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Global Health Econ Sustain Interventional psychiatry: Disparities and solutions

MDD varies by geographical region (Vyas et al., 2022), it in access to mental health services are influenced by various
affects individuals of all ages, races, and socioeconomic factors, including socioeconomic status (SES), cultural
backgrounds. Treatment-resistant depression (TRD) refers beliefs, stigma surrounding mental health, geographical
to a subset of MDD that does not respond adequately to location, and the availability of mental health services (Araya
standard first-line antidepressant treatments, including et al., 2018; Barksdale et al., 2022; Terlizzi & Norris, 2021).
psychotherapy and pharmacotherapy. While TRD affects For example, studies in the United States revealed that
individuals across all demographic groups, certain factors, racial, ethnic, and cultural minorities have lower rates of
such as substance abuse, poor social support, co-occurring access to mental health care than their respective majorities
medical conditions, and a prolonged history of depression, (Barksdale et al., 2022; Terlizzi & Norris, 2021). Furthermore,
may increase the risk of its development (Kautzky when minorities have access to health care, providers more
et al., 2019). frequently exhibit implicit biases that can lead to misdiagnosis
Interventional psychiatry refers to a rapidly growing and underdiagnosis of mood disorders (Black Parker et
branch of psychiatry that utilizes minimally invasive al., 2021; Merino et al., 2018; Moran, 2018). In addition,
procedures to treat mental health disorders. Since the 1930s, disparities in research participation and representation
neuromodulation has been a medical technique used to within psychiatric studies significantly impact access to
address mental health disorders (Conroy & Holtzheimer, mental health treatments (Ruiz-White et al., 2023). Despite
2021). The ongoing technological advancements accounting for sociodemographic and economic factors,
have significantly enhanced the effectiveness of these minorities exhibit higher rates of MDD compared to their
approaches in addressing treatment resistance. This shift White counterparts (Vyas et al., 2020). This underscores the
has fostered greater acceptance of neuromodulation and urgent need to reduce mental health treatment disparities
other rapidly acting device-based and pharmaceutical within underrepresented communities in both practice and
therapies, particularly for the treatment of conditions research efforts.
such as TRD (Staudt et al., 2019). Common interventional 2.1. Geographical barriers
approaches that have gained federal regulatory approval
include repetitive transcranial magnetic stimulation One of the primary factors influencing disparities in access
(rTMS), first approved in 2008; esketamine, approved in to interventional psychiatry relates to the unrepresentative
2019; and electroconvulsive therapy (ECT), first approved geographical distribution of facilities and psychiatrists,
in 1976. These treatments can provide fast-acting symptom particularly those that deliver interventional treatments.
improvement compared to psychotherapies and traditional In addition to the substantial time required to access
pharmacotherapies, with ongoing research trials aimed at services, patients must overcome the burden of securing
further improving their efficacy through individualization transportation. Research indicates that access to health
and optimization of treatment parameters (Appelbaum care, particularly transportation, disproportionally
et al., 2023). Despite these methodological advances, affects socioeconomically disadvantaged and racially
disparities in access, specifically in historically minoritized populations, with longer distance-normalized
underrepresented groups, continue to present a challenge trip times for Black individuals compared to their White
to addressing the burden of TRD. For example, ethnic counterparts (Labban et al., 2023; Walker et al., 2021).
minorities are considerably less likely to receive ECT Moreover, transportation and financial instability emerge
(Giacobbe et al., 2023), to be referred for psychiatric as significant barriers to health-care access (Walker et al.,
treatment and proper diagnoses (Smith et al., 2021), and 2021). Considering America’s growing racial diversity,
are more hesitant to participate in psychedelic therapy ensuring reliable transportation becomes even more
(Smith et al., 2021). These shortcomings necessitate imperative. As central and southern regions of the United
proactive measures to ensure comprehensive and equitable States continue to experience growing racial diversity, it
mental health interventions. As such, the aims of this paper is crucial to correspondingly expand psychiatric services
are twofold (i) to delineate the barriers to interventional in these areas (Jensen et al., 2021). A survey conducted in
psychiatric treatment and (ii) to propose solutions that 2020 by the National Mental Health Services (SAMHSA,
could reduce these disparities. 2021) characterized these discrepancies and reported
that the central and southern regions of the United States
2. Challenges contributing to disparities had the lowest ratio of psychiatrists, especially geriatric
While developments and improvements in psychiatric health psychiatrists, which further exacerbates the gap in mental
care have led to more effective treatments for TRD and related health care, given the prevalence of TRD among older
mental health disorders, access to psychiatric care, especially patients (Kautzky et al., 2023). Rural communities were
interventional services, is unevenly distributed. Disparities found to be especially understaffed, whereby 65% of

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/ghes.2456