Transcript: 

Hello, I’m Dr Leslie Citrome, Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, New York. Welcome to our program on schizophrenia.  

Disparities in mental healthcare, particularly for schizophrenia, are pronounced in the United States, where minority populations, rural communities, and economically disadvantaged groups face significant barriers to accessing quality treatment.

In one investigation, approximately 60% of individuals with schizophrenia reported receiving care at least once in the past 6 to 12 months, with around 50% receiving specialty care. In other words, at least 40% had no consistent contact with mental health services.  

Additionally, consistent research findings show a disproportionately high rate of psychotic disorder diagnoses (including schizophrenia) within Black Americans, at a rate of almost 5 times that of their White counterparts admitted in state psychiatric hospitals. While a narrowing of the gap between White and Black patients and White and Latino populations does appear to be continuing, there are a number of geographical differences. For example, in a review of publicly insured adults in 4 large US states, Latinos had lower quality of care than White patients in each state aside from Florida, with an improvement of care in Black patients. Conversely, in California, Latinos experienced greater improvement in care. Further targeted research is needed to better establish the systemic barriers to race, and other factors that influence care.

Key barriers include lack of knowledge and difficulty identifying mental illness, lack of information on where to seek specialized treatment, and lack of training for caregivers. These issues may be exacerbated in areas with lower socioeconomic status, where patients may have less access to appropriate care.

The healthcare infrastructure in rural areas often lacks sufficient psychiatric providers, with the majority of mental healthcare facilities being centered in urban areas, resulting in delayed diagnoses and suboptimal care for individuals with schizophrenia. Additionally, minority populations, specifically Black Americans, are consistently misdiagnosed with schizophrenia relative to their White counterparts.

Economic barriers, including high treatment costs, lack of insurance, and inadequate coverage for mental health services, contribute to the inequities faced by these populations. Factors like fewer medical specialists, lack of public transportation, and fewer financial resources combine to further worsen the barriers to care. Additionally, stigma and misinformation within certain communities can discourage individuals from seeking help, perpetuating cycles of untreated mental illness.

Increasing funding for community mental health centers and mobile psychiatric units can enhance access to care for rural and underserved populations.

The COVID-19 pandemic also highlighted the need for policy-level changes related to schizophrenia, such as advocating for expanded Medicaid coverage and mental health parity laws, as widespread weaknesses within the healthcare system were on full display. It is essential that healthcare companies and institutions continue to lobby to alleviate those financial barriers.

Implementing mandatory cultural competency training for healthcare providers can improve communication and understanding with diverse populations, fostering a more inclusive healthcare environment. Technology-driven solutions, such as telepsychiatry programs, can bridge care gaps in remote areas.

I hope this has been helpful to you in better understanding schizophrenia and the challenges that our patients and caregivers face.  

For more information, please listen to the other podcasts in this series: 


References:

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