Patterns of mental health utilization among island Puerto Rican poor.

Abstract

BACKGROUND: This paper describes utilization of mental health services by poor Puerto Ricans living on the island. It examines the utilization rates, within health sectors, and settings for the provision of mental health services. METHODS: Data are based on an islandwide probability sample of 18- to 64-year-old respondents living in low socioeconomic areas. We assessed need with the Psychiatric Symptom and Dysfunction Scales. RESULTS: Approximately one-third of our study population (31.5%) met criteria for need. Of these, only 32% had received any mental health care in the past year. Need was significantly associated with use of physical or mental health services for mental health problems. We found those who needed services to be five times more likely than those who did not need services to have used one or both sectors of care at least once in the past year. Among the first group 21.8% used the physical health sector to deal with mental health problems in contrast with 17.9% who sought care in the mental health sector. In the physical health sector, subjects used the public and private settings equally. In the mental health sector, 70% of subjects used the public setting. CONCLUSIONS: This suggests the nonpsychiatric physician as a main provider for mental health treatment.

Latino Adults’ Access to Mental Health Care: A Review of Epidemiological Studies

“…The articles present findings from the seven epidemiological studies: the ECA Wells, Hough, Golding, Burnam, & Karno, 1987;Wells, Hough, Golding, Burnam, & Karno, 1989), NCS , MAPSS (Peifer, Hu, & Vega, 2000;Vega, Kolody, & Aguilar-Gaxiola, 2001;Vega et al, 1999), the Puerto Rico Mental Health Utilization Study (PRMHUS; AlbizuGarcia, Alegría, Freeman, & Vera, 2001;Alegría et al, 1991;Pescosolido, Wright, Alegría, & Vera, 1998;Vera, Alegría, Freeman, Robles, Pescosolido, & Pena, 1998), South Florida Refugee Study (Portes et al, 1992), National Surveys on Drug Use and Health (NSDUH; Harris et al, 2005), and the Robert Wood Johnson Foundation's Healthcare for Communities Study (RWJF HCS; Wells et al, 2001;Young, Klap, Sherbourne, & Wells, 2001). The 16 publications are summarized in Table 1.…”

“…Albizu-Garcia et al (2001), Alegría et al (1991), Ortega and Alegría, (2002), Vera et al (1998) used PRMHUS data to examine the mental health service use of Puerto Ricans living in low socioeconomic areas of Puerto Rico. Peifer et al (2000), Vega et al (1999), and used MAPSS data to examine the mental health service use of Mexican Americans in Fresno County, California.…”

“…Eight articles did not specify a theoretical model or framework to guide research questions and/or data analysis (Alegría et al, 1991;Harris et al, 2005;Hough et al, 1987;Peifer et al, 2000;Vega et al, 1999;Wells et al, 1987Wells et al, , 2001Young et al, 2001). All of these articles were descriptive in nature reporting service use rates and examining factors associated with accessing mental health care.…”

“…Six articles (Alegría et al, 1991;Hough et al, 1987;Portes et al, 1992;Wells et al, 1987Wells et al, , 1989Young et al, 2001) defined service use as a continuous variable measuring the frequency of services used over a specified period of time. Hough and colleagues (1987) using data from the ECA Los Angeles site measured the number of times respondents' visited specialty mental health, general health, and other human services in the previous 6-months for problems with emotions, nerves, drugs, alcohol or mental health.…”

“…Need Factors-Needs factors were consistently found to be associated with the use of both specialty mental health and general medical providers (Albizu-Garcia et al, 2001;Alegría et al, 1991;Peifer et al, 2000;Portes et al, 1992;Wells et al, 1989). Need factors associated with the use of these providers included functional impairment due to mental illness, presence of one or more psychiatric diagnosis, comorbidity, defined either as two or more mental disorders or the combination of a substance abuse and mental disorder, and self-reported measures of poor physical and/or mental health.…”