From all appearances, the presentation of a new report on mental illness by Surgeon General David Satcher, M.D., Ph.D., at the APA convention in San Francisco in late August was a smashing success, reminding America about its neglected masses craving for help.
But now come the details.
Satcher’s tenure as surgeon general will soon end–in February to be exact. As a Clinton appointee, he does not expect to be asked to continue, raising the issue who will be the next surgeon general, will he or she continue the agenda begun by Satcher. Will Satcher’s successor, when appointed by President Bush, bring an agenda with altogether different priorities, tossing Satcher’s well-intentioned effort to the proverbial junk heap?
An attentive crowd of 500 packed a meeting room at the Marriott Hotel in one of the country’s most culturally diverse cities to hear Satcher’s report.
The psychologists seemed to take pleasure in Satcher having chosen APA as his venue for releasing his latest report, titled “Mental Health: Culture, Race and Ethnicity.” It highlighted minorities in America comprising millions who, for one reason or another, receive little or no mental health support. They included African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders and Hispanic Americans. The report did not include individuals in vulnerable, high-need subgroups such as persons who are homeless, incarcerated or institutionalized.
But the report did not intimate that these minorities experience higher statistics of serious mental illness. Rather, it pointed to difficulties in accessing relief, the language barrier based on providers limited to English and thus unable to communicate with clients, and clients–some, including one speaker who shared the podium with Satcher–who spoke no English despite living here for 30 years since leaving China.
Gaps in service for these minorities were shown in the report as overwhelming. “Culture Counts” was an oft-repeated phrase at the San Francisco gathering. Cultural and social factors contribute to the cause of mental illness. The report speaks of “mistrust” of mental health services as an important reason for deterring minorities from seeking treatment, and that their concerns are reinforced by direct and indirect evidence of clinician bias and stereotyping. “The cultures of the clinician and the service system affect diagnosis, treatment and the organization and financing of services,” the report explains.
The report indicates that among clinically trained mental health professionals, only 2% of psychiatrists, 2% of psychologists and 4% of social workers said they were African American. “African Americans seeking help who would prefer an African American provider will have difficulty finding such a provider in these prominent mental health specialties,” the report went on.
Also, the report stated that availability depends on where one lives. Relatively high proportion of African Americans live in the rural South, and evidence indicates that mental health professionals are concentrated in urban areas and are less likely to be found in the most rural counties of the United States. A further dilemma is that African Americans living in urban areas are often concentrated in poor community while urban practitioners who do not accept Medicaid or offer services to high-need clientele are out of reach to them.
These are huge disparities in terms of access and availability to mental health services. American Indians are covered if they live on reservations but large numbers are scattered through other venues. There is, too, a great disparity among African American attitudes toward mental illness which represent barriers to seeking mental health care. One study quoted in the report stated that the proportion of African Americans who fear mental health treatment is 2.5 times greater than the proportion of whites. Another study of parents of children meeting criteria for ADHD discovered that parents of black children were less likely than white parentis to describe their child’s difficulties.
Incredibly, although 25% of black people are uninsured, those with better insurance did not assure better coverage to eliminate disparities in access because many African Americans with adequate private coverage “still are less inclined to use services.” And those with coverage were prone to use primary care coverage as opposed to mental health specialty care, and overabundantly using emergency rooms, psychiatric hospitals and that they delay seeking treatment until their symptoms are more severe.
The report on African Americans indicates that 34 million people or 12% identify as African Americans, and that their population is increasing in diversity as greater numbers arrive from Africa and the Caribbean, particularly from the Dominican Republic, Haiti and Jamaica, with 6% of all blacks in the U.S. today being foreign-born.
Dismal figures persist in findings that 44% of homeless people in 1994 were African American, that 3.5% times as many blacks as whites are homeless which includes many women, children and youth. Their most serious disorders are schizophrenia, 11 to 13% vs. 1% of the general population; mood disorders (22 to 30% of homeless vs. 8% of the general public.
American Indians and Alaska Natives
They are, according to the report, the most impoverished of today’s minority groups. Over 25% live in poverty, compared to 8% of whites. Alcohol-related deaths are high, and suicide rates are 50% higher than the national average. The imbalance is that the Indian Health Service established hospitals and clinics on reservations since its creation in 1955, but fewer people live on them. Meanwhile, fewer mental health providers, particularly child and adolescent specialists in rural communities.
Asian Americans and Pacific Islanders
This is a rapidly increasing population of diverse people consisting of 43 separate ethnic groups. In 2001, about 60% were born overseas. The report shows diversity in another way: The per capita income is almost as high as that for whites, but despite the many successful Southeast Asian and Pacific Islander Americans, the overall poverty rates are much higher than the national average.
http://nationalpsych.com/wp-admin/edit.php?post_type=page Although prevalence of mental health problems does not differ significantly from other Americans, refugees from Southeast Asian countries are at risk for PTSD as a result of trauma and terror preceding their immigration.
They are the largest and fastest growing minority in the U.S. About 40% of Hispanic Americans in the 1990 census reported they do not speak English “very well.” The report asserts that “very few” providers identify themselves as Hispanic or Spanish-speaking with the “result that most Hispanic Americans have limited access to ethnically or linguistically similar providers.” Their rate of lacking insurance is astronomically high at 37%, twice the average for whites. Thus, they are less likely than whites to receive needed mental health care.
Vision for the Future
Declaring there are striking disparities in knowledge, access, utilization and quality of mental health care for racial and ethnic minorities, the report points to the need for “a steadfast commitment by all sectors of Americans” reduce or eliminate them. It goes on: “Overcoming mental health disparities and promoting mental health for all Americans underscores the nation’s commitment to public health and to equality.”
To obtain printed copies of the Executive Summary and/or the Full Report of Mental Health: Culture, Race, and Ethnicity, try any of the following options: Telephone 800/789-2647, M-F, 8:30 a.m. to 5 p.m. requesting inventory number SMA-01-3613; or write: Knowledge Exchange Network, CMHS, P.O. Box 42490, Washington, D.C. 20015; or email: KEN@mentalhealth.org or FAX request to 301/984-8796.