Race has no effect on quality of services or clinical outcomes for mentally ill homeless patients, Yale researcher reports

A homeless psychiatric patient's race and the race of his or her case managers has no effect on the quality of mental health services the patients receive, or on their clinical outcomes, Yale researcher Robert Rosenheck, M.D. reports in a recent study published in Psychiatric Services.

"Our results show that at least in the area of services for homeless people with severe mental illness, delivery of services and the outcomes of services are not different for African Americans and whites," said Rosenheck, professor of psychiatry and in the Department of Epidemiology and Public Health at Yale. "Treatment is as effective when clinician and client are of different races as when they are of the same race."

In light of public concern and research papers suggesting that ethnic minorities get lower quality health care, Rosenheck said more studies are being done to find out more about the issue.

"In mental health, the crucial part of treatment is the relationship between the case manager and the client or the therapeutic alliance," Rosenheck said. "Distrust is a major threat to this alliance. If tensions exist, those tensions will express themselves in the relationship and might eventually affect the amount and quality of services received and the outcome. This was not the case based on these results."

In his five-year study of 1,791 homeless people with severe mental illness, Rosenheck and colleagues conducted a structured interview of 818 white clients and 973 African Americans. The participants were asked a series of questions at the time they entered the mental health program, and at three months and 12 months later. The team also did an interaction analysis-pairing African American patients with white case managers, white patients with black case managers, and vice versa.

In this study, as with others he has conducted, Rosenheck said he found no evidence of differences in service delivery and no evidence of differences in quality of the relationship between the case manager and the client. He said the clients also showed the same amount of improvement in a broad range of outcome variables, including substance abuse, psychiatric symptoms, housing and overall quality of life. There were also no differences in use of services including emergency services, employment services, medical/surgical services, substance abuse and outpatient psychological services.

"It is difficult to generalize from these findings to other areas of health care," Rosenheck said. "The kinds of people who work with the homeless are generally those who have a special commitment to fairness and social justice, so these results don't necessarily translate easily elsewhere."

The findings were consistent in some of Rosenheck's other work. He noted, "In other studies of this type involving homeless veterans and Vietnam veterans, these findings were consistent in public sector health programs."

Rosenheck's co-authors on the study included Mathew Chinman and Julie Lam in the Department of Psychiatry at Yale.