People with long commutes to mental health services are more likely to disengage from their treatment programs, and this effect is even more pronounced for racial and ethnic minorities, a recent Washington State University study found.
The National Institutes of Health (NIH)-supported research investigates the relationship between geographic proximity and engagement with mental health services for early psychosis, a mental condition where a person has difficulty distinguishing between what is real and what is not. Published in the journal Administration and Policy in Mental Health and Mental Health Services Research, the study also examines whether proximity helps explain racial and ethnic disparities in mental health treatment and outcomes.
“This study shines a light on the under-researched area of mental health in rural populations and racially and ethnically diverse communities that are traditionally underserved,” said lead author Oladunni Oluwoye, an associate professor in the WSU Elson S. Floyd College of Medicine. “A lot of work has focused on disparities in mental health services for first episode psychosis, but surprisingly no one has linked engagement with proximity and explored how that may be a contributing factor.”
Working with the Washington State Health Care Authority, the researchers analyzed data from 225 Washington residents participating in New Journeys, a coordinated specialty care (CSC) program for teens and young adults with first episode psychosis. CSC is a comprehensive early intervention model that supports recovery through individualized therapy and medication management, education and employment support, and patient and family education.
Keeping up with an intensive schedule of appointments can be challenging, however, especially for clients who live farther from services. Comparing travel time with measures of program engagement, the researchers found clients with long commutes scheduled and attended fewer appointments and were less likely to complete the program.
The researchers also investigated whether travel time and program engagement differed by race and ethnicity, testing Hispanic versus non-Hispanic ethnicity and white versus Black, Asian, American Indian, Alaska Native, and Pacific Islander race. Past research has shown these groups have less access to and lower engagement with mental health services as well as worse mental health outcomes.
While the study found no differences in average travel time based on race or ethnicity, rates of disengagement were higher for Hispanic and non-white clients with long commutes compared to their non-Hispanic and white counterparts. The results show geographic proximity is likely playing a role in racial and ethnic disparities in engagement with mental health services.
Potential interventions to increase access and engagement include placing new services in underserved areas, conducting appointments via phone or telehealth to reduce attendance barriers, and providing culturally tailored care, according to the researchers.
With funding for CSC programs on the rise across the U.S., the placement of new services is particularly important to ensure programs don’t exacerbate existing disparities, Oluwoye said. The research team, including co-authors Biostatistician Megan Puzia, Associate Professor Ofer Amram, and Research Professor Douglas Weeks from the College of Medicine, has worked closely with the state health care authority and federal funders to inform the placement of new services in Washington as part of an ongoing evaluation of the New Journeys program.
“Coordinated specialty care is the gold standard of care for early psychosis,” Oluwoye said. “We need continued investment in these programs, and we need to be mindful of where we place them and flexible about how we deliver services to people who don’t live close to them.”
