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Global Health Econ Sustain Interventional psychiatry: Disparities and solutions

counties lacked sufficient psychiatrists, compared to 27% providers and their underlying racial biases (Garb, 2021).
in metropolitan counties (Morales et al., 2020). Another For example, black individuals are often misdiagnosed with
identified issue was the severe lack of interventional psychotic disorders instead of affective disorders, resulting
psychiatric treatments, with only 1% of all facilities offering in fewer referrals to interventional psychiatric treatments
ketamine treatment, 7% offering ECT in two states, and at (SAMHSA, 2021). Furthermore, underrepresented
least 5% offering rTMS in five states. These data highlight groups, including racial and ethnic minorities, LGBTQ+
the disparities in resources such as transportation or access individuals, and refugees, may face additional challenges
to health care in rural and racially diverse states, which in accessing mental health services due to discrimination
further accentuate the gap in mental health treatments and a lack of culturally competent health care (Buchanan,
available to historically underserved communities. 2020; Choi et al., 2023). Approximately 1 in 10 youths in
the United States identify as LGBTQ+ and have three
2.2. Cultural barriers times the prevalence of depression and anxiety compared
Racial disparities are prominent within interventional to heterosexual youth, and 42% have contemplated suicide
psychiatry and can be attributed to cultural barriers, at some point in their lives (Choi et al., 2023). Only 28%
differences, and a lack of cultural competence among of mental health facilities have personalized care for such
providers. Cultural barriers and differences among identity issues, highlighting once again the challenges of
ethnicities also exacerbate disparities in access to mental individualized and specified care for under-represented
health treatments. Beliefs and stigma surrounding mental groups (Choi et al., 2023).
health can also deter individuals from seeking help. Black 2.4. Financial barriers
communities are especially sensitive to new treatment
modalities due to historical discrimination and abuse Additional important factors that contribute to disparities
from trials such as the Tuskegee study and the lack of in mental health access are the cost of treatment, their lack
information disseminated about novel, interventional of integration with primary care, and the limited insurance
treatments to these communities (Cabrera et al., 2021; coverage and reimbursement provided for the therapies.
Dean & Smith, 2021; Moran, 2018). Furthermore, Patients with illnesses such as TRD, anxiety, and postpartum
studies indicate that Black individuals with depression depression experience significantly higher treatment costs,
are less likely to receive therapy compared to their White worse outcomes, and ultimately a greater burden of disease
counterparts, and when they do, it is less intensive, lower in compared to those with MDD but no comorbidities
quality, and less commonly provided by specialists (Bailey (Proudman et al., 2021). Barriers to treatment are amplified
et al., 2019). Historically, Black individuals have received in interventional psychiatry as many insurance plans have
ECT at a much lower rate than their White counterparts, multiple stipulations to cover costs and require patients to
which could be attributed to a greater proportion of have failed several other therapies (Bermudes, 2021). For
their therapy being based in public hospitals that are example, typical treatment costs for transcranial magnetic
less likely to offer ECT (Asnis et al., 1978; Bailine & Rau, stimulation (TMS) are around USD $6,000 – $12,000,
1981; Black Parker et al., 2021; Kramer, 1990). Even when while accelerated TMS protocols are not yet covered
MDD patients were referred to hospitals that offered ECT by insurance and are completely paid out-of-pocket by
services, White individuals still received ECT treatment patients (Health; Psychiatry). While most Medicaid and
at higher rates (Jones et al., 2019). Ketamine and other Medicare plans cover a portion of some costs, they often
psychedelic therapies exhibit the greatest racial disparities, do not cover all modalities or the full amount and may
with approximately 74% of patients identifying as Whites only cover treatment if the patient has a higher-tier, more
and only 9% as Black, while 80% of patients in psychedelic expensive plan. Since minorities are more likely to have a
trials identify as Whites, with only 3 – 9% as Black (Simon, lower SES and be covered by Medicare, the extra out-of-
2023). In addition, disparities in race between providers pocket costs are an added barrier to these groups (Cohen
and patients contribute to increased racial biases, gaps in & Cha, 2023). Due to the cost of interventional treatments,
cultural awareness, and communication barriers (Wyse access often requires individuals to have health insurance,
et al., 2020). As a result, clients tend to be less trusting and and racial minority groups are less likely to be covered by
limit the amount of information they disclose, as well as health insurance compared to their White counterparts
their medication adherence (Pugh et al., 2021). (Lee et al., 2021; Weissman et al., 2023).

2.3. Provider biases 3. Solutions to alleviate disparities
Another source of discrepancies stems from the misdiagnosis While the systemic, cultural, financial, and socioeconomic
of symptoms due to a lack of cultural understanding by obstacles described above lead to disparities in treatments

Volume 2 Issue 1 (2024) 3 https://doi.org/10.36922/ghes.2456