Unequal Access to Mental Health Services

Abstract

The purposes of this article are: (i) to review some of the evidence that access to mental health services is not in fact equal, (2) to explore some of the dynamics or rationales by which professionals attempt to mask or justify these inequalities, and (3) to evaluate the effectiveness of strategies created to promote more equal access. I. Some Facts About Unequal Access: Sex, Age, Social Class, and Race The most obvious aspect of access is getting in the door and getting an appointment for services as promptly as possible. This is a major difficulty for some patients. Levenson and Pope (1980), for example, explore ways in which the implicit policies and procedures of some mental health centers might appear were they made explicit: 'All slim, attractive female patients will be moved automatically to the head of the waiting list by the appointments secretary and will be assigned to male therapists on the basis of seniority, clout, and ability to feign detachment and to deny countertransference in case conferences,' or 'Blacks will routinely receive medication for serious mental disturbances; whites will receive talking therapy; and those with Spanish surnames or accents of any kind will be referred elsewhere.' It is apparent, however, that getting in the door is but one of many challenges faced by those seeking timely and appropriate services. Once in the door, they may encounter personnel, theoretical orientations, assessment and treatment plans, allocations of resources, and systems factors which serve to prevent or divert adequate help, thus ensuring a lack of equal access to effective services.