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Using Collaborative Care to Reduce Racial and Ethnic Disparities in Mental Health Care

NAMHC Concept Clearance

Presenter

Pamela Y. Collins, M.D., M.P.H.
Director, Office for Research on Disparities & Global Mental Health
Director, Office of Rural Mental Health Research

Goal

This initiative aims to support innovative research on the implementation of evidence-based interventions to reduce disparities in mental health care among diverse racial and ethnic groups in the United States. The research supported will contribute to the reduction of disparities in access to care, retention in care, and treatment outcomes.

Rationale

Members of racial and ethnic minority groups in the United States are less likely to access mental health services (Wang et al, 2005), more likely to receive lower quality care (Alegría et al., 2008), more likely to use inpatient hospitalization and emergency rooms, and less likely to utilize community mental health services (Samnaliev et al., 2009). Reduced access and utilization of care among these communities are associated with delayed treatment seeking (Wang et al, 2005), premature termination of treatment (Fortuna, et al., 2010), and, in some cases, preference for non-traditional mental health services (Abe-Kim et al., 2007). These differences in access and utilization cannot be attributable solely to lower prevalence of disorders (Lee, 2011). Although the prevalence of mood and anxiety disorders is lower among many racial/ethnic minorities compared to Whites (Kessler et al., 2005; Takeuchi, Hong, Gile, & Alegría, 2007), the course of illness for these disorders is often more severe, persistent, and disabling (Breslau, 2005; Williams & Neighbors, et al., 2007). Not having access to timely, coordinated, sustained mental health care among racial/ethnic minorities leads to a significant burden of disease among sufferers and may also result in greater healthcare costs.

Collaborative care has the potential to reduce racial/ethnic disparities in mental health service access, quality of care, and clinical outcomes (Steenbergen-Weijenburg et al., 2010; Woltmann et al., 2012; Davis, 2011). Elements of this model include coaching patients to self-manage symptoms, facilitating the flow of clinical information between providers and patients, training medical professionals and staff to provide preventive and other collaborative care services, supporting generalist clinicians with on-site specialty consultations, equipping patients with community resources, and building organization-level capacity to meet care coordination goals (Bauer et al., 2006; Bodenheimer, 2002; Woltmann et al., 2012). Specific elements of collaborative care have also been efficacious in improving access to and quality of mental health services among racial/ethnic minorities (Interian et al., 2010; Miranda et al., 2003). Despite the success of collaborative care models for management of common mental disorders, broader implementation in clinical settings that serve impoverished communities--where members of racial and ethnic minority groups are frequently over-represented--is needed.

Scientific areas of interest include, but are not limited to:

  • Research that identifies and studies the implementation of key components of collaborative care that can increase the access to, as well as engagement and retention in, mental health services for mood and anxiety disorders among members of diverse racial and ethnic groups;
  • Effectiveness studies on the implementation of a package of evidence-based interventions that will increase the likelihood of improved clinical, functional, and economic outcomes for members of diverse racial and ethnic groups.

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References

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Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C.-n., Takeuchi, D., et al. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264-1272. doi: 10.1176/appi.ps.59.11.1264

Bauer, M. D. M., McBride, M. S. N. L., Williford, P. D. W., Glick, P. D. H., Kinosian, M. D. B., Altshuler, M. D. L., . . . and Coauthors for the Cooperative Studies Program 430 Study, T. (2006). Collaborative Care for Bipolar Disorder: Part I. Intervention and Implementation in a Randomized Effectiveness Trial. Psychiatric Services, 57(7), 927-936. doi: 10.1176/appi.ps.57.7.927

Bodenheimer T, W. E. H. G. K. (2002). Improving primary care for patients with chronic illness: The chronic care model, part 2. JAMA: The Journal of the American Medical Association, 288(15), 1909-1914. doi: 10.1001/jama.288.15.1909

Breslau, J. K., Kenneth S.; Su, Maxwell; Gaxiola-Aguilar, Sergio; Kessler, Ronald C. (2005). Lifetime risk and persistence of psychiatric disordes across ethnic groups in the United States. Psychological Medicine, 35(3), 317-327.

Davis, T. D. D., T.; Bryant-Bedell, K.; Tate, V.; Fortney, J. (2011). Does minoirty racial-ethnic status moderate outcomes of collaborative care for depression? Psychiatric Services, 62(1282-1288).

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Interian, A., Martinez, I., Rios, L. I., Krejci, J., & Guarnaccia, P. J. (2010). Adaptation of a motivational interviewing intervention to improve antidepressant adherence among Latinos. Cultural Diversity and Ethnic Minority Psychology, 16(2), 215-225. doi: 10.1037/a0016072

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. doi: 10.1001/archpsyc.62.6.593

Lee, S. Y. M., S.S.; Keyes, K.M., Lee, H.B. (2011). Mental health service use by persons of Asian ancestry with DSM-IV mental disorders in the United States. Psychiatric Services, 62(10), 1180-1186.

Miranda, J., Duan, N., Sherbourne, C., Schoenbaum, M., Lagomasino, I., Jackson-Triche, M., & Wells, K. B. (2003). Improving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities? Results of a Randomized, Controlled Trial. Health Services Research, 38(2), 613-630. doi: 10.1111/1475-6773.00136

Samnaliev, M. & McGovern, M. P. & Clark, R. E.(2009). Racial/Ethnic Disparities in Mental Health Treatment in Six Medicaid Programs. Journal of Health Care for the Poor and Underserved 20(1), 165-176. The Johns Hopkins University Press. Retrieved July 31, 2012, from Project MUSE database.

Steenbergen-Weijenburg, K. v., van der Feltz-Cornelis, C., Horn, E., van Marwijk, H., Beekman, A., Rutten, F., & Hakkaart-van Roijen, L. (2010). Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review. BMC Health Services Research, 10(1), 19.

Takeuchi, D. T., Hong, S., Gile, K., & Alegría, M. (2007). Developmental contexts and mental disorders among Asian Americans. Research in Human Development, 4(1-2), 49-69. doi: 10.1080/15427600701480998

Wang, P. B., P.; Olfson, M.; Pincus, H. A.; Wells, K. B.; Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 603-613. doi: 10.1001/archpsyc.62.6.603

Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C.-n., Takeuchi, D., . . . Meng, X.-L. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264-1272. doi: 10.1176/appi.ps.59.11.1264

Bauer, M. D. M., McBride, M. S. N. L., Williford, P. D. W., Glick, P. D. H., Kinosian, M. D. B., Altshuler, M. D. L., . . . and Coauthors for the Cooperative Studies Program 430 Study, T. (2006). Collaborative Care for Bipolar Disorder: Part I. Intervention and Implementation in a Randomized Effectiveness Trial. Psychiatric Services, 57(7), 927-936. doi: 10.1176/appi.ps.57.7.927

Bodenheimer T, W. E. H. G. K. (2002). Improving primary care for patients with chronic illness: The chronic care model, part 2. JAMA: The Journal of the American Medical Association, 288(15), 1909-1914. doi: 10.1001/jama.288.15.1909

Breslau, J. K., Kenneth S.; Su, Maxwell; Gaxiola-Aguilar, Sergio; Kessler, Ronald C. (2005). Lifetime risk and persistence of psychiatric disordes across ethnic groups in the United States. Psychological Medicine, 35(3), 317-327.

Davis, T. D. D., T.; Bryant-Bedell, K.; Tate, V.; Fortney, J. (2011). Does minoirty racial-ethnic status moderate outcomes of collaborative care for depression? Psychiatric Services, 62(1282-1288).

Lee, S. Y. M., S.S.; Keyes, K.M., Lee, H.B. (2011). Mental health service use by persons of Asian ancestry with DSM-IV mental disorders in the United States. Psychiatric Services, 62(10), 1180-1186.

Steenbergen-Weijenburg, K. v., van der Feltz-Cornelis, C., Horn, E., van Marwijk, H., Beekman, A., Rutten, F., & Hakkaart-van Roijen, L. (2010). Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review. BMC Health Services Research, 10(1), 19.

Williams, D. G., H. M.; Neighbors, H., & et al. (2007). Prevalence and distribution of major depressive disorder in african americans, caribbean blacks, and non-hispanic whites: Results from the national survey of american life. Archives of General Psychiatry, 64(3), 305-315. doi: 10.1001/archpsyc.64.3.305

Woltmann, E. G.-K., A.; Perron, B.; Georges, H.; Kilbourne, A.; Bauer, M. (2012). Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health settings: Systematic review and meta-analysis. American Journal of Psychiatry, AiA, 1-15.