Community Mental Health Journal

, Volume 34, Issue 2, pp 133–144 | Cite as

I. Comparing Use of Public and Private Mental Health Services: The Enduring Barriers of Race and Age

  • Marvin S. Swartz
  • H. Ryan Wagner
  • Jeffrey W. Swanson
  • Barbara J. Burns
  • Linda K. George
  • Deborah K. Padgett


Data from the NIMH-Epidemiologic Catchment AreaProject were used to predict differential use of privateversus public outpatient mental health services, asalient concern in integrating public and private services in market-based health care reformefforts. Having a recent psychiatric disorder, being age25-44, female, white, of higher educational level, andunmarried increase the odds of any mental health service use. However, odds of treatment in thepublic sector are increased for males, AfricanAmericans, those with low educational and income levels,and odds are mark edly decreased for the elderly,suggesting significant barriers to care for these mentallyill subpopulations.


Health Care Psychiatric Disorder Educational Level Mental Health Service Health Psychology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Broman, C.L., (1987). Race differences in professional help seeking. American Journal of Community Psychology, 15:473–480.PubMedGoogle Scholar
  2. Burns, B.J., & Taube C.A., (1990). Mental health services in general medical care and nursing homes. In Fogel, B.S., Furino N., Gottlieb, G.L., (Eds.): Mental Health Policy for Older Americans: Protecting Minds at Risk. Washington, D.C.: American Psychiatric Press Inc.Google Scholar
  3. Carter, J.H., (1994). Racism’s impact on mental health. Journal of the National Medical Association, 86 543–547.PubMedGoogle Scholar
  4. Fayne, F.A., (1975). Psychiatry and the black physician. Journal of the National Medical Association, 314–316.Google Scholar
  5. Freidman, E., (1994). Money isn’t everything: Non-financial barriers to access. Journal of the American Medical Association, 271:1535–1538.CrossRefPubMedGoogle Scholar
  6. Horgan, C.M., (1985). Specialty and general ambulatory mental health services: comparison of utilization and expenditures. Archives of General Psychiatry, 42:565–572.PubMedGoogle Scholar
  7. Hough, R.L., Landsverk, J.A., Karno, M., Burnam, A., Timbers, D.M., Escobar, J.I., (1978). Utilization of health and mental health services by Los Angeles Mexican Americans and Non-Hispanic Whites. Archives of General Psychiatry, 44:702–709.Google Scholar
  8. Hu, T., Snowden, L.R., Jerrell, J.M., Nguyen, T.D., (1991). Ethnic populations in public mental health: services choice and level of use. American Journal of Public Health, 81:1429–1434.PubMedGoogle Scholar
  9. Kessler, L.G., Burns, B.J., Shapiro, S., Tischler, G.L., George, L.K., Hough, R.L., Bodison, D., Miller, R.H., (1987). Psychiatric diagnoses of medical service users: Evidence from the Epidemiological Catchment Area Program. American Journal of Public Health, 77:18–24.PubMedGoogle Scholar
  10. Landerman, L.R., Burns, B.J., Swartz, M.S., Wagner, H.R., George L.K., (1994). The relationship between insurance coverage and psychiatric disorder in predicting use of mental health services. American Journal of Psychiatry, 151:1785–1790.PubMedGoogle Scholar
  11. Leaf, P.J., Livingston, M.M., Tischler, G.L., Weissman, M.M., Holzer, C.E., Myers, J.K., (1985). Contact with health professionals for the treatment of psychiatric and emotional problems. Medical Care, 23:1322–1327.PubMedGoogle Scholar
  12. Leaf, P.J., Bruce, M.L., Tischler, G.L., Freeman, D.H., Weissman, M.M., Myers, J.K., (1988). Factors affecting the utilization of specialty and general medical mental health services. Medical Care, 26:9–26.PubMedGoogle Scholar
  13. Lindsey, K.P., & Paul, G.L., (1989). Involuntary commitments to public mental institutions: Issues involving the overrepresentation of blacks and assessment of relevant functioning. Psychological Bulletin, 106:171–183.CrossRefPubMedGoogle Scholar
  14. McGuire, T.G., & Weisbrod, B.D., (Eds.), (1981). Economics and Mental Health. EN No. I. DHH Pub. No. (ADM), 81-1114, Washington, D.C.: National Institute of Mental Health Series.Google Scholar
  15. Mollica, R.F., (1983). From asylum to community: the threatened disintegration of public psychiatry. New England Journal of Medicine, 1307:367–373.Google Scholar
  16. Mollica, R.F., Blum, J.D., Redlich, F., (1980). Equity and the psychiatric care of the black patient, 1950 to 1975. Journal of Nervous and Mental Disease, 168:279–286.PubMedGoogle Scholar
  17. Nam, C.B., & Powers, M.G., (1983). The Socioeconomic Approach to Status Measurement. Houston: Cap & Gown Press.Google Scholar
  18. Neighbors, H.W., Bashshur, R., Price, R., Selig S., Donabedian, A., Shannon, G., (1992). Ethnic minority mental health service delivery: a review of the literature. Research in Community Mental Health, 7:53–69.Google Scholar
  19. Padgett, D.K, Patrick, C, Burns, B.J., (1994). Ethnicity and the use of outpatient mental health services in a national insured population. American Journal of Public Health, 84:222–226.PubMedGoogle Scholar
  20. Padgett, D.K., Burns, B.J., Grau, L., George, L.K., Wagner, H.R., (in press). Mental health services use by older women: a review and proposed research agenda.Google Scholar
  21. Robins, L.N., Holzer, J.E., Croughan, H., Ratcliff, K.S., (1981). National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry, 38:381–389.PubMedGoogle Scholar
  22. Robins, L.N., & Regier, D.A., (Eds.), (1991). Psychiatric Disorders in America: the Epidemiologic Catchment Area Study. New York, NY: Free Press.Google Scholar
  23. Scheffler, R.M., & Miller, A.G., (1989). Demand analysis of mental health service use among ethnic subpopulations. Inquiry, 26:202–215.PubMedGoogle Scholar
  24. Shah, B.V., (1989). SUDDAAN: Professional software for survey data analysis. Research Triangle Park, NC: Research Triangle Institute.Google Scholar
  25. Shapiro, S., Skinner, E.A., Kessler, L.G., Von Korff, M., German, P.S., Tischler, G.L., Leaf, P.J., Benham, L., Cottler, L., Regier, D.A., (1984). Utilization of health and mental services: three epidemiologic catchment area sites. Archives of General Psychiatry, 41:971–978.PubMedGoogle Scholar
  26. Shapiro, S., Skinner, E.A., Kramer, M., Steinwachs, D.M., Regier D.A., (1985). Measuring need for mental health services in a general population. Medical Care, 23:1033–1043.PubMedGoogle Scholar
  27. Snowden, L.R., (1988). Ethnicity and utilization of mental health services: an overview of current findings. In Proceedings: Oklahoma Mental Health Research Institute, 1988 Professional Symposium. Oklahoma City, Oklahoma: Oklahoma Mental Health Research Institute.Google Scholar
  28. Sue, S., (1977). Community mental health services to minority groups. American Psychologist, 32:616–624.CrossRefPubMedGoogle Scholar
  29. Sussman, L.K., Robins, L.N., Earls, F., (1987). Treatment-seeking for depression by Black and White Americans. Social Science and Medicine, 24:187–196.CrossRefPubMedGoogle Scholar
  30. Taube, C.A., Kessler, L.G., Burns, B.J., (1986). Estimating the probability and level of ambulatory mental health service use. Health Services Research, 21:321–339.PubMedGoogle Scholar
  31. Temkin-Greener, H., Clark, K.T., (1988). Ethnicity, gender, and utilization of mental health services in a Medicaid population. Social Science & Medicine, 10:989–996.Google Scholar
  32. Weiss, J., Freeborn, D.K., Lamb, S., (1973). Use of mental health services by poverty and non-poverty members of a prepaid group practice plan. Health Services Research, 88:653.Google Scholar
  33. Wells, K.B., Manning, W.G., Duan, N., Ware, J.E., Newhouse, J.P., (1982). Cost sharing and demand for ambulatory mental health services. DHH Pub. No. (R2960-HHS), Santa Monica, CA: Rand.Google Scholar
  34. Wells, K.B., Golding, J.M., Hough, R.L., Burnam A., Karno, M., (1988). Factors affecting the probability of use of general and medical health and social/community services for Mexican Americans and non-Hispanic Whites. Medical Care, 26:441–452.PubMedGoogle Scholar
  35. Yamamoto, J., Silva, J.A., (1987). Do Hispanics underutilize mental health services? In Gaviria, M., & Arana, J.D., (Eds.) Health and Behavior: Research Agenda for Hispanics. Chicago, Ill: Simon Bolivar Hispanic American Psychiatric Research and Training Center.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1998

Authors and Affiliations

  • Marvin S. Swartz
  • H. Ryan Wagner
  • Jeffrey W. Swanson
  • Barbara J. Burns
  • Linda K. George
  • Deborah K. Padgett

There are no affiliations available

Personalised recommendations