Removing obstacles to eliminating racial and ethnic disparities in behavioral health care
Open accessAbstract
Despite decades of research, racial and ethnic disparities in behavioral health care persist. The Affordable Care Act expanded access to behavioral health care, but many reform initiatives fail to consider research about racial/ethnic minorities. Mistaken assumptions that underlie the expansion of behavioral health care run the risk of replicating existing service disparities. Based on a review of relevant literature and numerous observational and field studies with minority populations, we identified the following three mistaken assumptions: Improvement in health care access alone will reduce disparities, current service planning addresses minority patients' preferences, and evidence-based interventions are readily available for diverse populations. We propose tailoring the provision of care to remove obstacles that minority patients face in accessing treatment, promoting innovative services that respond to patients' needs and preferences, and allowing flexibility in evidence-based practice and the expansion of the behavioral health workforce. These proposals should help meet the health care needs of a growing racial/ethnic minority population.
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Appropriate evidence-based treatments for generalized anxiety disorder in this Latino population are missing.
“Although GAD has been found to be prevalent among several Latino subgroups, particularly Puerto Ricans, appropriate evidence-based treatments for this population are missing (Alegría et al., 2007; Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016).”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016
The Evidence-Based Practices section (page unavailable) says most evidence-based practices have not been tested with different racial or ethnic populations or culturally adapted for them. This supports a general concern about appropriate treatments, but the paper does not establish that evidence-based treatments for GAD are missing for Latinos specifically. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCompared with non-Hispanic Whites, Latinos are less likely to receive guideline congruent treatment for mental health problems.
“In comparison with non-Hispanic Whites, studies have demonstrated that Latinos rely more on primary care providers for mental health care and are less likely to receive guideline congruent treatment for mental health problems (Alegría et al., 2002a,b, 2016; Chapa, 2004; Hogan, 2003; Lagomasino et al., 2005; Cabassa, Zayas, & Hansen, 2006; Institute of Medicine, 2003; US Department of Health and Hu”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría et al., 2002a,b, 2016
The Abstract reports that Latino adults were less likely than whites to receive depression treatment, and the Responding To Diverse Populations section says minority patients have fewer options for accessing psychotherapy than white patients. Neither passage establishes that Latinos who receive mental health care are less likely to receive guideline-congruent treatment; the Abstract's comparison of adequate depression care concerns black patients, not Latinos. No page numbers are available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredA major factor contributing to persistent mental health care disparities is the mistaken assumption that evidence-based treatments are easily available for diverse populations.
“Alegría et al. (2016) sustain that a major factor that has contributed to the persistence of mental health care disparities is the mistaken assumption that evidence-based treatments are easily available for diverse populations.”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría et al., 2016
Latinos' mental health care needs are largely unfulfilled.
“Substantial evidence sustains that Latinos’ mental health care needs are largely unfulfilled.”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría et al., 2002a,b, 2016
Scant availability of linguistic and culturally competent services is a key barrier to mental health care access for minority populations.
“They highlight that the scant availability of linguistic and culturally competent services is a key barrier to mental health care access for minority populations.”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría et al., 2016
Generalized anxiety disorder is prevalent among several Latino subgroups, particularly Puerto Ricans.
“Although GAD has been found to be prevalent among several Latino subgroups, particularly Puerto Ricans, appropriate evidence-based treatments for this population are missing (Alegría et al., 2007; Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016).”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016
The Abstract discusses treatment disparities for depression and substance use disorders, not the prevalence of generalized anxiety disorder. Searches for GAD, anxiety prevalence, and Puerto Ricans found no passage in our copy addressing prevalence among Latino subgroups. (LLM, conf=0.75)
Experimental — accuracy not yet measuredCompared with non-Hispanic Whites, Latinos rely more on primary care providers for mental health care.
“In comparison with non-Hispanic Whites, studies have demonstrated that Latinos rely more on primary care providers for mental health care and are less likely to receive guideline congruent treatment for mental health problems (Alegría et al., 2002a,b, 2016; Chapa, 2004; Hogan, 2003; Lagomasino et al., 2005; Cabassa, Zayas, & Hansen, 2006; Institute of Medicine, 2003; US Department of Health and Hu”
From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Alegría et al., 2002a,b, 2016
The ‘Responding To Diverse Populations’ section discusses minority patients’ treatment options even when referred from primary care, but does not compare how often Latino and white patients rely on primary care providers for mental health care. A search for the claimed comparison and for ‘primary care’ found no passage addressing it; page numbers were unavailable in our copy. (LLM, conf=0.75)
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References 43 · Cited by 201
- Authors
- Alegría, M., Alvarez, K., Ishikawa, R. Z., DiMarzio, K., & McPeck, S.
- Affiliations
- Margarita Alegría ( ) is a professor of psychology in the Department of Psychiatry at Harvard Medical School and chief of the Disparities Research Unit, Department of Medicine, at Massachusetts General Hospital (MGH), both in Boston.
- Kiara Alvarez is a postdoctoral research fellow in the Disparities Research Unit, Department of Medicine, at MGH.
- Massachusetts General Hospital (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2016-06
- Volume
- 35
- Issue
- 6
- Pages
- 991-999
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC5027758
- OpenAlex
- W2416464179
- Cited by
- 201
- References
- 43
- Citations by year
- 2026: 27 · 2025: 28 · 2024: 21 · 2023: 24 · 2022: 24 · 2021: 29 · 2020: 13 · 2019: 14 · 2018: 14 · 2017: 5 · 2016: 1
- FWCI
- 32.41
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Patient-Centered Outcomes Research Institute (CD‐12‐11‐4187)
- National Institutes of Health (5p60md002261-05)
- National Institute on Aging (R01AG046149)
- National Institute of Mental Health (P50MH073469, R01MH098374, U01MH062209)
- National Institute on Drug Abuse (R01DA034952)
- National Institute on Minority Health and Health Disparities (P60-MD-002261)
- Topics
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- racial and ethnic disparities, behavioral health services, Affordable Care Act, health care access, minority patients, patient preferences, evidence-based interventions, behavioral health workforce, health care reform, tailored care
- MeSH terms
- Health Services Accessibility, Humans, Mental Health Services, Socioeconomic Factors, United States, Racial Groups, Healthcare Disparities, Evidence-Based Practice, Patient Protection and Affordable Care Act
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