Ethnic disparities in mental health treatment gap in a community-based survey and in access to care in psychiatric clinics.

BACKGROUND: Contrasting social status of ethnic groups differentially impacts the use of psychiatric services, including in Israel, despite its universal health system. However, relevant studies are limited. AIMS: To examine ethnic differences in mental health treatment gap and in access to specialized care. METHODS: Data were gathered from two sources. Study I included Mizrahi (Jews of North African/Asian origin, socially disadvantaged, n = 136) and Ashkenazi (Jews of European American origin, socially advantaged, n = 69) who were diagnosed with common mental disorders in the preceding 12 months in the Israeli component of the World Mental Health Survey. Study II included Mizrahi (n = 133) and Ashkenazi (n = 96) service users entering ambulatory mental health care. RESULTS: Study I showed that the treatment gap was larger among Mizrahi compared with Ashkenazi respondents (28% standard error (SE) = 4.1 and 45% SE = 6.2, respectively, sought services) following adjustment for sociodemographic confounders (adjusted odds ratio (AOR) = 2.28, 95% confidence interval (CI) = 1.1-4.8). Study II showed that the access to specialized care lagged over a year among 40% of service users of both ethnic groups. No significant ethnic differences emerged in variables related to delay in accessing care. CONCLUSIONS: Treatment gap was larger among ethnically disadvantaged compared with the advantaged group. However, once in treatment, service users of both ethnic groups report similar barriers to care.

Dropout, early termination and detachment from a public psychiatric clinic.

BACKGROUND: Dropout from an outpatient clinic is the loss of a patient to scheduled follow-up. Due to movement of mental health care to the community, adherence to ambulatory care is crucial to maintain stability among individuals with mental disorders. We hypothesized that patients drop out from ambulatory psychiatric care when regardless of the therapist's evaluation, they feel that they have recovered, or because they are dissatisfied with treatment. The aim was to examine the phenomenon of premature termination of treatment in a public community-based ambulatory psychiatric clinic serving a catchment area with a population of 200,000. SUBJECTS AND METHODS: The study sample was drawn from patients who had at least one ambulatory therapy session during the previous five years, immediately or shortly following initial treatment and who were subsequently lost to follow-up. Participants completed a questionnaire that evaluated their satisfaction with treatment and described their reasons for early termination of treatment. RESULTS: The sample included eighty-two patients. Eighty percent of the responders (N=65) terminated therapy on their own, and twenty percent (N=17) decided to end treatment together with their therapists. DISCUSSION: Increased involvement of patients in treatment planning, duration and end of therapy, may improve attendance in ambulatory mental health care settings. CONCLUSIONS: Though dropouts generally reported satisfaction with the ambulatory service, some explained early termination of treatment as being due to dissatisfaction with the therapist, the type of treatment or because of therapist turnover. Others terminated treatment because they felt their problems were solved or their conditions had improved, though therapists had determined otherwise.