Drop Out Disparity in US Mental Health Treatment

Presenter: Chih-Nan Chen, Cambridge Health Alliance and Harvard Medical School

Abstract

Studies have shown that even for those who gain access to psychiatric treatment, early dropout (often after just the first session) and high rates of missed appointments for psychiatric care are a persistent problem for minority patients. In this paper we assess disparities in dropout rates of mental health and substance abuse treatment among several racial and ethnic groups in the US and identify predictors of drop out. Drop-out is measured among those with any mental health service use by asking if respondents quit before completing treatment or before their provider indicated that the respondent no longer needed care. The data come from the Collaborative Psychiatric Epidemiology Surveys (CPES), a representative sample of the U.S. non-institutionalized population with detailed diagnostic measures of psychiatric illness, mental health services and a rich array of social and contextual variables. Our findings evidence that 12.4% of whites in contrast to 21.2% of Latinos, 19.0% of Asians, 21.6% of African Americans and 16.5% of Afro Caribbean drop out of mental health or substance abuse treatment before completing the recommended dose of care, almost half (49.4%) of all patients drop out before their third visits. In models only controlling for age, gender and mental health need, we found that African Americans and Latinos show significantly higher drop-out rates in contrast to non-Latino whites. Young aged, married as well as perceiving receipt of low quality care and poor effectiveness of treatments were the best predictors of drop out. We found that patients with depressive disorders had increased likelihood of dropping out of care in comparison to those without depression. Type of provider and type of treatment offered (e.g. pharmacological, psychotherapy, combined) predict premature termination of mental health and substance abuse care. We discuss implications for research and clinical care, and the potential to tailor services to eliminate ethnic/racial disparities.