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Culture Counts in Mental Health Services and Research Finds New Surgeon General Report

FOR IMMEDIATE RELEASE
August 26, 2001
Contact: Damon Thompson
(301) 443-4000

Striking disparities in access, quality and availability of mental health services exist for racial and ethnic minority Americans, according to the new report of the Surgeon General released today, Mental Health: Culture, Race and Ethnicity.

The report, a supplement to the 1999 first-ever Surgeon General's report on mental health, highlights the role culture and society play in mental health, mental illness, and the types of mental health services people seek. It finds that, although effective, well-documented treatments for mental illnesses are available, racial and ethnic minorities are less likely to receive quality care than the general population. Overall, one in three Americans who need mental health services currently receives care. A critical consequence of this disparity is that racial and ethnic minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental health problems and mental illnesses.

"While mental disorders may touch all Americans either directly or indirectly, all do not have equal access to treatment and services. The failure to address these inequities is being played out in human and economic terms across the nation – on our streets, in homeless shelters, public health institutions, prisons and jails," said U.S. Surgeon General Dr. David Satcher. "The revolution in science that has led to effective treatments for mental illnesses needs to benefit every American of every race, ethnicity and culture. Everyone in need must have access to high-quality, effective and affordable mental health services. Critically, culture counts. That means we need to embrace the nation's diversity in the conduct of research, in the education and training of our mental health service providers and in the delivery of services."

Dr. Satcher observed that culture, broadly defined as a common set of beliefs, norms and values, influences many aspects of mental illness and mental health. It influences, for better or for worse, how patients communicate and manifest their symptoms, how they cope, the range of their family and community supports, and their willingness to seek treatment However, a history of racism, discrimination and economic impoverishment can combine with mistrust and fear to deter minorities from using services and receiving appropriate care.

The cultures of clinicians and the service system itself further influence diagnosis and treatment. Providers need to know how to build upon the cultural strengths of the people in their care. After all, while not the sole determinants, cultural and social influences do play important roles in mental health, mental illness and service use, when added to biological, psychological and environmental factors.

Dr. Satcher observed that mental illnesses are real, disabling conditions that affect all populations in the nation. He emphasized they are as treatable or more treatable than other illnesses like diabetes, cancer or heart disease.

"Mental health is fundamental to a person's overall health, indispensable to personal well-being and instrumental to leading a balanced and productive life," said Dr. Satcher. "I want to be absolutely certain that my message is heard by America's millions of Hispanic Americans, African Americans, Asian Americans, Pacific Islander Americans, American Indians, and Alaska Natives. The message is this: If you or a loved one is experiencing what you think might be symptoms of a mental disorder, seek treatment and seek it now. Insist on the kinds of services that can and should be available to you, whatever your language, your income, your geographic location, your race or your ethnicity. You will discover that your community has a wealth of resources."

The volume focuses on the four most recognized racial and ethnic minority groups in the United States: African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanic Americans. Within each of the categories are many distinct ethnic subgroups, such as Mexican Americans and the Navajo Nation. The report describes the historical context and mental health issues of specific subgroups. However, because data are limited, the primary focus is on findings for the broader racial and ethnic categories.

The 200-page report not only articulates the foundation for understanding the relationships among culture, society, mental health, mental illness, and services, but also provides information about these issues as they affect each of the four major racial and ethnic minority groups. For example, the report highlights that:

  • Disproportionate numbers of African Americans are represented in the most vulnerable segments of the population – people who are homeless, incarcerated, in the child welfare system, victims of trauma – all populations with increased risks for mental disorders;
  • As many as 40 percent of Hispanic Americans report limited English-language proficiency. Because few mental health care providers identify themselves as Spanish-speaking, most Hispanic Americans have limited access to ethnically or linguistically similar providers.

  • The suicide rate among American Indians/Alaska Natives is 50 percent higher than the national rate; rates of co-occurring mental illness and substance abuse (especially alcohol) are also higher among Native youth and adults. Because few data have been collected, the full nature, extent and sources of these disparities remains a matter of conjecture.

  • Asian Americans/Pacific Islanders who seek care for a mental illness often present with more severe illnesses than do other racial or ethnic groups. This, in part, suggests that stigma and shame are critical deterrents to service utilization. It is also possible that mental illnesses may be undiagnosed or treated early in their course because they are expressed in symptoms of a physical nature.

The report concludes by proposing broad courses of action to improve the quality of mental health care available to racial and ethnic minority populations. They include continuing to build the science base, improving access to treatment, reducing barriers to and improving the quality of mental health services, and supporting culturally relevant capacity development and leadership opportunity.

Dr. Satcher said, "The state of our knowledge about health and illness has never been greater. The best way to ensure an end to the disparities we have discovered is for everyone engaged in mental health services to make a steadfast commitment to accomplish the goal. It will take all of us."

He urged all Americans concerned about racial and ethnic disparities in mental health care – from consumers of mental health services to providers, from researchers to administrators to policymakers – to call the toll-free number 1-800-789-2647 to receive the executive summary of the report and fact sheets. A full copy of the Report is available on the World Wide Web at www.surgeongeneral.gov.

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