July 29, 2011
Research to Improve Treatment Engagement for Mental Health Care across Diverse Groups
Dana March, PhD, MPH
Scientific Program Manager
Office for Research on Disparities and Global Mental Health
To fill critical gaps in the treatment engagement (TE) evidence base for people who are members of racial/ethnic minority groups and for people with serious mental illness (SMI), regardless of race/ethnicity; and, to facilitate implementation and uptake of evidence-based TE interventions across diverse groups to increase the public health impact of mental health care.
Marked disparities by race/ethnicity exist in the treatment of depression, anxiety disorders, and SMI. The course of psychiatric disorders for people who are members of racial/ethnic minority groups and for people living with SMI, regardless of race/ethnicity, tends to be more chronic and disabling. Treatment engagement (TE), along with other factors, appears to contribute to this pattern. For example, racial/ethnic minorities have been reported to have poorer access to care, receive lower quality service, and have higher attrition rates, compared to Whites, regardless of diagnosis1. Similarly, regardless of race/ethnicity, people with SMI encounter more barriers to service access and experience diminished continuity and quality of care, compared to people with depression and anxiety2. There are effective evidence-based TE interventions for racial/ethnic minorities (e.g., quality improvement and motivational interviewing) and for people of all races/ethnicities living with SMI, ranging from low intensity interventions (e.g., system responsiveness and reaching out) to high intensity interventions (e.g., Assertive Community Treatment). However, TE is both complex and inconsistently defined across studies. Moreover, there are a number of barriers to implementation and uptake of existing evidence-based TE interventions at the level of the individual, family, network, community, and system.
To date, little research has comprehensively addressed the components of TE (e.g., factors at the level of the individual, family, network, community, and system) that are relevant to racial/ethnic minorities, people of all races/ethnicities living with SMI, and the multiple barriers to successful implementation and uptake of evidence-based TE interventions.
Scientific areas of interest include, but are not limited to:
- Generation of evidence on the effectiveness of TE interventions using multiple outcome measures;
- Identification of barriers to implementation of evidence-based TE interventions across levels—individual, family, network, and system; and,
- Facilitation of effective uptake of evidence-based TE interventions for racial/ethnic minorities and for all people living with SMI.
1Miranda, J., McGuire, T.G., Williams, D.R., & Wang, P., Mental Health in the Context of Health Disparities. American Journal of Psychiatry 165 (9), 1102-1108 (2008).
2Kreyenbuhl, J., Nossel, I.R., & Dixon, L.B., Disengagement From Mental Health Treatment Among Individuals With Schizophrenia and Strategies for Facilitating Connections to Care: A Review of the Literature. Schizophrenia Bulletin 35 (4), 696-703 (2009).