APA Works to Reduce Care Disparities
Two landmark reports have clearly placed the elimination of disparities in mental health care as a major objective for the country. Most recently, the 2003 report of the President’s New Freedom Commission on Mental Health proposed that this country transform its mental health system by focusing on six aims; one of these is to eliminate disparities in mental health services. Two specific recommendations in this area are to “improve access to quality care that is culturally competent” and “improve access to quality care in rural and geographically remote areas.”
Second, the 2001 supplement to the “Surgeon General’s Report on Mental Health,” titled “Mental Health: Culture, Race, and Ethnicity,” clearly documented the disparities in mental health care for ethnic minorities in terms of access, quality, and outcomes. It also noted that ethnic minorities are grossly underrepresented in psychiatric research. These disparities impose a greater disability burden on individuals from the four ethnic minority groups. The 2004 APA Institute on Psychiatric Services, chaired by Gloria Pitts, D.O., will have the theme “Mental Health Disparities in the Community.”
Furthermore, the 2002 Institute of Medicine’s (IOM) “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,” made similar recommendations for health care in general after a comprehensive review of the literature. The IOM pointed to multiple causes for these disparities even beyond insurance, including clinician bias, patient factors, and the health care system itself. It called for action along system design, training, and research fronts to tackle these many causes.
APA has supported efforts to reduce disparities in several important ways. As APA president, Richard Harding, M.D., appointed the Steering Committee for Eliminating Disparities in Access to Psychiatric Care, soon after the surgeon general gave a plenary talk about the 2001 report at APA’s fall component meetings in September of that year. Co-chaired by Altha Stewart, M.D., and Dale Walker, M.D., the steering committee was charged with recommending specific actions that APA could take to implement the report’s findings. Its draft report will be presented in a component workshop at APA’s 2004 annual meeting on Wednesday, May 5, at 9 a.m.
Second, the 2003 report titled “A Vision for the Mental Health System,” written by a task force chaired by APA Vice President Steven Sharfstein, M.D., included as one of its 12 goals: “Mental health care should be readily available for patients of all ages, with particular attention to the specialized needs of children, adolescents, and the elderly. Unmet needs of ethnic and racial minorities require urgent attention.”
The Work Group to Actuate the Vision Statement, chaired by immediate past president Paul Appelbaum, M.D., has been working this year on specific recommendations (see Original article: page 3 and April 2 issue).
Third, APA has successfully recruited a director for the Department of Minority and National Affairs. She is Annelle Primm, M.D., an associate professor of psychiatry at Johns Hopkins University, who will be an important voice within APA on this issue (see Original article: page 1).
With eliminating disparities as the eventual goal, increasing workforce diversity and increasing cultural competence are seen by many as important means, among others, for achieving that goal. For example, the Institute of Medicine recently issued “In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce” in which it stated that increasing racial and ethnic diversity among health professionals is important because evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students, among many other benefits (Psychiatric News, March 19).
In Defending Diversity: Affirmative Action at the University of Michigan (University of Michigan Press, 2004), Patricia Gurin and her colleagues present clear evidence for the educational value of diversity. The importance of cultural competence can now be seen at the system level in such documents as in the 2000 “Culturally and Linguistically Appropriate Services (CLAS) Standards of the HHS Office of Minority Health” and the 2001 “Cultural Competence Standards in Managed Mental Health Care Services of the Center for Mental Health Services.”
APA’s Council on Minority Mental Health and Health Disparities believes that the important work to date that has focused on ethnic minority groups should now be broadened to look at the disparities related to other critical demographic factors, especially when they intersect. We hope APA and its membership will continue to engage these issues for the health and mental health of all. ▪
Francis Lu, M.D., is a professor of psychiatry at the University of California at San Francisco and chair of the APA Council on Minority Mental Health and Health Disparities.
