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Open Access Publications from the University of California

Disparities in Mental Health Service Utilization Among African Americans with Severe Mental Illness

  • Author(s): Hampton, Michelle DeCoux
  • Advisor(s): Chafetz, Linda
  • et al.


Multiple studies have found that AAs are more likely to use crisis and acute care services and less likely to use outpatient services than Whites with severe mental illness (SMI). This difference might be related to less access to outpatient services by AAs.


The purpose of this study is to determine predictors of the number of crisis, inpatient, and residential services used in 12 months.


This study was a secondary analysis of the Clinical Trial for Wellness Training (NR05350-04), a randomized controlled trial. Data were extracted from interviews and mental health service utilization records. Data were analyzed using descriptive methods, logistic regression, and negative binomial and Poisson regression. The Behavioral Model for Vulnerable Populations, a model that proposes health service utilization is predicted by predisposing characteristics, enabling resources, and need, was used as the theoretical framework.


On bivariate analysis, only the number of residential services used varied by race. In the regression analyses, which controlled for multiple factors, race was no longer an influence, despite AAs having higher rates of homelessness and greater likelihood of victimization. The number of crisis services used was predicted by drug use, receipt of social security benefits, and age. The number of inpatient services used was predicted by drug use and receipt of social security benefits. And the number of residential services used was predicted only by enrollment in an outpatient mental health program.


Crisis and inpatient service use was roughly equal between AAs and Whites. Far fewer subjects used inpatient services than crisis indicating that access to this particular service is severely limited. Predisposing characteristics and enabling resources rather than need predicted service use. Residential service use was predicted only by enabling resources in that patients enrolled in outpatient programs were most likely to use this service. It is possible that professionals in outpatient mental health programs might refer AAs less to residential services. Another consideration regarding crisis and inpatient service utilization is that the extreme vulnerability of the subjects might have obscured racial differences in this study.

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