Black, Hispanic kids receive less mental healthcare than whites

Racial disparities could play a role in the scant access Hispanic and black American kids have to mental health care, according to a study published in the International Journal of Health Services.

Not only that, mental health problems among these populations more often result in disciplinary measures such as school suspensions or incarceration rather than mental health treatment.

Overall, more than half of all American children with some kind of mental health issue don’t receive care for their condition. This lack of treatment can translate into bigger personal and societal problems down the road, including behavioral problems that might lead to contact with law enforcement, for example. American children belonging to racial and ethnic minority groups are even more likely than the population as a whole to experience the potential legal problems of lack of treatment for mental illness.

The study points out that 63 percent of all children in juvenile detention facilities are black or Hispanic. Starting in preschool, black children are more likely than white counterparts to be suspended from school. By the age of 23, roughly half (49 percent) of black men and boys have been arrested. Many of them may eventually join the U.S. prison population, where about half, according to Department of Justice estimates, have mental health problems.

The researchers explained that “youthful transgressions that might result in referral for treatment among non-minority children more often incur criminal sanctions for minorities.”

Study authors examined data from the Medical Expenditure Panel Survey collected by the National Center for Health Statistics between 2006 and 2012. They looked at mental healthcare expenditures spent on each individual included in the survey based on individual and insurer payments and the would-be cost of any “free” care administered. Costs were included for inpatient, outpatient, emergency, office, clinical and hospital care. They then compared these categories to the self-reported races of black, white or non-white Hispanic of the survey participants.

Looking at the general population, most children of any race do not come into contact with any mental healthcare environment. Within the last year, 2.25 percent of black kids, 2.27 percent of Hispanics and 5.66 percent of whites had contact with a mental health professional.

According to the researchers, these differences cannot be explained by incidence of mental health problems; kids of all races and ethnicities tend to have mental health issues at about the same rate.

When looking at children ages 5 to 17, black children made about 47 percent fewer mental healthcare visits than white children, while Hispanic children made about 58 percent fewer visits than white children. (Black and white children of this age group had similar rates of hospitalization for reasons of mental health, however, while Hispanic children’s hospitalization rates for mental health were still lower.)

For young adults ages 18 to 34, the disparities grew. Black people in this age group made about 68 percent fewer mental healthcare provider visits than white people, while Hispanic young adults made about 62 percent fewer visits than their white peers. Substance abuse treatment disparities were especially high among this young adult group: Black young adults received substance abuse treatment at an 85 percent lower rate than their white peers.

Analyzing the data along gender lines, the researchers found that young girls were less likely to receive mental healthcare, but when looking at young adults, women were more likely to men to receive help for mental health concerns. And the racial disparities continued even when measured along these lines.

Such differences are complex combinations of cultural, structural and economic influences. It is possible members of some racial minority groups feel more comfortable seeking mental health counseling from a family member or religious or community leader than a health professional. Or perhaps there are not enough mental health providers practicing in the areas where these minority children live.

When that lack of treatment leads to an unchecked mental health issue that becomes a behavioral issue, it’s possible minority children are more likely than white children to have “non-criminal misbehaviors such as truancy and curfew violations” or drug offenses (despite similar rates of abuse) result in contact with law enforcement, possibly setting them up for more (and more severe) interactions in the future.

The study authors also note these interactions can have negative consequences that only exacerbate existing mental health issues (or contribute to creating mental health issues for family members), such as lower income, housing insecurity, lack of access to government benefits and poor ability to bond with their own children, "effectively (and perhaps intentionally) disenfranchising a significant portion of the black community.”

Given these serious consequences that could arise from poor access to mental health care, especially when it is unequally unavailable, means “even modest reductions in incarceration rates through improved mental health treatment might have an important impact on these social determinants of ill health,” wrote the study's authors.