Mental Health and Disparities: There Just Isn't a Lot of Data

One of the things that I found striking in the Rosie D. decision was that the judge, who clearly saw the inadequacy of the current system for children's mental health care, did not find enough evidence to declare that the system discriminated against people of color.  Most of know that, given the disparities that we see in the allocation of resources to treat physical illness, there ought to be disparities in screening, diagnosis and treatment of mental illness as well.  When I went looking for the evidence, however, it was sparse.  Now part of that was just the lack of data;  I had trouble getting information on the prevalence of ADHD, depression and anxiety disorders in kids in Massachusetts.  Suicide rates we could follow, but rates of suicide attempts, depression, substance abuse- these were hard to find on a city or regional basis.  And breaking it all down by race and ethnicity- well, it just seemed that no one did the work.  

Earlier in the month, I had the opportunity to attend a meeting of the Health Disparities Council, now chaired by Byron Rushing and Susan Fargo of the General Court, and trying to develop a coherent set of recommendations for the Commonwealth on what steps the government should take to reduce and eliminate racial and ethnic disparities.  The Department recently released "A Profile of Health Among Massachusetts Adults, 2007: Results from the Behavioral Risk Factor Surveillance System",  downloadable as a .pdf and chock for of interesting data;  but still, there seems to be little  which relates to disparities in mental health treatment and outcome. It seems most interesting to look at this from the standpoint of what DID they measure:

Marker over Time Trend Gap vs. Af-Am Gap vs. Hispanic

Fair/poor health  Same Persists Persists

% insured Better Persists Persists

Disability Better Persists Persists

Smoking Better Closing Closing

Obesity Worse Persists Persists

Physical active Better Persists Persists

Cholesterol Same Closed N/A

Diabetes Worse Worse Worse

Screening Better Closed Closed

(Turns out to be hard to put a table on a blog, but you get the idea)  With the usual public health indicators, you can see that we made a bit of progress on cigarette smoking, access to care and screening, and have some work to do on diabetes and overweight.  But what about depression treatment?  What about ADHD?  How can we measure the disparities?

My notes from the session point out that there were a few indicators that suggest few disparities in mental health care:  

"Two bits relevant to mental health: Poor mental health no gap, re drinking whites worse."

We need some data on this if we are going to change it.  A thought for the future.  Got to go eat chile now.  Happy New Year!