Agency effect on the outcomes of mental health services for minority patients

Objective – We examine the pattern of outcomes among a sample of adults receiving outpatient mental health services and what effect, if any, the community mental health agency (CMHA) at which their treatment was provided had on the occurrence of disparities between minority and white patients. The goal was to better understand the relationship between agency context and the efficacy of outpatient services for racial and ethnic minorities.

Methods – The study included 808 individuals (28% minority) experiencing a serious mental illness and receiving services at 13 CMHAs. Outcomes were measured three times using the BASIS-24, an indicator of patients' symptomology and functioning. Data were analyzed using hierarchical linear modeling (HLM) with repeated measures of treatment outcomes at level 1, patient demographic, psychiatric, and service factors at level 2, and CMHAs as a structural factor at level 3. The analysis controlled for numerous client predictors including, diagnosis, service usage, insurance type, employment status, and use of psychotropic medications.

Results – There was significant variability among CMHAs in the general pattern of outcomes experienced by patients as well as in the occurrence of outcome disparities between minority and white patients. Differences between CMHAs accounted for 3.9% of variability in overall patient outcomes and 21.7% of variability in outcome disparities.

Conclusions – Some agencies appear to magnify outcome disparities for racial and ethnic minority patients, while others minimize them. Our analysis indicates that the efficacy of outpatient psychiatric treatment for patients from racial and ethnic minority groups is linked to agency-level factors.