UCLA

Mental health disorders are common but often remain untreated, resulting in a considerable burden of illness in the population. This burden falls most heavily on racial/ethnic minority populations who, compared to Non-Latino Whites, experience significant disparities in mental health services (MHS). Under the Affordable Care Act adults with a mental health disorder will experience new access to the Patient Centered Medical Home (PCMH). However, it is not yet known if core features of the PCMH will be effective towards improving all patients' access to MHS.

This dissertation consists of three studies that examine core features of the PCMH and disparities in MHS use among Non-Latino White, Non-Latino Black, and Latino adults. Components of the PCMH were approximated using patient reports of their healthcare experiences in the Medical Expenditures Panel Survey (2004 to 2010). Multivariate logistic regression models were employed to estimate the effect of PCMH components on MHS use for Non-Latino White, Non-Latino Black, and Latino populations.

This research found significant disparities in primary care- and specialist-based MHS. Having a designated provider was associated with increased use of primary care-based MHS among Non-Latino White and Black populations. When Black patients had a designated provider who delivered services consistent with the PCMH, these patients appeared more likely than those without a designated provider to receive mental health counseling. Even when Black and Latino patients reported having a designated healthcare provider, they continued to experience significant disparities in MHS.

Spreading the adoption of core features of the PCMH may help to reduce the burden of untreated mental illness among Non-Latino White and Black populations. However, the current healthcare reforms appear insufficient to meaningfully reduce racial/ethnic disparities in MHS. Results indicate a need for culturally targeted programs and interventions to improve MHS delivery for Black and Latino adults with a mental health disorder. In particular, findings suggest a need to develop additional policies that will strengthen the patient-provider partnership. As new patients enter the primary care system it will be critical that providers are given the training and resources needed to diagnose and treat mental health disorders in racially and ethnically diverse populations.