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Disparities in Utilization of Mental Health Services: Explanations and Possible Solutions

  • Danielle Laraque
    Correspondence
    Address correspondence to Danielle Laraque, MD, Professor of Pediatrics and Community & Preventative Medicine, Debra & Leon Black Professor of Pediatrics, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029.
    Affiliations
    School of Medicine and Dentistry and the Department of Pediatrics, University of Rochester, Rochester, NY (Dr Szilagyi) Mount Sinai School of Medicine, New York, NY (Dr Laraque)
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  • Peter G. Szilagyi
    Affiliations
    School of Medicine and Dentistry and the Department of Pediatrics, University of Rochester, Rochester, NY (Dr Szilagyi) Mount Sinai School of Medicine, New York, NY (Dr Laraque)
    Search for articles by this author
      It is increasingly understood that at the root of hope for recovery from a mental health disorder is the therapeutic alliance created by the partnership of the clinician, the patient, and the family and their engagement in the process of care.
      • Kaplan S.H.
      • Greenfield S.
      • Gandek B.
      • et al.
      Characteristics of physicians with participatory decision-making styles.
      • Hoagwood K.E.
      Family-based services in children's mental health: a research review and synthesis.
      Elements of a therapeutic alliance and utilization of mental health services include access and availability of the clinician; a shared belief in what has caused the disability; a common understanding of the possible therapies and their effectiveness; trust in the relationship between healer and the one to be healed; and an understanding of what needs to be done, how it is to be done, and the time course. However, there are serious concerns about the current child mental health system's ability to provide the opportunity for this therapeutic alliance and to meet the mental health care needs of youth.
      • Knitzer J.
      Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services.
      • US Public Health Service
      Mental Health: A Report of the Surgeon General.
      • Cooper J.L.
      • Aratani Y.
      • Knitzer J.
      • et al.
      Unclaimed Children Revisited: The Status of Children's Mental Health Policy in the United States.
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