"Talk to anybody on the street, and they have a gripe about the health care system," says graduate student Janet Cummings, but issues related to mental health have a particularly troubled niche. While there’s "a huge chasm between scientific advances" and what most people actually get in terms of regular medical care, she says, "the chasm is even bigger" in mental health.

What’s worse, the cost of not treating may be higher. Compared to physical illnesses, mental health conditions often arrive at a younger age and thus "can have a lifetime of consequences," Janet says, and not just for the individuals but for society, which often feels the impact in terms of poverty and social instability.

Yet, people who suffer from mental health problems may not get—or even seek—the care they need. The cost is one obstacle: health insurance reimbursements for mental health care often fall in the 50% range, compared to 70% or 80% reimbursement for treatment of physical maladies. Perhaps of more significance is the continuing social stigma related to mental health problems and their treatment, "still one of the biggest barriers to people getting help." While "it’s very difficult to measure stigma," Janet hopes that her doctoral research may provide some first steps.

A considerable body of work has examined how an individual’s income, socioeconomic standing, race, and ethnicity affect the decision to use mental health services and the outcomes for those who pursue care. But "very few researchers have looked at attributes of the community and whether where someone lives affects getting the services he or she needs," Janet says. One element of this might be the hard-to-measure impact of stigma: whether community attitudes play a role. Since stigma resists measurement, Janet will take care to measure other community factors that may be related to stigma.

The National Longitudinal Survey of Adolescent Health provides detailed descriptions of the school-centered areas where data is collected, and it also includes measures of depressive symptoms, suicidal thoughts, substance abuse, and delinquency among youth between 11 and 19 years old during the first period of data collection. Using the individual data, Janet can identify students who might have benefited from mental health services, as well as those who got them. Then she can look at characteristics of the schools and communities where they lived.

Her preliminary findings explore the relationship between community socioeconomic status (measured by median household income) and whether adolescents received services in clinic settings outside of school. The big question: Is a deciding factor in whether or not someone gets care the level of resources of the community or the cultural attitudes of a community? An early answer: "I found an income effect that was independent of the racial and ethnic composition of the community," Janet says. In communities with more resources, adolescents "were more likely to use counseling services in a clinical setting." A related hypothesis: In locations with fewer resources, what is the relative importance of school-based mental health services?

Janet recently defended her proposal and is now beginning the hard work of analysis and writing. Her defense provided a good example of what makes Janet special, her adviser, Professor Ninez Ponce, says. "The prepared portion, of course, was seamless," she says, "but the questions and answers part was pretty tough, and it demonstrated why she’s going to be a star. The way that she answered questions in a nondefensive and thoughtful way was very impressive." Janet’s extensive work in statistics has made her "methodologically one of the very best of our students," Professor Ponce says, "and she’s a deep thinker. Now she’s challenged in applying all those research skills in solving the mental health research questions."

Janet’s road to her mental health specialization began as an undergraduate at the University of North Carolina at Chapel Hill, where she was an economics major with an interest in health-related issues. After graduation, she worked for RTI International, a think tank, in a group focused on the economics of mental health and substance abuse.

Having found a research focus, Janet decided to get a PhD in Public Health so that she could develop her own area of expertise and carve out her own niche. She was attracted to UCLA by its high-ranking School of Public Health and the range of high-caliber researchers not only there but also at the Semel Institute for Neuroscience and Human Behavior. "I thought there would be opportunities to work on different projects," she says, and she found plenty of them.

As a research assistant for Dr. Susan Ettner in the Department of General Internal Medicine, Janet conducted a literature review and coauthored a book chapter entitled, "Mental Health Services and Policy Issues," a useful assignment for a new graduate student looking to get grounded in the field. Then, she worked with Dr. Bowen Chung to help develop depression-related outreach events at the Pan African Film Festival, where she collected survey data for the Semel Institute’s Health Services Research Center. This study explored the impact of several interventions designed to address the stigma surrounding depression in the African American community. Finally, as a research assistant to Dr. Carol Aneshensel of the Department of Community Health Sciences, she studied community-level socioeconomic effects on depression, cognition, and physical health among the elderly. It was only a couple of small steps from there to her own dissertation research.

After obtaining her PhD, Janet hopes to widen her current research project, using other datasets for adolescents or expanding her focus to young adults. "Looking at how community and context affect health services and health behaviors is a burgeoning field," Janet says, and one where she promises to make an important contribution.

Published in Spring 2008, Graduate Quarterly