Racial disparities in treatment of behavioral health disorders in Philadelphia

Objective: This study is a follow up to a prior study that examined the extent that racial disparities existed in the Philadelphia public mental health system in 1993. That study showed African Americans had less access and lower psychiatric service use than whites and were less likely to receive psychotropic medications or to receive psychiatric services from a physician. This study examines the extent that racial disparities continue to exist in the Philadelphia public mental health system in 2005. Possible explanations and the usefulness of GIS methods for identifying areas of focus to address the problem are discussed. Methods: A cross-sectional, observational analysis of 224,654 adult Medicaid recipients in a managed care behavioral health plan was employed to identify treated individuals from 2005 claims records. GIS methods were used to examine disparities in treatment for mental health disorders. Results: Our study showed that while African Americans had higher Medicaid enrollment rates than Whites (59.4% vs 18.2%), they continue to have lower rates of treatment for mental health disorders (20.2% vs. 30.0%), as well as lower rates of specific types of services such as psychiatric and substance abuse inpatient hospitalization, emergency room visits and outpatient services. With respect to those who use services, Whites have a higher intensity of use for psychiatric outpatient and inpatient services whereas African American had a higher intensity of inpatient drug and alcohol services. Conclusions: Variation by catchment area suggests possible access and capacity explanations for disparities related to service providers.