Examining Geographic Variation in Racial and Ethnic Disparities in Child Mental Health Access

Background: Racial and ethnic disparities in mental health service use and access to care among children are well established. These disparities have worsened significantly over time—particularly for Black children and youth—despite significant shifts in health and mental health policies at the federal level. The role that structural forces may play in exacerbating or alleviating these disparities has been under examined but may be reflected in well-documented geographic variation in mental health service utilization and unmet mental health needs among children—particularly across state systems. To establish if state structures may contribute to geographic variation in these disparities, this study aims to estimate the size and scope of racial and ethnic disparities in parent-reported child mental health access nationwide and for each state in the United States.

Methods: Using a retrospective cross-sectional design, this study drew on the National Survey of Children’s Health, pooling data from years 2016-2019. Rates of parent-reported unmet need for mental health care and difficulty accessing care among children were generated for each of the following racial and ethnic groups: white (non-Hispanic), Black (non-Hispanic), and Hispanic. Logistic regression with marginal post-estimation, using complex survey weights to reflect state and national probabilities, and controlling for sociodemographic characteristics, estimated the size and significance of disparities between Black and white children and Hispanic and white children. Due to insufficient sample sizes, 13 states were not examined for Black/white disparities, and 2 states were not examined for Hispanic/white disparities.

Findings: National estimates find that rates of unmet mental health need among Black children were nearly 14 percentage points higher than among white children, but no significant difference was found between Hispanic children and white children. No significant disparities were observed in parent reported difficulty accessing care between any racial groups at the national level. Six states were found to have significantly higher rates of unmet need for mental health care among Black children than among white children, and the reverse was found in one state. Only three states had significantly higher rates of difficulty accessing mental health care among Black children than among white children, but the reverse was found in six states. One state was found to have significantly higher rates of parent-reported unmet need for mental health care among Hispanic children than among white children, but the reverse was found in seven states. Three states had significantly higher rates of parent-reported difficulty accessing mental health care among Hispanic children than among white children, but the reverse was found in five states. Generally, for all children, states with disparities in unmet mental health needs were not the same states with disparities in reported difficulty accessing mental health care.

Conclusion: The size and nature of mental health access disparities varies across states, and by measures of mental health access. Variation in racial and ethnic disparities across states provides evidence that geographically specific structural forces may contribute to these inequities. Further research is needed to uncover state policy, cultural, and geographic features that exacerbate or alleviate these disparities.