Surgeon General Releases Mental Health Report Supplement

Surgeon General Releases New Supplement to Mental Health Report

Mental Health: Culture, Race, and Ethnicity
A Supplement to Mental Health: Report of the Surgeon General
Select here to read the report online.

Mental Health: A Report of the Surgeon General, the first Surgeon General's Report on this important health topic, asserts that mental illness is a critical public health problem that must be addressed by the Nation.
Select here to read the report online.

To receive a copy of the Executive Summary of Mental Health: A Report of the Surgeon General, please call toll free 1-800-789-2647.

Despite progress treating mental illnesses, afflicted members of racial and ethnic minority groups are more likely than whites to receive inadequate treatment or none at all, according to a U.S. Surgeon General's report issued Sunday.

Recommendations

U.S. Surgeon General David Satcher released a report Sunday detailing the disparities in mental health care for minorities. His recommendations include:

	Provide more research into mental health issues among minorities.
	Promote better cultural awareness among mental health professionals.
	Educate the public.
	Integrate mental health treatment with general medical care.
	Develop services tailored for minorities.
	Offer training and support to increase the number of minorities in mental health professions.
	Consider offering outreach to minorities in the community, increasing the number of bilingual community health workers and working with alternative medicine practitioners.

SOURCE: Wire reports

The report, "Mental Health: Culture, Race, and Ethnicity," calls on minorities and local governments to close the health gaps. It is the first report from the nation's top doctor exclusively to address the disproportionate burden of mental illnesses shouldered by blacks, Latinos, American Indians, Alaska Natives, Asian-Americans and Pacific Islanders. It says mental disorders take a heavier toll on members of such communities, causing needless misery and often disrupting already precarious lives.

Among the reasons cited for the pervasive lack of treatment among minorities are poverty, lack of health insurance, language barriers, biases among health workers and cultural stigmas against acknowledging disorders such as schizophrenia.

Though some mental health professionals praised the report as momentous, its release at a San Francisco conference of the American Psychological Association was not accompanied by official word of new government programs or funding to address the matter. Solving the problem will fall largely to community professionals and to state and local governments, which have "primary oversight of public mental health spending," the report says.

Still, Dr. David Satcher, the surgeon general, said he was hopeful that the National Institutes of Mental Health and other federal agencies would develop and perhaps fund initiatives to address the problem.

"I expect to see new programs to come out of this," he said at a news conference.

"This is one of the best investments we can make."

Mark Gottlieb, a health physicist with the California Department of Health Services and past president of the National Depression and Manic Depression Association, said the report was drastically needed.

"What it does is get the motivation out there for people in the community to change," he said.

But he criticized it for not crediting consumer groups with having a larger role in reaching under-treated patients.

Although the report spotlights problems among members of minority groups, it also points out that most Americans with mental disorders, regardless of race or ethnicity, receive too little treatment or none for their afflictions. Similarly, although some minority groups may have a higher-than-average risk of some disorders, they also have lower risks of others.

Blacks suffer from more phobias than non-Latino whites, but they also appear to have less major depression, the report says. Also, blacks have half the overall suicide rate of non-Latino whites, though among young black men, the suicide rate is higher than that of whites.

Among Latinos, mental disorders are generally no more common than among non-Latino whites, the report says. But mental illness may have a disproportionate effect on Latinos because they are least likely to have health insurance of all the groups studied, with 40 percent uninsured.

Language is a key barrier for many Latinos. Only one in 20 Latino immigrants with a mental disorder seeks treatment from a qualified professional. The report cites one study that found 24 percent of Latinos with depression and anxiety received appropriate care, compared with 34 percent of whites.

Asian-Americans, research shows, suffer no more mental disorders than do whites, but they were the least likely of the groups studied to seek treatment. Only 17 percent of afflicted Asian-Americans and Pacific Islanders, whom the report tallies together, sought care.

"Shame and stigma are believed to figure prominently" in the lower use rates, the report says.

Access to services was perhaps most limited among American Indians or Alaska natives, who are served by just one mental health professional for every 1,000 people. Alcohol abuse in those groups exacerbates mental illness, the report says.

Racism and intolerance can contribute directly to mental illness by heightening anxiety and depression, the report says. And prejudice can also make disorders worse by making people who already feel persecuted because of their ethnicity less likely to come forward, Dr. Satcher told reporters.

To address the problem, the report suggests general approaches such as doing more research and making community clinics more accessible.

The 200-page report supplements the first surgeon general's report on mental illness, issued in 1999.

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EXECUTIVE SUMMARY

MENTAL HEALTH: CULTURE, RACE, AND ETHNICITY A Supplement to Mental Health: A Report of the Surgeon General

DEPARTMENT OF HEALTH AND HUMAN SERVICES

U.S. Public Health Service America is home to a boundless array of cultures, races, and ethnicities. With this diversity comes incalculable energy and optimism. Diversity has enriched our Nation by bringing global ideas, perspectives, and productive contributions to all areas of contemporary life. The enduring contributions of minorities, like those of all Americans, rest on a foundation of mental health.

Mental health is fundamental to overall health and productivity. It is the basis for successful contributions to family, community, and society. Throughout the lifespan, mental health is the wellspring of thinking and communication skills, learning, resilience, and self esteem. It is all too easy to dismiss the value of mental health until problems appear. Mental health problems and illnesses are real and disabling conditions that are experienced by one in five Americans. Left untreated, mental illnesses can result in disability and despair for families, schools, communities, and the workplace. This toll is more than any society can afford.

This report is a Supplement to the first ever Surgeon General's Report on Mental Health, Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services [DHHS], 1999). That report provided extensive documentation of the scientific advances illuminating our understanding of mental illness and its treatment. It found a range of effective treatments for most mental disorders. The efficacy of mental health treatment is so well documented that the Surgeon General made this single, explicit recommendation for all people: Seek help if you have a mental health problem or think you have symptoms of a mental disorder.

The recommendation to seek help is particularly vital, considering the majority of people with diagnosable disorders, regardless of race or ethnicity, do not receive treatment. The stigma surrounding mental illness is a powerful barrier to reaching treatment. People with mental illness feel shame and fear of discrimination about a condition that is as real and disabling as any other serious health condition.

Overall, the earlier Surgeon General's report provided hope for people with mental disorders by laying out the evidence for what can be done to prevent and treat them. It strove to dispel the myths and stigma that surround mental illness. It underscored several overarching points about mental health and mental illness (see box). Above all, it furnished hope for recovery from mental illness.

But in the Preface to the earlier report, the Surgeon General pointed out that all Americans do not share equally in the hope for recovery from mental illness:

Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age, and gender (DHHS,1999, p.vi). Mental Health: A Report of the Surgeon

General Themes of the Report:

Mental health and mental illness require the broad focus of a public health approach.

Mental disorders are disabling conditions.

Mental health and mental illness are points on a continuum.

Mind and body are inseparable.

Stigma is a major obstacle preventing people from getting help. Messages from the Surgeon General

Mental health is fundamental to health.

Mental illnesses are real health conditions.

The efficacy of mental health treatments is well documented.

A range of treatments exists for most mental disorders.

This Supplement was undertaken to probe more deeply into mental health disparities affecting racial and ethnic minorities. Drawing on scientific evidence from a wide-ranging body of empirical research, this Supplement has three purposes:

To understand better the nature and extent of mental health disparities;

To present the evidence on the need for mental health services and the provision of services to meet those needs; and

To document promising directions toward the elimination of mental health disparities and the promotion of mental health.

This Supplement covers the four most recognized racial and ethnic minority groups in the United States. According to Federal classifications, African Americans (blacks), American Indians and Alaska Natives, Asian Americans and Pacific Islanders and white Americans (whites) are races. Hispanic American (Latino) is an ethnicity and may apply to a person of any race (U.S. Office of Management and Budget [OMB], 1978). For example, many people from the Dominican Republic identify their ethnicity as Hispanic or Latino and their race as black.

The Federal Government created these broad racial and ethnic categories in the 1970s for collecting census and other types of demographic information.1 Within each of the broad categories, including white Americans, are many distinct ethnic subgroups. Asian Americans and Pacific Islanders, for example, include 43 ethnic groups speaking over 100 languages and dialects. For American Indians and Alaska Natives, the Bureau of Indian Affairs currently recognizes 561 tribes. African Americans are also becoming more diverse, especially with the influx of refugees and immigrants from many countries of Africa and the Caribbean. White Americans, too, are a profoundly diverse group, covering the span of immigration from the 1400's to the 21st century, and including innumerable cultural, ethnic, and social subgroups.

Each ethnic subgroup, by definition, has a common heritage, values, rituals, and traditions, but there is no such thing as a homogeneous racial or ethnic group (white or nonwhite). Though the data presented in this Supplement are often in the form of group averages, or sample means (standard scientific practice for illustrating group differences and health disparities), it should be well noted that each racial or ethnic group contains the full range of variation on almost every social, psychological, and biological dimension presented. One of the goals of the Surgeon General is that no one will come away from reading this Supplement without an appreciation for the intrinsic diversity within each of the recognized racial or ethnic groups and the implications of that diversity for mental health.

Clearly, the four racial and ethnic minority groups that are the focus of this supplement are by no means the only populations that encounter disparities in mental health services. However, assessing disparities for groups such as people who are gay, lesbian, bisexual, and transgender or people with co-occurring physical and mental illnesses is beyond the scope of this Supplement. Nevertheless, many of the conclusions of this Supplement could apply to these and other groups currently experiencing mental health disparities.

1 The Office of Management and Budget has recently separated Asian Americans from Native Hawaiians and other Pacific Islanders (OMB, 2000).

Source: http://www.surgeongeneral.gov

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