More data sought on disparities in mental health care

Boston Statehouse

BOSTON (SHNS) – The state’s Health Policy Commission would be required by a bill filed this session to issue an annual report on the prevalence of mental health disorders and accessibility to treatment based on demographics in an attempt to identify and eliminate racial and gender disparities.

The Mental Health, Substance Use, and Recovery Committee solicited testimony Monday on a Rep. Marjorie Decker bill (H 2082) that advocates say would be a first step to reducing barriers to mental health treatment and ushering in a more diverse behavioral health workforce.

The legislation directs the Health Policy Commission to examine differences in the prevalence of mental illness, substance use disorders, and suicide between various groups based on race and ethnicity, sexual orientation and gender identity, income levels, age, place of residence, homelessness, disability, primary language, and incarceration status.

The commission would also investigate and study the accessibility of behavioral health and substance use disorder services based on geographic distribution and how diversionary services are reimbursed, among other things.

The legislation requires the Health Policy Commission to submit the wide-ranging study annually by July 1 to the secretary of health and human services, public health commissioner, mental health commissioner, insurance commissioner, attorney general, Legislature, and various joint committee chairs.

Sally Reyering, former president of Massachusetts Psychiatric Society, said 2020 was a watershed year for many in the mental health profession. As the pandemic wore on, Reyering said many organizations and individuals struggled with the devastating effects of COVID-19 and the racial reckoning “that was demanded of us all.”

“I remember well when one of our physician members, a woman of color, brought to our attention the emerging trend that individuals of color were dying disproportionately of COVID-19,” Reyering said during the hearing. “The absence of data about differences in infection rates, hospitalization, and deaths among non-majority citizens of the commonwealth delayed action directed to mitigate these inequities”.

Mental health and substance use disparities documented prior to the pandemic, she said, have worsened, adding that there is an increased suicide rate among Black, Hispanic, Latinx, and LGBTQ youth.

“Our goal for this legislation is to take the first step to end mental health and substance use disorder disparities among racial and gender minorities, and that first step is to collect data,” Reyering said during the hearing. “[The bill] is a key first step in achieving equity and justice in health care.”

The legislation also directs the commission to review mental health and substance use disorder workforce demographics and talent pipelines.

Dr. Michelle Durham, a pediatric and adult psychiatrist at Boston Medical Center, said over 70 percent of patients at BMC identify as Black or Latinx and 30 percent do not speak English as their first language.

Over the past year, she said doctors have seen “lots of racism and discrimination at play for many of the patients we see.” One of the ways to address this, she said, is to have a diverse mental health workforce.

“Mental health treatment … is something where you really want to be able to engage and develop a rapport with that provider. It’s very intimate. There’s a lot that you need to discuss and say,” Durham said. “And it’s critical to have someone that maybe understands your culture, where you come from, what language you speak, or even just by basis of what you look like that they can engage.”

Dr. Parnika Saxena, a psychiatrist at Brockton Neighborhood Health Center, said her work affords her the opportunity to interact with people from different races and ethnicities, noting that most of her patients represent racial and ethnic minority groups.

“I’ve often witnessed the lack of access to health care services, especially mental health services for various reasons — societal distrust in the health care industry due to racism and past history of unjust treatment at the hands of these institutions, a lack of culturally competent providers, and economic disadvantages are just a few of these,” Saxena said. “Despite being a physician of color myself, I still noticed the struggle many of my patients have for trusting medical diagnoses and treatment.”

One of the “most unique ways” to overcome this barrier in an expedited fashion, she said, is to include community health care workers in treatment teams.

“The reason being that many of them are often members of the community that the patients belong to,” Saxena said. “So they work in the community, and therefore they have a special level of trust and understanding with them.”

Saxena pointed to a 2020 report from the attorney general’s office that showed the community health care workforce in the state is more diverse and representative of patient populations than other health care professions.

“And as a result, they’re able to form trusted relationships with the communities they serve, and improve health outcomes and reduce disparities for a wide array of conditions,” Saxena said.

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