This Month's Highlights

Seeking Explanations for Disparities

Two studies reported in this month's issue take a closer look at racial-ethnic disparities. In the first, the authors sought to explain the apparent lack of black-white and Latino-white disparities in receipt of substance abuse treatment documented in previous studies. Benjamin Lê Cook, Ph.D., M.P.H., and Margarita Alegría, Ph.D., analyzed 2005–2009 data (N=25,159) from the National Survey on Drug Use and Health to assess the extent to which criminal history and socioeconomic indicators contributed to disparities. Treatment was rare (about 10%) for all groups. No black-white or Latino-white disparities were found. However, when analyses adjusted for criminal history and enrollment in Medicaid, blacks and Latinos were significantly less likely to receive treatment. The authors note that treatment programs mandated by the justice system may provide access to those who are resistant to care, but the results highlight the need to identify clinical and policy interventions that increase accessibility of less coercive options (Original article: page 1273). The second study looked at racial-ethnic differences in response rates of 360 veterans treated for depression at primary care clinics. Veterans were assigned to usual care or to a collaborative care intervention. Teri D. Davis, Ph.D., and colleagues found no significant differences in response to usual care between the white veterans and those from minority groups, but the latter had a higher response rate to the intervention (42% versus 19% for whites), even after adjustment for factors associated with minority status. The authors conclude that racial-ethnic disparities in depression care may be ameliorated through collaborative care programs (Original article: page 1282).

Barriers to Supported Employment in the VA

In 2004 the Department of Veterans Affairs (VA) began national implementation of supported employment. Over two years, beginning in July 2006, researchers interviewed 110 VA leaders, clinicians, and supported employment staff to document perceived barriers to implementation. Terri K. Pogoda, Ph.D., and colleagues used qualitative methods to identify categories of barriers. Paternalistic and uninformed concerns about the ability of persons with serious mental illness to be gainfully employed and a lack of organizational structures and leadership to promote and integrate the supported employment program were common implementation barriers identified during the first-year interviews. Most sites had addressed these challenges by the second year (Original article: page 1289). In a related Taking Issue commentary, Robert E. Drake, M.D., Ph.D., and Deborah R. Becker, M.Ed., C.R.C., note that a critical barrier to more widespread implementation of supported employment is “our failure to develop a clear, simple, direct funding mechanism” (Original article: page 1251).

Assessing an Array of Interventions

Ten other studies reported in this issue examined interventions for people with mental illness. One examined the effectiveness of YourSchizophreniaCare, a Web-based tool to empower patients with schizophrenia to talk with their clinicians about the quality of their care (Original article: page 1296). Another randomized trial compared two strategies for improving follow-up treatment rates among suicidal youths after discharge from an emergency department (Original article: page 1303). In a third study, researchers in Germany assessed the relative restrictiveness of seclusion and restraint from the point of view of inpatients with schizophrenia (Original article: page 1310). In Pennsylvania, a randomized trial examined whether a home-based intervention for HIV disease management reduced viral load among persons with serious mental illness (Original article: page 1318). Using national data for veterans participating in transitional housing programs, VA researchers did not find reasonable support for requiring abstinence from substances before program admission (Original article: page 1325). Researchers in New York analyzed results of a program of health risk monitoring (body mass index, activity level, smoking, and alcohol and drug use) in a large group of youths with psychiatric disorders treated in outpatient and day treatment settings (Original article: page 1331). Evaluation of a federal outreach intervention underlined its success in increasing access to disability benefits in homeless and at-risk populations (Original article: page 1373). A large academic medical center demonstrated the feasibility of implementing interpersonal and social rhythm therapy (IPSRT), an evidence-based practice for mood disorders, across the continuum of care (Original article: page 1377). Another study evaluated an IPSRT intervention that encourages patients with bipolar disorder to log in to a Web-site daily (Original article: page 1267). In Georgia a public-academic partnership deploys teams of community navigators to enhance community integration of people with mental illness (Original article: page 1270).

Briefly Noted …