Access to mental health treatment by English language proficiency and race/ethnicity

Abstract

BACKGROUND: Limited English proficiency (LEP) may contribute to mental health care disparities, yet empirical data are limited. OBJECTIVE: To quantify the language barriers to mental health care by race/ethnicity using a direct measure of LEP is the objective of the study. DESIGN: Cross-sectional analysis of the 2001 California Health Interview Survey is the study's design. PARTICIPANTS: Adults aged 18 to 64 who provided language data (n = 41,984) were the participants of the study. MEASUREMENT: Participants were categorized into three groups by self-reported English proficiency and language spoken at home: (1) English-speaking only, (2) Bilingual, and (3) Non-English speaking. Mental health treatment was measured by self-reported use of mental health services by those reporting a mental health need. RESULTS: Non-English speaking individuals had lower odds of receiving needed services (OR: 0.28; 95% CI: 0.17-0.48) than those who only spoke English, when other factors were controlled. The relationship was even more dramatic within racial/ethnic groups: non-English speaking Asian/PIs (OR = 0.15; 95% CI: 0.30-0.81) and non-English speaking Latinos (OR: 0.19; 95% CI: 0.09-0.39) had significantly lower odds of receiving services compared to Asian/PIs and Latinos who spoke only English. CONCLUSIONS: LEP is associated with lower use of mental health care. Since LEP is concentrated among Asian/PIs and Latinos, it appears to contribute to racial/ethnic disparities in mental health care. Heightened attention to LEP is warranted in both mental health practice and policy. © 2007 Society of General Internal Medicine.