Understanding Mechanisms of Mental Health Care Disparities

Understanding Mechanisms of Mental Health Care Disparities

Background: In order to implement federal policies to reduce service gaps in mental health and substance disorders, policymakers require concrete, coherent data on the magnitude and sources of disparities. However, to date, there is insufficient information about which mechanisms might operate in service disparities or what policy leverage can be used to remediate the service disparities.

Dr. Benjamin Cook’s study looks to understand the mechanisms of disparities among adults by measuring disparities in episodes of mental health care and emphasize the identification of effective tools for policymakers to reduce mental health care disparities.

The project aims to:


AIM I: Investigate disparities in initiation, intensity, duration, and quality of mental health care episodes. We test the hypothesis that racial/ethnic disparities exist in initiation of care and quality of care, and that disparities remain but are comparatively smaller in duration and intensity of care. We also tests the hypothesis that disparities in mental health care episodes and quality of care will be smaller but significant among individuals with the most severe mental health problems as compared to the less severe.

AIM II: Assess role of geography in disparities identifying area-level correlates of mental health service use. Multi-level modeling will be used to provide a comprehensive look at the interrelation of geographic and racial/ethnic disparities, and to identify for policymakers whether significant area-level correlates of mental health care vary by race/ethnicity. We test the hypothesis that geographic differences in care significantly contribute to, but do not fully explain, mental health care disparities. We will assess geographic and racial/ethnic disparities in initiation, intensity, and duration for adults with psychiatric illness and quality of care for adults with depression. We also identify for policymakers the area-level factors that hold promise for simultaneously improving overall mental health care and reducing mental health care disparities.

AIM III: Develop a report card/index of disparities in states’ mental health care expenditure and quality. We explore the creation of a mental health care disparities report card and index that provides a synthesized state-by-state comparison of mental health care expenditures and quality to directly inform policymakers’ disparities reduction interventions. The disparity report card will provide specific information about the relationship between disparities in mental health expenditures and quality of care across states, and can be used as a tool for tracking the success of future disparities reduction efforts.


    This work is being supported by grant #1 R01 MH091042-01 from the National Institute of Mental Health.