title: Assessing racial/ethnic disparities in treatment across episodes of mental health care.
abstract: OBJECTIVE
  To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment.
  
  
  METHODS
  We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing disparities at the beginning, middle, and end of episodes of care (initiation, adequate care, having an episode with only psychotropic drug fills, intensity of care, the mixture of primary care provider (PCP) and specialist visits, use of acute psychiatric care, and termination).
  
  
  RESULTS
  Compared with whites, blacks and Latinos had less initiation and adequacy of care. Black and Latino episodes were shorter and had fewer psychotropic drug fills. Black episodes had a greater proportion of specialist visits and Latino episodes had a greater proportion of PCP visits. Blacks were more likely to have an episode with acute psychiatric care.
  
  
  CONCLUSIONS
  Disparities in adequate care were driven by initiation disparities, reinforcing the need for policies that improve access. Many episodes were characterized only by psychotropic drug fills, suggesting inadequate medication guidance. Blacks' higher rate of specialist use contradicts previous studies and deserves future investigation. Blacks' greater acute mental health care use raises concerns over monitoring of their treatment.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Center for Multicultural Mental Health Research, 120 Beacon Street, 4th Floor, Somerville, MA, 02143.
authors.forename: Benjamin Lê
authors.initials: BL
authors.lastname: Cook
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Zuvekas
authors.forename: Nicholas
authors.initials: N
authors.lastname: Carson
authors.forename: Geoffrey Ferris
authors.initials: GF
authors.lastname: Wayne
authors.forename: Andrew
authors.initials: A
authors.lastname: Vesper
authors.forename: Thomas G
authors.initials: TG
authors.lastname: McGuire
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D017050:Episode of Care; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy*; D008875:Middle Aged; D015233:Models, Statistical; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data
keywords: Racial/ethnic disparities in mental health care; episodes of care; longitudinal data; panel data; psychotropic drug use