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Global Health Econ Sustain Interventional psychiatry: Disparities and solutions

and poorer health outcomes for some, several avenues States Department of Health and Human Services, will
can improve representation and access to interventional make interventions more accessible and improve their
therapies. These improvements could emanate from representation in both clinical settings and clinical trials.
approaches that facilitate patient access and increase equity, Furthermore, the hiring teams can enhance diversity
including the removal of economic barriers, increased by implementing inclusive hiring practices by sourcing
representation of research providers and participants, candidates from diverse channels such as community
investment in cultural competency, and increased organizations, providing greater incentives to alleviate the
education on procedures. burden of relocating, and using more inclusive platforms.
To address economic barriers, policymakers should Promoting diversity can also involve incorporating a
advocate for equitable insurance coverage for mental diverse interview panel, requiring diversity training for the
health treatments overall, with a particular focus on hiring team, and adopting practices such as anonymous
interventional procedures. This could entail expanding resume reviews and structured interviews to foster a more
Medicare coverage to fully cover the cost of rTMS representative workforce.
treatments, rather than only a portion of the treatment, In terms of research, having a diverse and
as is currently practiced. At present, insurance companies understanding team may ease the complicated consent
impose restrictions on rTMS for TRD, so efforts need to be and procedure processes of clinical trials for participants
made to persuade insurance companies to eliminate such and, ultimately, may lead to the recruitment of participants
restrictions (Weissman et al., 2023). Another economic from populations that would otherwise have language and
barrier that prevents equitable treatment stems from the cultural barriers. The current resident physician workforce
lack of adequate transportation for patients (Labban et al., is also unrepresentative of minorities, with Blacks/African
2023). While this problem is not unique to interventional Americans and Hispanics/Latinos accounting for 6.3% and
treatments, it is exacerbated because interventional 8.3% of residents, respectively (AAMC, 2023). Specifically,
procedures typically require in-person services, and in interventional psychiatry, a recent study showed that
as noted above, these are less common in rural and most residents believed that familiarity with ECT (91.3%)
underserved communities. Improved accessibility to and rTMS (56.5%) were required for licensure; however,
and reduced costs of medical transportation services only a small percentage were able to achieve competency
can lead to a decrease in such transportation barriers. during their training (ECT: 24.3% and rTMS: 3.1%)
Moreover, there has been a recent attempt to implement (Giacobbe et al., 2021). This highlights the need for
mobile interventional services, such as the Montana TMS psychiatrists to receive better training in interventional
Mobile Medical Unit, which recently began operation as procedures and, more importantly, to combine their
part of the Veterans Administration hospitals, bringing cultural competence training to effectively provide services
services to patients who might not otherwise be able to for minorities. This can be achieved by incorporating
obtain these treatments. Similarly, while the vast majority simulation-based education into interventional psychiatric
of interventional services are provided in private health- training and providing neuroethics training to physicians
care systems, there is a need to expand such services in and residents as a part of their learning curriculum
public health-care systems, such as those currently being (Giacobbe et al., 2023).
implemented by the Los Angeles County Department of Clinical trials need to increase the representation of
Mental Health (Chung, 2022). underrepresented minorities so that findings from studies
Cultural barriers exacerbate disparities in access ensure efficacy and appropriate treatment for minorities.
to mental health treatments overall, particularly for The National Institutes of Health has made significant
interventional therapies such as ECT. There are several efforts to ensure greater representation in clinical trials,
potential paths to reduce these barriers, both for health- including requirements for racial and gender representation
care providers and in the treatments that they provide. The of research participants. Despite this, there remains a
first step is to increase both the number of psychiatrists marked underrepresentation of minorities (Turner et al.,
and non-clinician caregivers from minority groups 2022). While there are many factors driving disparity, there
that are engaged in interventional treatments. Hiring are several ethnic factors that may specifically contribute
medical professionals and affiliated technicians from to the underrepresentation of minorities in rTMS clinical
diverse backgrounds that represent local demographics, trials. For example, ethnic differences in hairstyles and
and training them in culturally competent health care head coverings may dissuade some individuals from
through programs offered by the Substance Abuse and participating in studies that measure brain activity,
Mental Health Services Administration and the United leading to inaccuracies in the dosing and treatment

Volume 2 Issue 1 (2024) 4 https://doi.org/10.36922/ghes.2456