teens also have disproportionate contact with the juvenile justice system, with higher arrest rates for nonviolent, low-level offenses such as drug possession, as well as for non-criminal misbehaviors such as truancy and curfew violations.”
“Youthful transgressions that might result in referral for treatment among non-minority children more often incur criminal sanctions for minorities.”
The researchers also observed that minorities’ very low substance abuse treatment rates contrast with their high rates of arrest for substance abuse.
“It has become increasingly clear that minorities are overrepresented in the criminal justice system and underrepresented in the receipt of mental health care. We need to look closely at how equitably our health care institutions are serving all segments of society,” said study leader Dr. Lyndonna Marrast, who was a fellow at Harvard Medical School and Cambridge Health Alliance when she began the study. She is currently assistant professor of medicine at the Hofstra Northwell School of Medicine in New York.
The study’s co-authors are Dr. Steffie Woolhandler and Dr. David Himmelstein, professors at the City University of New York at Hunter College and lecturers at Harvard Medical School.
“Minority kids don’t get help when they’re in trouble. Instead they get expelled or jailed. But punishing people for mental illness or addiction is both inhumane and ineffective. The lack of care for minority youth is the real crime,” said Woolhandler.