Racial Disparities in Mental Health Outcomes Among Individuals with Serious Mental Illness

Background and purpose: In 2001, former Surgeon General, Dr. David Satcher, reported that minorities in the U.S. suffer a disproportionate burden of mental illness because of a large gap between the need for mental health services and the services actually provided. Within the past few decades, social work researchers have begun turning to the issue of race in understanding the disparities related to mental health care. While racial disparities in mental health outcomes have been widely documented in non-institutionalized community psychiatric samples, few studies have specifically examined the effects of race among the most vulnerable individuals with mental health needs, i.e. those with severe mental illness (SMI). In this study, we used individual growth curve modeling in a large longitudinal sample (N = 925) of to examine the presence of racial disparities in mental health outcomes following psychiatric inpatient hospital discharge.

Methods: Employing a longitudinal, multi-site sample of 925 individuals hospitalized for SMI, African-American (30%) and White (70%) subjects were followed for one year post-hospital discharge to examine the presence of racial disparities in mental health outcomes. Subjects were assessed in the community every 10 weeks on a number of broad symptom and functioning domains, and racial differences in rates of improvement in these domains were examined using individual growth curve modeling after adjusting for socioeconomic, diagnostic, and other potential confounding variables.

Results: Results from a series of growth curve models indicated that African-Americans with SMI experienced significantly less improvement in global functioning, activation and anergia symptoms, and were less likely to return to work in the year following hospitalization. These racial disparities persisted even after adjustment for sociodemographic and diagnostic confounders, and were largely consistent across gender, socioeconomic status, and psychiatric diagnosis. However, some evidence suggested that African-Americans with the lowest socioeconomic status were particularly less likely to return to work post-hospital discharge compared to more affluent African-Americans.

Conclusions and implications: These findings call attention to the existence of disparities in mental health outcomes between minority and majority groups of individuals with severe mental illness. Such results highlight the importance of future investigations seeking to identify service and/or discriminatory mechanisms that contribute to poorer mental health outcomes among minority populations with severe psychiatric disabilities, and point to the need to improve psychosocial and social work interventions for this population. Those domains that showed the most marked differences in improvement between races, i.e. anergia and activation symptoms, global functioning, and reemployment, may rely more heavily on psychosocial treatments for their effective management than positive psychotic symptoms. As such, improvement in access to and the quality of psychosocial treatments for minority consumers with severe mental illness might be some of the most critical factors to improving mental health outcomes among this population. A clearer understanding of the degree to which racial and ethnic minority individuals who suffer from a severe mental illness have less favorable mental health outcomes once they are discharged to the community is particularly important for mobilizing appropriate social work and behavioral health services for this population.