Document Type

Working Paper

Publication Date



mental health care, health insurance, empirical research, race, income


In previous work (Richman 2007), we found that even under conditions of equal insurance coverage and access to mental healthcare providers, whites and high-income individuals consume more outpatient mental health services than nonwhites and low-income individuals. We follow-up that study to determine (1) whether nonwhite and low-income individuals obtain medical substitutes to mental healthcare, and (2) whether disparate consumption leads to disparate health outcomes. We find that nonwhites and low-income individuals are more likely than their white and high-income counterparts to obtain mental health care from general practitioners over mental healthcare providers, and nearly twice as likely not to follow up with a mental health provider after hospitalization with a mental health diagnosis. We further are unable to find any evidence that this leads to adverse health outcomes. These findings echo concern expressed in Richman (2007) that low-income and nonwhite individuals might be paying for health services that primarily benefit their white and more affluent coworkers.

Library of Congress Subject Headings

Race discrimination, Income, Mental health services, Health insurance