Racial/Ethnic Differences in Mental Health Service Use among Adults
In 2001, the U.S. Surgeon General released a seminal report, Mental Health: Culture, Race, and Ethnicity, that documented substantial differences in mental health service utilization between non-Hispanic white adults and other racial/ethnic groups.1 The report also noted racial/ethnic differences in the types of services that are used. Moreover, the Surgeon General determined that not all differences in mental health service utilization resulted from personal preference. Rather, many of the racial/ethnic differences in mental health service utilization resulted from structural barriers, such as lack of transportation, low availability of care providers, cost, and insurance barriers.
At the same time, the Surgeon General identified an acute need for additional information on racial/ethnic differences in mental health care delivery, as well as ongoing national surveillance of mental health service utilization.1 Currently, most national estimates of mental health service use among racial/ethnic groups are based on data nearing or more than a decade old. Since the release of the Surgeon General’s report, significant policy changes have occurred, such as the Mental Health Parity and Addiction Equity Act of 2008. These policy changes have affected insurance coverage for mental health care and access to care. Moreover, with the passage of the Affordable Care Act of 2010, further changes in access to care are expected.
The purpose of this chartbook is to provide more recent, nationally representative estimates of mental health service utilization among adults aged 18 or older across different racial/ethnic groups in the United States. These data may serve as a benchmark for examining future national-level changes in mental health service utilization among adults in different racial/ethnic groups in the United States, particularly in the context of relevant policy changes.
This chartbook uses combined 2008 to 2012 data from the National Survey on Drug Use and Health (NSDUH). NSDUH is the primary source of statistical information on the use of illegal drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey also includes several modules of questions that focus on mental health issues. Conducted by the Federal Government since 1971, the survey collects data through face-to-face interviews with a representative sample of the population at the respondent’s place of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, and is planned and managed by SAMHSA’s Center for Behavioral Health Statistics and Quality (CBHSQ). Data collection and analysis are conducted under contract with RTI International.
Methods for this chartbook are presented in Section 2. The chartbook presents information on racial/ethnic differences in mental health service utilization among all adults (Section 3), among adults with any mental illness (AMI) (Section 4), and among adults with serious mental illness (i.e., mental illness with serious functional impairment; SMI) (Section 5). Data on racial/ethnic differences in mental health service utilization also are examined in the context of other characteristics, such as age, gender, and education. Sections 3 to 5 are organized uniformly, each with an introduction that describes relevant points for interpreting the data presented and a variety of figures showing racial/ethnic differences in mental health service utilization. All of the figures present annual average percentages for the 2008 to 2012 period and 95 percent confidence intervals (CIs) to show the precision of the estimates.
Because of small sample sizes for some racial/ethnic groups even with 5 years of data, some estimates may be imprecise, as indicated by the wide CIs. In these situations, large apparent differences between groups may not be statistically significant. In cases where the estimates are too imprecise, statistical comparisons may not be conducted and/or estimates may be suppressed. All unsuppressed estimates are available in Appendix A (estimates among all adults), Appendix B (estimates among adults with AMI), and Appendix C (estimates among adults with SMI).
