Closing the Gaps: The Role of Research in Reducing Mental Health Disparities in the U.S.
• Meeting Summary
- Sponsored by:
- Office for Research on Disparities and Global Mental Health (ORDGMH)
- National Institute of Mental Health (NIMH)
On May 5, 2010, the Office for Research on Disparities and Global Mental Health (ORDGMH) in the Office of the Director of NIMH convened a meeting of representatives of key federal agencies and thought leaders from a range of fields—including genetics, cultural neuroscience, epidemiology, psychology, clinical psychiatry, and community-based services and intervention research—to discuss novel directions that, if investigated empirically, could foster the reduction of mental health disparities across race/ethnicity, socioeconomic status (SES), and geography.
Evidence regarding mental health disparities paints a puzzling picture that is complicated by the interrelationships of race/ethnicity, SES, and geography across the life course. For example, although the prevalence of common mental disorders is higher in White Americans than in Black Americans and Latino Americans, the latter groups have a more pernicious course of illness, and poorer access to services.1 However, certain other mental disorders exhibit different patterns of prevalence and trajectory. Thus, it is necessary to understand how patterns of mental health disparities differ by disorder, along with the factors that create these patterns, including causes and mechanisms. Furthermore, it is critical to close gaps in treatment access and service provision affecting these populations. Collaborations with other federal agencies will be essential to strengthening links between research and practice.
The meeting was structured to allow for substantial discussion. In an introductory presentation, Pamela Collins, M.D., M.P.H., director of ORDGMH, outlined the overarching issues of the meeting, telescoping from broader patterns of health disparities and the associated economic burden to those in mental health disparities, and proposed a population-based strategy for studying mental health disparities. Four discussion sections covered the following areas: root causes, risk and protective factors, and mechanisms; treatment availability, use, and quality; measuring mental health disparities; and, leveraging partnerships and building systems to assemble evidence and take action. Participants were asked to inform creative approaches to understanding and addressing mental health disparities within these domains. A final discussion section, led by NIMH Deputy Director Philip Wang, M.D., Dr.P.H. addressed how the Institute might shape its research priorities, given the issues in each of the four preceding areas. NIMH Director Thomas Insel, M.D. led the concluding discussion and concretized the issues raised.
The thematic areas that emerged from the meeting discussion include:
- The need to understand the patterning of health disparities by diagnosis;
- The need to study development, resilience, and sensitive periods during the life course and the associated need for longitudinal studies;
- The need to move from prevalence research to incidence research; the critical roles of context and SES;
- The needs to build on place-based initiatives and to engage communities;
- The imperative to foster trust between researchers and populations across communities;
- The centrality of measurement and standardization and the need for indices of mental health disparities, data tools (e.g., registries), and novel uses of technology;
- The key roles of incarceration and trauma in producing and reproducing mental health disparities;
- The unique research opportunities presented by the economic crisis and health care reform;
- The importance of reducing the stigma and negative language associated with mental illness; and,
- The fundamental need to capitalize on partnerships and forge novel partnerships to strengthen mental health disparities research, as well as its impact and uptake.
For more information, please contact Dana March, Ph.D., 301-435-4582.
1Miranda J, McGuire TG, Williams DR, Wang P. Mental health in the context of health disparities. American Journal of Psychiatry 165 (9): 1102-1108, 2008.