title: Racial-ethnic differences in access, diagnosis, and outcomes in public-sector inpatient mental health treatment.
abstract: This study investigated inequities in access, diagnosis, and treatment for African Americans and Hispanic Americans receiving treatment in northeast, public sector, inpatient mental health settings as part of a Department of Mental Health and Addiction Services Health Disparities Initiative. Data from 1,484 adults were obtained through a random extract of patients admitted to state inpatient facilities between 2002 and 2005. After controlling for demographic variables and symptom severity, logistic and linear regression showed that Hispanic Americans were significantly more likely to enter inpatient care through crisis/emergency sources and were significantly less likely to self-refer or come to inpatient care through other sources (e.g., family, outpatient). After admission, Hispanic Americans were more likely to be diagnosed with other psychotic disorders (e.g., schizoaffective disorder, delusional disorder), were less likely to receive an Axis II diagnosis at discharge, and had a shorter length of stay than non-Hispanic White Americans. African Americans were more likely than other groups to be diagnosed with schizophrenia, drug-related, and Cluster B diagnoses (discharge only), and they were less likely to be diagnosed with mood disorders and other nonpsychotic disorders. Although African Americans were more likely than other groups to come to inpatient units from numerous routes, including self-referral and referral from other sources (e.g., family, outpatient), they were more likely to terminate treatment against medical advice and displayed shorter length of stay despite receiving ratings of greater symptom severity at discharge. These findings highlight the need for policies, programs, and system interventions designed to eliminate disparities and improve the quality and cultural responsiveness of behavioral health services.
authors.affiliation: Department of Psychiatry, Yale School of Medicine.
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Delphin-Rittmon
authors.affiliation: Department of Psychiatry, Yale School of Medicine.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Flanagan
authors.affiliation: Department of Psychiatry, Miami VA Healthcare System.
authors.forename: Raquel
authors.initials: R
authors.lastname: Andres-Hyman
authors.affiliation: Hispanic Health Council.
authors.forename: Jose
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Psychology Unit, American University Cairo.
authors.forename: Mona M
authors.initials: MM
authors.lastname: Amer
authors.affiliation: Department of Psychiatry, Yale School of Medicine.
authors.forename: Larry
authors.initials: L
authors.lastname: Davidson
mesh_terms: D000328:Adult; D003237:Connecticut / Q000208:ethnology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006783:Hospitals, State / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D008875:Middle Aged; D016896:Treatment Outcome