Differences in white-nonwhite community mental health center service utilization patterns

A Reflection on the Status of Racial/Ethnic Minority Research

This article provides a nonexhaustive and critical review of selective research on client-counselor variables to exemplify the type and status and/or quality of work conducted on racial/ethnic minorities. In addition, specific and generic methodological and professional recommendations for improving the quality of research across topics and variables are proposed.

Community mental health and ethnic minority populations

National trends in minority utilization of mental health services are reviewed, and recommendations are made for needed research. In relation to their representation in the population, blacks use services more than expected, and Asian American/Pacific Islanders use services less; Hispanics and Native American/Alaska Islander use varies according to type of service. Hospitalization accounts for part of the increase in minority utilization; this trend is problematic. Disruptions in service continue to plaque minority clients, possibly stemming from inadequacies in the organization and financing of care, and from cultural incongruity. Much more must be learned about these problems in utilization, as well as about other key issues.

Low-income blacks in community mental health: forming a treatment relationship

Sociodemographics, psychological symptom distress, and global adjustment were related to perceived quality of the therapeutic relationship at a community mental health center serving a predominantly low-income and black clientele. Data were collected at intake describing 56 clients; additional data were collected after two sessions of treatment, recording therapist perceived quality of the therapeutic relationship. Results indicated that with all else controlled, three factors predicted a favorable therapist evaluation: having ever been married; reporting more symptoms of psychological distress; having been rated as better adjusted. Apart from symptoms of hostility and somatization, the type of symptom distress suffered appeared less important than the number of symptoms and their severity. In this little studied but increasingly prevalent population of clients, it is possible to predict the formation of a promising therapeutic relationship by means of a relatively straightforward model of symptoms and adjustment.

Cues of disability and treatment continuation of chronic schizophrenics

Serious questions have arisen concerning the retention of the chronically ill in outpatient community mental health clinics (CMHC). This study tests a model based upon sociological theories of disability and the sick role to explain differential continuation in treatment among schizophrenics. We hypothesized that economic, social and medical cues facilitate a patient's self-definition of disability and contribute to continuation in treatment. Data were collected from the clinical charts of 879 chronic schizophrenic patients at five CMHC's. Hypotheses were tested using OLS multiple regression and logistic regression. Findings indicated level of functioning may be an important explanatory variable. Analysis strongly indicated the efficacy of the medical model in the area of treatment continuation.

Service utilization by black and white clientele in an urban community mental health center: revised assessment of an old problem

Results of a four-year evaluation project by Harborview Community Mental Health Center to assess equity of service to its black constituency are reported. Demographic, service, and psychometric data were gathered on black and white groups which were compared with each other. It was anticipated that service delivery would be proportionate to the social and psychiatric functioning of patients regardless of race or sex. The expectation was partially confirmed. Black patients were found to be somewhat less impaired than whites, yet were referred to treatment modalities and units with apparent equity. Patterns of service at one year were significantly different, reflecting earlier termination for blacks than for whites. This finding is discussed in the context of equal socio-economic class and diagnostic grouping between ethnic groups, but differing indexes of impairment.

Race as a factor in the perceived importance of the use of psychotropic medication

The importance of getting medication as a reason for contacting an outpatient psychiatric service was studied from the perspective of white (N = 265) and black (N = 42) patients, together with their white interviewers. Interviewers rated the importance of getting medication as greater among blacks than whites. However, the finding did not seem to reflect difference in patient demography or disturbance, nor did it seem due to racial bias. Largely, it reflected a greater importance ascribed to getting medication by black patients, themselves.