The NIMH Office for Research on Disparities and Global Mental Health (ORDGMH) recently convened
representatives from universities, community
organizations and government for a day-long summit to discuss strategies for increasing our understanding of group differences in mental
health status and rapidly reducing disparities in mental health care in the United States. With expertise ranging from cultural neuroscience and medical anthropology to service delivery and policymaking, the group nevertheless faced a daunting task.
“Mental disorders have far-reaching implications
for an individual’s participation in society, interpersonal relationships, physical well-being and overall quality of life,” said ORDGMH director
Dr. Pamela Collins. “Disadvantages along the axes of socioeconomic status (SES), race or ethnicity,
gender and geography have created unacceptable
gaps in the availability of and access to evidence-based care.”
In her introductory overview to the meeting, Collins cited a 2009 report by the Joint Center
on Economic and Policy Studies stating that eliminating health disparities among racial and ethnic minorities would have reduced indirect
costs associated with illness and premature death by more than $1 trillion between 2003 and 2006. Also in 2009, the Agency for Healthcare Research and Quality issued a report indicating that minorities’ access to care and quality of care compared to non-minorities is worsening.
Health disparities can be defined in a variety of ways—by distribution of resources, by health care quality, as well as by disease incidence, prevalence, morbidity, mortality or survival rates. NIH recognizes that health disparities occur along racial and ethnic, geographic and socioeconomic lines. However,
research has shown that a broad range of social factors—including immigration, education level, early childhood experiences and geography—can either increase or decrease risk for various diseases
in different populations as well. Disparities in treatment availability, quality and use and access to care further compound the problem.
This complex web of influences does not lend itself to easy resolution. For example, though many populations have seen improvements in overall health and life expectancy that coincided with gradual increases in SES over time, increasing
SES alone does not help to close the health gaps between minorities and non-minorities. Thus the charge to the invited representatives was multi-faceted:
- Inform approaches to reduce mental health disparities in the groups most affected
- Make recommendations to optimize the reach and cost effectiveness of interventions
- Discuss ideas for better, broader and swifter dissemination of scientific knowledge
and interventions to impact mental health disparities in the United States.
Throughout the day, NIMH staff presented information on the current state of the institute’s research investments. They discussed the root causes, protective and risk factors and mechanisms for mental illness; treatment availability, use and quality and how to measure mental health disparities. In response, many of the experts’ comments coalesced around building a sustainable infrastructure for research, including fundamental changes to study design and to new investigator
training and career support. For example, as noted by Dr. Sergio Aguilar-
Gaxiola of the University of California, Davis, and former member of the National Advisory Mental Health Council, most studies are currently conceptualized
in a manner far removed from the community that is the focus of study or intervention.
Following the day’s discussion and debates, NIMH director Dr. Thomas Insel summarized the state of mental health disparities and priorities for research. Among the strategies deemed actionable in the short term were studying model programs to determine which components are effective; focusing on population-
based approaches and community engagement in research; and supporting
studies aiming to improve basic resources for people typically excluded from research, including those with serious mental illness and the homeless. Insel further
recognized that genetic studies and other biologically based research, which some minority populations may regard with special distrust due to historic misuse
of such methods, hold the promise of transforming treatment, as long as they are conducted in a culturally sensitive manner.
“Reducing mental health disparities requires a cooperative effort, so it’s crucial to hear from the various sectors working towards this common goal and discuss how we can work together most effectively,” said Insel.