Disparities Within Serious Mental Illness Technical Brief

Project Summary Title and Description

Disparities Within Serious Mental Illness Technical Brief
Adults with serious mental illness (SMI) often experience gaps in access to needed health care compared with other populations. Such disparities may be even more pronounced between certain groups of patients with SMI, differing by race, ethnicity, gender, economic disadvantage (including housing stability) and socioeconomic status, and geographic location (chiefly, rural versus urban residence); disparities arise as well for lesbian, gay, bisexual, and transgender (LGBT) individuals and those who have difficulty communicating in English (because it is a second language).
Authors of Report
Methodology description
We reviewed the published and gray literature and interviewed Key Informants (KIs) to address four Guiding Questions (GQs). The four refined GQs for this Technical Brief focus on the critical areas of concern in relation to disparities—access to health insurance with appropriate coverage for these SMI conditions, accurate diagnostic evaluations, receipt of necessary and appropriate therapeutic services, quality of the health services, adherence to treatment over the long term, and various outcomes of care. The principal focus for the first three GQs is a description of the interventions (GQ 1), the context in which they are implemented (GQ 2), and a description of the evidence about the effectiveness of the interventions (GQ 3); GQ 4 examines the gaps in the knowledge base and the high-priority needs for future research. We included interventions addressing diagnosis, access to and quality of treatment and support services among disparity groups of adults with SMI.
Publication of the final report and PMID are pending. Very limited study data were entered retrospectively using SRDR's built-in abstraction function. More detailed descriptions of the characteristics and outcomes of the interventions are included in Appendix F of the report, which has been uploaded to SRDR (DSMI_AppendixF_Final.docx) as a separate file. Appendix F includes, but is not limited to: sample size, length of intervention and followup, study goals, intervention description, comparator description, outcomes studied, and a narrative summary of the main study results.
Funding Source
This report is based on research conducted by the RTI International–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA290201500011I_ HSA2903

Key Questions

1. From available evidence and input from Key Informants (KIs): Describe interventions (types or modalities) to reduce disparities among SMI groups. Interventions may address one or more of the concerns stated above. Primary subquestions include: a. What are the goals, components, and outcomes of the interventions? b. What are the disparity subgroups that are the focus of the interventions? c. What are the potential advantages and disadvantages of these types of interventions?
2. From available evidence and input from KIs: Describe the context for each intervention (type or modality) identified in GQ 1 to reduce disparities among SMI groups. Key contextual subquestions concern the following: a. What is the setting for the intervention? b. What responsibilities do the health professionals (including clinicians) participating in the intervention have for the medical and mental health care of patients with SMI? c. What resources (e.g., health information technology) are needed to provide the intervention?
3. From available evidence: Describe the current evidence about the effectiveness (or comparative effectiveness) of interventions that have been implemented to reduce disparities among SMI groups. Interventions may address one or more of any of the concerns identified for GQs 1 and 2. Data on a specific intervention will include but not be limited to: a. Patient inclusion criteria; b. Type of intervention and setting; c. Comparator intervention(s) used in comparative effectiveness evaluations, if any; and d. Outcomes
4. From available evidence and input from KIs, identify gaps in knowledge and future research needs, with specific attention to the following subquestions: a. Are any interventions to address disparities among SMI groups planned by researchers, clinicians, patient advocacy groups, or others, but not yet implemented? b. In current interventions, are the correct outcomes being measured? Are relevant outcomes being measured with appropriate instruments and data? c. What gaps exist in the evidence base for best practices or interventions for addressing disparities in SMI? d. What are possible areas of future research? What are potential long-term (10 years or more) developments in this field?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Improving depression care for older, minority patients in primary care.2005
Impact of housing and work supports on outcomes for chronically homeless adults with mental illness: LA's HOPE.
Feasibility and acceptability of clinic-based telepsychiatry for low-income Hispanic primary care patients.2012
Comparative effectiveness of standard versus patient-centered collaborative care interventions for depression among African Americans in primary care settings: the BRIDGE Study.2013
Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.
A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms.2000
Depression care management for Chinese Americans in primary care: a feasibility pilot study.2013
Street outreach for homeless persons with serious mental illness: is it effective?1999
A randomized trial of assertive community treatment for homeless persons with severe mental illness.1997
Treating depression in predominantly low-income young minority women: a randomized controlled trial.2003
A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.
Housing outcomes for homeless adults with mental illness: results from the second-round McKinney program.1997
Serving street-dwelling individuals with psychiatric disabilities: outcomes of a psychiatric rehabilitation clinical trial.2000
Improving access to care for women veterans suffering from chronic pain and depression associated with trauma.2013
Immigrant families coping with schizophrenia. Behavioral family intervention v. case management with a low-income Spanish-speaking population.1995
Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial.2013
A randomized-controlled trial of an intervention to improve antidepressant adherence among Latinos with depression.2013
The ability of multifamily groups to improve treatment adherence in Mexican Americans with schizophrenia.
Impact of motivational pharmacotherapy on treatment retention among depressed Latinos.2013
A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study.2010
A randomized controlled trial of cognitive-behavior therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: a cross-over design.
Effects of psychoeducation for Korean Americans with chronic mental illness.2002
Development and pilot testing of a new psychosocial intervention for older Latinos with chronic psychosis.2005
Telephone depression care management for Latino Medicaid health plan members: a pilot randomized controlled trial.2011
Use of standard Webcam and Internet equipment for telepsychiatry treatment of depression among underserved Hispanics.
Randomized trial of critical time intervention to prevent homelessness after hospital discharge.2011

Downloadable Data Content

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