The goal of this study was to test the hypothesis that a high proportion of minority clients in an outpatient mental health program marks the presence of a minority-oriented program which, in turn, promotes relatively favorable patterns of minority utilization. Favorable patterns of utilization are measured in this study as an increased number of outpatient visits (either psychotherapy or medication management) and increased hours of case management.

All clients who received outpatient mental health services for fiscal years 1987-1988, 1988-1989, and 1989-1990 in the study county were included. For the three years, the average proportions of non-white clients in the programs were 0.38 (s.d.=0.15), 0.42 (s.d.=0.15) and 0.42 (s.d.=0.17) respectively. These analyses controlled for patient characteristics (ethnicity, gender, age, marital status, employment status, assessment of functioning (GAS), and diagnosis), clinician characteristics (gender, licensure status, and professional status), and whether or not the client and clinician matched on ethnicity, language, both or neither.

The study found that, during each of the fiscal years examined, an increase in the percentage of minority clients in the program predicted greater outpatient service use and fewer hours of case management (this analysis controlled for the variables listed above). An increase in minority representation in the program by 10% was associated with an increase of between three-quarters to one visit for each of the three years examined. Conversely, a 10% increase in the proportion of non-whites in the program was associated with 0.80 fewer case management hours in the first year, 2.0 fewer hours in the second year, and 1.7 fewer hours in the third year. These results were all statistically significant, with the exception of the number of outpatient visits in the second year examined (fiscal year 1988-1989).

The authors suggest that a possible explanation for the increased use of outpatient care and decreased use of case management services could be differences in case-mix (severity or type of illness) between programs that emphasize the treatment of minority populations (and therefore have more minority clients) and programs that are targeted to non-minority populations. Practice styles and other program-related factors were also suggested as possible explanations.

A match of client and clinician with regard to ethnicity and language was not consistently associated with outpatient service use, but a match of both ethnicity and language was associated with a reduction in the number of outpatient visits in all three years examined (by between 1.3 and 2.1 visits over the three years). Matches of client and clinician with regard to ethnicity alone, as well as ethnicity and language, were both associated with an increase in case management hours by between 3.5 and 4.4 hours over the three years examined. The authors suggest one explanation related to the immigration status and acculturation level of certain clients. “It is plausible that clients who are least accustomed to the dominant culture and most psychologically and socially vulnerable would be assigned clinicians who are similar both in ethnicity and in language; and these clinicians may prefer case management…with its broad focus of intervention and attention to mobilizing a wide range of resources in order to promote successful community adjustment.”