Examining Why Mental Health Service Use and Dropout Rates Vary Across Racial/Ethnic Groups

Psychology, mental therapy and people concept - young Indian man patient and woman psychologist at psychotherapy session.

Mental illnesses often go untreated, especially for people in racial/ethnic minority groups. Among U.S. adults with mental disorders, racial/ethnic minorities are only half as likely as Whites to get treatment; they are also more likely to drop out before completing their treatment. As a result, although they are less likely than Whites to have a mental disorder in their lifetime, racial/ethnic minorities have more severe cases of mental disorders.

There are multiple reasons why people with mental disorders may not get treatment. An NIMHD-supported study aimed to uncover some of these reasons among Asians, Blacks, Latinos, and Whites by using data from three nationally representative surveys conducted from 2001 to 2003. The data included survey responses from 1,417 adults with untreated mental disorders for 12 months. All individuals were interviewed to assess their conditions, including anxiety, substance use, and behavioral and mood disorders, ranging from mild to severe. The survey asked about reasons for not seeking treatment or for discontinuing treatment early. Some reported reasons were that the respondents wanted to handle the problems themselves, did not think their problems were severe, or did not believe that the treatment would work. Other reasons cited were that people could not afford or access treatment, especially in disadvantaged neighborhoods with fewer health providers.

The survey data showed that Latinos and Asians were more likely than Blacks and Whites to report that they received no treatment for mental disorders lasting 12 months. Latinos and Asians were also more likely to report that they did not think they needed treatment.

Latinos and Asians were also more likely than Blacks and Whites to drop out of their mental health treatments. The most common reason cited for dropout was that they did not believe they needed intervention. One unexpected finding was a higher dropout rate for Asians due to reported treatment costs. However, the researchers found no significant association between racial/ethnic group and difficulty paying for or accessing treatment—a problem more common among people over 60 years old. The most common reason participants cited for not seeking treatment, particularly among Whites and Blacks, was wanting to handle the problem themselves.

This study aligns with results from prior studies on racial/ethnic disparities in mental health service use and dropout rates, with some new findings. By examining reasons for these disparities across three large surveys, this study exposes various factors that future efforts may address to improve mental health outcomes for racial/ethnic minorities. The fact that Latino respondents were the least likely to report that they wanted to handle the problem on their own—and the least likely to use mental health services—suggests that Latinos use informal support groups. As researchers shed light on the barriers to receiving mental health treatment, having culturally sensitive discussions about mental health in communities and with providers may encourage more people to use these targeted health services.

Green, J. G., McLaughlin, K. A., Fillbrunn, M., Fukuda, M., Jackson, J. S., Kessler, R. C., . . .  Alegría, M. (2020). Barriers to mental health service use and predictors of treatment drop out: Racial/ethnic variation in a population-based study. Administration and Policy in Mental Health and Mental Health Services Research, 47(4), 606–616. doi:10.1007/s10488-020-01021-6

Page updated March 3, 2021