Disparities in Access to Mental Health Care among Racial and Ethnic Minorities in the United States

Health Policy Issue Analysis Paper

Select a population-based health policy issue that can be either an issue within a community or organization. Your policy analysis should include an analysis of why this is an issue, possible alternatives, selected recommendation for policy change, and include strategies to achieve this policy decision.

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Disparities in Access to Mental Health Care among Racial and Ethnic Minorities in the United States

The unfair incongruences witnessed in the access to quality mental health care services have long represented a contemporary issue of grave concern within the United States. Mental health disparities disproportionately affect racial and ethnic minorities seeking to access mental health services integral in the management of respective conditions. Persistence in the aforementioned disparities has led healthcare pundits such as Clare Bambra to conclude that they are a direct result of structural guidelines deeply ingrained in prevailing healthcare policy (Bambra, 2016). Although proponents of this current system strongly defended its efficacy in providing access to quality care, a growing body of evidence supports claims of serious disparities in the access to mental health care within the United States. The high cost of quality healthcare, cultural stigma surrounding psychiatric health and discrimination are now linked to the overarching disparities in mental health care among racial and ethnic disparities. This is disconcerting especially considering 2 in every 6 American adults are diagnosed with a psychiatric illness annually (Arul & Mesfin, 2016).

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It is also worth acknowledging that mental health problems may have severe consequences for sufferers since they are capable of interfering with normal functioning within any ordered society. Inadequate access to mental health services typically results in negative outcomes for persons diagnosed with psychiatric disorders.  Racial and ethnic minorities particularly bear the brunt of this current state, with many grappling with a reduced quality of life, risk of incarceration due to antisocial behavior and an increase in financial difficulties. Private insurers, the Centers for Medicare and Medicaid (CMS) and the Ministry of Health and Human Services (HHS) are now linked to mental heal disparities based on their involvement in policy decisions. An evaluation of these disparities is, therefore, fundamental, in addition to feasible recommendations for policy change and strategies to achieve this strategy decision.

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Background and significance

Historical context

            Mental health services in the United States date back to the 18th century in era when society was just beginning to come to grips with the reality and effects of psychological disorders.  Efforts by influential policy makers in Williamsburg, Virginia resulted in the construction of Eastern State Hospital in 1773 which is generally regarded as the first mental health facility in the United States. Following the relative success of this initial milestone, the federal government embarked on an elaborate healthcare campaign with the primary aim of opening new facilities across the country to improve access to essentials services. During this period, mental health was generally regarded as a fringe element of wellbeing and the main reason why it was not underscored by healthcare providers (Chan, Parikh, Thorpe, & Gaskin, 2019). Yet, the federal government still played an active role in the provision of mental health services through respective agencies. Mental health as an emerging problem was highlighted by Clifford W. Beers in 1908 when he suffered an extreme episode of his manic depressive disorder. It was during his stint at a mental health facility that he had a personal experience of discrepancies in mental health facilities and the effects of inconsistencies, documented in his autobiography dubbed A Mind That Cannot Find Itself.  This was among the first instance of disparities in mental health care being elucidated, later resulting in awareness regarding disproportions in access to quality services.

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Alignment with public health core functions and essential services

            In the United States, the Ministry of Health and Human Services (HHS) is responsible for coordinating the provision of mental health services to patients with psychiatric.  HHS has been at the forefront of aligning core functions of public health and essential services to create a robust system capable of identifying the requirements of at-risk populations.  The HHS essentially participates in the creation of a mental health safety net to identify unmet needs, thus broadening access to integral services while building capacity in professionals to improve patient outcomes. Due to the wide array of actors, mental health services now represent a multibillion-dollar sector yet still incapable of serving an ever-growing population. According to Ezra E. H. Griffith, Billy E. Jones and Altha J. Stewart (2018), the United States allocates $113 billion annually to mental health services in a bid to guarantee the provision of essential services to the public (p. 40). This particular provision seeks to realize core public health functions such as healthy behaviors, helping at-risk populations to recover from adverse health conditions, and the provision of quality and convenient health services.  The alignment of mental health services with core public health functions is now ranked among the main priorities of the HHS. It is through this configuration that the department and its agencies seek to realize its goal of providing essential services required by individuals in dire need. 

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Current status

            Mental health services currently take center stage in the United States due to their integral nature.  Typically, they are included in the annual budget to pledge the provision of essential health services while improving the quality of treatment options. However, it is worth noting that a considerable amount of this allocation goes to prescription medications for persons with psychiatric disorders and outpatient treatment. This is an indication of government policies adopted in the 1960s encouraging a shift from institutionalization to pave the way for a new framework based on treatment within a community setting.  Providing treatment in a less restrictive environment is now hailed for the leaps and bounds witnessed in the delivery of mental health services in the 21st century. Nevertheless, ethnic and racial disparities are still more prevalent in mental health care compared to other health services. This is further exacerbated by the Mental Health Professionals Shortage Areas policy which is responsible for hindering access to essential services in the case of individuals residing in non-federally designated areas. Additionally, the high cost of care associated with mental healthcare has now emerged as a looming barrier which further cements current disparities.

Synthesis of related literature

            Available literature on mental health services has been responsible for the identification of possible barriers to care and access to key mental health services. According to a longitudinal study conducted by Medlock, Shtasel, Trinh, and Williams (2018), low use of prescribed medication was identified among the prime reasons why ethnic and racial disparities are commonplace in mental health care. A review conducted by the researchers into mental health trends among African American and Hispanic American respondents revealed that three of five recently discharged patients failed to adhere to prescribed medications (Medlock, Shtasel, Trinh, and Williams, 2018).  Inexplicably low educations levels and a systematic failure by healthcare providers to disseminate integral information regarding the importance of following a regular treatment regimen were cited as possible reasons explaining these stark disparities.

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An overall breakdown in doctor-patient communication has also recently been identified as a possible reason for racial and ethnic disparities. Metrosa (2017) opines that a general lack of cultural competence in the provision of mental care may explain why Hispanic Americans record the highest number of individuals with mental health conditions yet they fail to gain access to essential services. Persistent stigma is also responsible for racial and ethnic disparities in the provision of mental health services. According to Ruiz and Primm (2016), failure by the Ministry of Health and Human Services (HHS) to address mental health stigma has created an ideal environment for racial and ethnic disparities to flourish. The result has often been failure to seek care, high relapse rates for patients undergoing treatment and premature discontinuation of prescribed drugs.

Theoretical framework in the analysis of mental health disparities among racial and ethnic minorities

The theoretical framework employed in this particular analysis will rely on Stewart and Nápoles-Springer’s model that the current disparities are a direct result of policy issues within the healthcare system. This framework is particularly significant in tracing the origin of disparities through different phases. The first phase entails a progressive evaluation of mental health disparities and its effects of vulnerable sections of the population. It is also during this stage this stage that key issues are identified as possible causes in addition to identifying strategies to mitigate its effects (Woo, 2017, p. 770). 

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The second phase within this framework entails gaining a comprehensive understanding of the main reason why such disparities exist in the first place. It is through this approach that gaps in the provision of healthcare are identified in addition to vulnerable individuals in society bound to experience adverse accompanying effects.  Determinants of racial and ethnic disparities within different levels of the healthcare system are also essential in this stage as a way of identifying possible relationships. The last phase when conducting analysis using the health system theoretical framework involves evaluation and the implementation of possible intervention strategies. This section also includes propositions on possible changes in policy with the aim of transforming the status quo, which is ultimately meant to introduce cumulative gains.

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Policy issue analysis

Key actors

            Mental health services are the prerogative of a number of several key actors. The Ministry of Health and Human Services (HHS) is one of the main players in the provision of mental health services within the United States.  It has been at the forefront of implementing the Mental Health Parity and Addiction Equity Act of 2008 to expand access to essential mental health services across the country. Health facilities and providers also represent key actors within the health sector tasked with ensuring individuals with psychiatric disorders receive suitable care services. Insurers also represent a class of important actors in the provision of mental health services. It was through the Affordable Care Act of 2010 (ACA) that insurance companies were first tasked with providing plans which now cover mental health and substance abuse related disorders.

Facilitating and limiting factors

            Several facilitating factors have emerged within the past decade to support the provision of mental health services within the United States.  One such factor is the active participation of the HHS in ensuring that the healthcare workforce is better equipped to deal with emerging challenges. Medical practitioners are now trained in offering care to vulnerable populations while adhering to a concise operational structure with the primary aim of improving the overall mental health system (Goldman, Frank, & Morrissey, 2019). Another facilitating factor now involves providing training to medical practitioners within a community setting to serve patient’s needs beyond the hospital setting. Diversifying the workforce has also resulted in improved outcomes for racial and ethnic minorities with mental disorders due to an improvement in cultural competence.

            Nevertheless, limiting factors also do exist.  For instance, lack of a clear mental health agenda fails to meet patient’s needs, therefore, resulting in a relatively ineffective distribution of resources. Additionally, an overall inadequacy in mental health advocacy within the United States is responsible for insufficient focus on disparities in the provision of essential mental health services which further widens the gap. Few national policies addressing disparities in mental health care also creates a scenario where little to no focus is given to mental health issues, further worsening current incongruences.  The social stigma surrounding mental health issues has also resulted in the adoption of indifference towards the services offered with many viewing it as private responsibility.

Economic impact of mental health disparities among racial and ethnic minorities

            In addition to the human toll of behavioral disorders, mental health disparities are also responsible for adverse economic impacts.  It is worth noting that mental health disorders and related disparities introduce economic costs to patients, employers, and federal departments. Current estimates place the economic cost of mental health disparities at $510 billion; a figure projected to grow twofold within the next decade (National Institute of Mental Health, 2019).  Disparities are also bound to result in substance abuse issues among patients with known psychiatric disorders which will further burden an already overstretched public health system.

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Enforcement implications

            The acknowledgement of mental health disparities among minorities is one of the most important steps when seeking to introduce lasting solutions to this modern debacle.  Changes instituted by policymakers working at the highest level of government will ensure that racial and ethnic disparities become a priority in order to remedy the current situation. This will involve the implantation of workable solutions with the government’s scope which will go a long way in addressing emerging challenges. The inclusion of mental health experts in panels for the reduction of mental health disparities will also ensure that changes in policy are informed by research to ultimately improve outcomes.

Impact on social justice

            Mental health disparities among racial and ethnic minorities also have an adversarial impact on social justice. Individuals with unmet mental health needs typically experience difficulties coping in society. This then results in demeanor that is typically viewed as antisocial and frequent encounters with the criminal justice system. It is currently estimated that 48 percent of individuals from minority communities who are incarcerated annually suffer from a spectrum of mental disorder (Gosselin, 2017). Furthermore, lack of access to mental health care may also result in substance abuse issues, which may explains the high numbers of individuals from the African American and Hispanic American communities who are indicted on drug charges.

Alternatives proposed by detractors

            Detractors of the current mental health system have proposed possible alternatives to aid in reducing disproportionate disparities recorded among ethnic and racial minorities. One such solution recommends awareness campaigns to bring attention to mental health disparities and possible interventions. Passing grand state resolutions will make certain that mental health issues take precedence which will ultimately go a long way in reducing disparities. Addressing mental health disparities will also ensure that law makers focus on passing legislation to improve access to care and essential services. Engaging affected populations is also regarded as a practical solution when seeking to reduce disparities. This will also include promoting cultural competence to improve access to mental health services while strengthening the workforce.

Potential unintended consequences

            Mental health disparities are now linked to a myriad of unintended consequences which patients now have to grapple with. For instance, it results in insufficient access to essential services leading to a reduced quality of life. It also fosters negative attitudes among individuals in minority communities who eventually conclude that mental health services do not work and are, therefore, incapable of offering any solution to many of their current challenges. Mental health stigma also creates a system which focuses more on non-minority values at the expense of vulnerable populations. This has resulted in outright discrimination in treatment settings with most of the individuals from minority groups missing out on essential services.

Mental health disparities and Healthy People 2020 objectives

            As part of its health promotion campaign, Healthy People 2020 has also addressed mental health disparities to improve the quality of life. This is done through prevention initiatives while still making certain that vulnerable populations gain access to essential services (Office of Disease Prevention and Health Promotion, 2018). The Healthy People 2020 campaign has also outlined its aim of improving the personal well-being of individuals by clamoring for an increased focus on mental health disparities by government agencies. The multilayer effects of disparities will also be explored with the primary aim of developing preventative interventions targeting ethnic and racial minorities.

Recommendations

Policy Recommendations

            An overall inadequacy in primary mental health providers in the United States has recently been linked to disparities presently witnessed in the provision of essential services. Addressing incentives within the healthcare system, reviewing the payer system and treatment of persons with mental health issues displaying criminal tendencies is thus crucial in addressing mental health disparities.

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             The primary care mandate should now include capacity building within the workforce to enable care providers to offer crucial services to at-risk populations. The incorporation of a policy addressing mental health care and screening under the Affordable Care Act (ACA) will be essential in improving the psychological wellbeing of minority communities. This policy should also incorporate a framework addressing specific needs of minorities with mental health issues by relying on specially trained mental health workers. A collaborative care approach will also guarantee participation during treatment while improving care seeking behavior among minority communities

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            The establishment of mental health care accountability organizations such as Centers for Medicare and Medicaid (CMS) will also prompt healthcare providers to adopt models bound to improve care. In particular, the adoption of a value based system will introduce lower costs for care services which will then enhance access to care. Psychiatric professionals will then be expected to adhere to identifying tenets of this new development in policy, making certain that healthcare providers are capable of providing on-site treatment to patients.

Summary

Disparities in access to mental health care have long represented an emerging challenge for the health care system in the United States. Ethnic and racial minorities have traditionally experienced numerous challenges when endeavoring to gain access to quality mental healthcare services within a complex framework. Mental health services are an essential part of the HHS’s mandate tasked with aligning its core functions with the provision of mental health care services. The HHS, care providers, and insurers are key actors in mental healthcare, which is also why they are linked to racial and ethnic disparities in the provision of care. Addressing incentives in the healthcare system, reviewing the payer system and treatment of persons with mental health issues displaying criminal tendencies is thus crucial in addressing mental health disparities. Nursing leaders also play a crucial role in effecting change by participating in advocacy campaigns seeking to remove barriers to mental healthcare, hence increasing its accessibility to racial and ethnic minorities.

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