Yale Bulletin and Calendar

February 23, 2001

Volume 29, Number 20

Race is not a factor in the delivery of mental health services, study by Yale researcher shows

A homeless psychiatric patient's race and the race of his or her case manager has no effect on the quality of mental health services the patients receive, or on their clinical outcomes, Yale researcher Dr. Robert Rosenheck reports in a study published in Psychiatric Services.

"Our results show that at least in the area of services for homeless people with severe mental illness, delivery of services and the outcomes of services are not different for African Americans and whites," says Rosenheck, professor of psychiatry and in the Department of Epidemiology and Public Health. "Treatment is as effective when clinician and client are of different races as when they are of the same race."

In light of public concern and research papers suggesting that ethnic minorities get lower quality health care, Rosenheck says more studies are being done to examine the issue.

"In mental health, the crucial part of treatment is the relationship between the case manager and the client or the therapeutic alliance," Rosenheck says. "Distrust is a major threat to this alliance. If tensions exist, those tensions will express themselves in the relationship and might eventually affect the amount and quality of services received and the outcome. This was not the case based on these results."

In his five-year study of 1,791 homeless people with severe mental illness, Rosenheck and colleagues conducted a structured interview of 818 white clients and 973 African Americans. The participants were asked a series of questions at the time they entered the mental health program, and at three months and 12 months later. The team also did an interaction analysis -- pairing African American patients with white case managers, white patients with black case managers, and patients with managers of the same race.

In this study, as with others he has conducted, Rosenheck says he found no evidence of differences in service delivery and no evidence of differences in quality of the relationship between the case manager and the client. He says the clients also showed the same amount of improvement in a broad range of outcome variables, including substance abuse, psychiatric symptoms, housing and overall quality of life. There were also no differences in use of services including emergency services, employment services, medical/surgical services, substance abuse services and outpatient psychological services.

"It is difficult to generalize from these findings to other areas of health care," Rosenheck says. "The kinds of people who work with the homeless are generally those who have a special commitment to fairness and social justice, so these results don't necessarily translate easily elsewhere."

The findings were consistent in some of Rosenheck's other work. He noted, "In other studies of this type involving homeless veterans and Vietnam veterans, these findings were consistent in public sector health programs."

Rosenheck's coauthors on the study include Matthew Chinman and Julie Lam in Yale's Department of Psychiatry.

-- By Karen Peart

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