Introduction: 
Massachusetts School of Professional Psychology (MSPP), founded 1974

PsyD	   Clinical
PsyD	   School
CAGS  School
MA 	   Forensic
MA      Counseling
MA Organizational
   
Mission Statement
MSPP strives to be a preeminent school of psychology that integrates rigorous academic instruction with extensive field education and close attention to professional development. We assume an ongoing social responsibility to create programs to educate specialists of many disciplines to meet the evolving mental health needs of society.

Access to 
Mental Health
	Mental illness, including suicide, accounts for over 15 percent of the burden of disease in established market economies, such as the United States. This is more than the disease burden caused by all cancers (National Institute of Health, 2004)

Mental Illness: Prevalence
Kessler et al., 2005
World Mental Health Survey Initiative (WHO)

Nationally Representative Sample, English speaking adults
(N = 9, 282)

12 month Prevalence Estimates
Anxiety (18%)	
Mood (9.5%)
Impulse (9%)
Drugs	(4%)
Other (26%)

Mental Illness: Facts
Kessler et al., 2005; Satcher, 2001

	30 % of US adults have a serious mental disorder

•	Fewer than 50% of those in need are treated
•	Independent of insurance, language, trust, relational style, prejudice are barriers to care
•	Culturally sensitive services show superior patient compliance

Global Burden of Disease: DALY
World Health Organization
	
The overall burden of disease is assessed using the disability-adjusted life year (DALY), a time-based measure that combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health.

Leading Causes of Mortality and Burden of Disease
World, 2004 (percentage reporting)
Mortality:
•	Ischaemic heart disease	12.2
•	Cerebrovascular disease      	9.7
•	Lower respiratory infections 	  7.1
•	COPD	   5.1
•	Diarrhoeal diseases 	   3.7
•	HIV/AIDS 	   3.5
•	Tuberculosis        	    2.5
•	Throat, bronchus, lung cancer   2.3
•	Road traffic accidents 	   2.2
•	Prematurity, low birth weight   2.0
                 
DALYS:
•	Lower respiratory infections 	6.2
•	Diarrhoeal diseases	 4.8
•	Depression	4.3
•	Ischaemic heart disease 	4.1
•	HIV/AIDS	3.8
•	Cerebrovascular disease     	3.1
•	Prematurity, low birth weight   2.9
•	Birth asphyxia, birth trauma 	2.7
•	Road traffic accidents 	   2.7
•	Neonatal infections and other	 2.7

Access to 
Mental Health
	Depression makes a large contribution to the burden of disease, being at third place worldwide and eighth place in low-income countries, but at first place in middle- and high-income countries.  Effective treatments for depression are available, suggesting that this burden could be reduced. (National Institute of Health, 2004)
	       
Substance Abuse
The Committee has concerns that people who are seeking substance abuse treatment are unable to access services due to the lack of an adequate clinical workforce.  People seeking treatment often have to wait for weeks or months before they are accepted into a treatment facility (Report of the Department of Health and  Human Services and the House Committee on Appropriations (2006)

               Substance Abuse
		23.5 million need drug or alcohol treatment
	  	  1.2 million report an inability to access care
		67,000 practitioners nationwide
		35% increased need for practitioners by 2010
	
“There is a workforce crisis in substance abuse care.” (Report of the National Survey of Drug Use and Health, 2005)

Children
	Living in Massachusetts	                     1, 464, 198	
	In need of mental health services:          146, 419
	Who need but will not receive:                102, 493

70% of children in Massachusetts who need mental health care will not receive it.” (MSPCC & Children’s Hospital,	 Children’s Mental Health in the Commonwealth: The time is now, 2006)

[Bar graph showing percentage of children getting needed mental health care by age and public/private insurance]

Unmet Children’s Mental Health Needs by Race/Ethnicity
White: 76 percent
Black: 77 percent
Latino: 88 percent
Other: 90 percent

Combat duty in Iraq and Afghanistan
 Barriers to Care
1.7	Million Veterans of Iraq, Afghanistan War:
•	% who report being shot at or near explosions	 90
•	% In need of mental health services      		 33
•	% victims of Traumatic Brain Injury			 20
•	% diagnosed with PTSD				           17

 “There is a significant risk of mental health problems and subjects report important barriers to care.” Hodge et al. (2000) 

Mental Health Access
Racial and Cultural Minorities 
Four main ethnic groups are projected to account for 40% of the U.S. population by 2025 then continue to grow

					2008 			2050 
Non-Hispanic whites 	66 % 			46 % 
Hispanics 			15 % 			30 % 
African Americans 		14 % 			15 % 
Asian Americans 		  5 % 			  9 % 

					         U.S. Census Bureau, 2008

     Race, Culture and Mental Health
The prevalence of mental disorders for racial and ethnic minorities in the United States is equal to or less than that of whites  (Satcher, 2001; Miranda et al., 2008)

Minorities have less access to, and availability of, mental health services (Neighbors et al., 2007) Mental Health Disparities (33%) are worse than those for Medical Health (17%) and they have declined in recent years (Cook et al., 2007)

Insurance coverage does not explain difference in access to care (Padgett et al., 1995; Snowden & Thomas, 2000) Prejudice, attitudes towards spirituality, lack of trust, stigma are offered as explanations (Keith, 2000; Cooper-Patrick et al.,1997) 

Mental Health Access
Racial and Cultural Minorities
African Americans are over diagnosed with Schizophrenia and under diagnosed for Depression. (Snowden & Cheung 1990) Seventeen percent of African Americans with mental illnesses are treated for them (Satcher, 2001)

Minority subjects and issues are underrepresented in mental health research (Hall, 2001; Hogg Foundation for Mental Health, 2006; Satcher, 2001) 

Some evidence supports ethnic matching to improve compliance and extend the length of treatment.  (Sue, 1998; Ziguras et al., 2003) 

Less than 2% of psychologists and mental health providers are capable of offering cultural and language competent care to racially and culturally diverse persons  (Holzer et al., 1998) 

Mental Health Access
Racial and Cultural Minorities
	“American Indians, Alaska Natives, African Americans, Asian Americans, Pacific Islanders, and Hispanic Americans bear a disproportionately high burden of disability from mental disorders. This higher burden does not arise from a greater prevalence or severity of illnesses in these populations. Rather it stems from receiving less care and poorer quality of care.” (Achieving the Promise: Transforming Mental Health Care in America New Freedom Commission on Mental Health, 2003)