Members of ethnic and racial minorities are less likely to seek and receive psychiatric care and are underrepresented in research on psychiatric treatment and in mental health professions, said APA Medical Director James H. Scully, M.D., at a Congressional Black Caucus (CBC) conference held in the House of Representatives in January.
The 2001 "Surgeon General’s Report on Mental Health: Race, Culture, and Ethnicity" notes that "more than other areas of health and medicine, the mental health field is plagued by disparities in availability and access to its services," said Scully at the Conference on Anti-Stigma and Mental Health sponsored by Rep. Donna Christian-Christensen (D-Virgin Islands), chair of the CBC Health Braintrust. The conference was convened by the National Consortium for African-American Children Inc.
A major reason that the disparities exist is that minorities are overrepresented among homeless, institutionalized, and incarcerated populations that do not receive adequate mental health services. "These populations are served by a fragmented public health system with few resources at the state and local level," explained Scully.
These factors, when coupled with discriminatory coverage of mental illness, are "creating a crisis in mental health care that disproportionately affects ethnic and cultural minority populations," said Scully.
In addition, a physician’s ethnic and cultural background can be a barrier to treatment when patients are from a different ethnic background, said Scully. "It is critical that physicians understand all the factors—including ethnicity and culture—that can have an impact on a patient’s mental health," said Scully.
APA’s Committee on Ethnic Minority Elderly found that only a small percentage of ethnic minorities participate in clinical trials of new psychiatric medications. "This is a potentially serious shortcoming that can have profound consequences for effective treatment of mental illness," said Scully. "We need to better understand the ethnic and cultural contexts of mental health care to overcome barriers to access, including the reluctance to seek treatment and the reluctance to participate in clinical trials."
Better incentives are needed for mental health professionals to practice in underserved inner-city and rural communities. "We should also expand special incentives to recruit and retain minority health professionals," said Scully.
APA has been promoting cultural competence as an integral part of psychiatric training through the work of the Committee on Ethnic Minority Elderly and the Council on National Affairs, according to Scully.
Scully said the mental health conference was a positive step in assessing the impact of stigma on minorities and addressing their needs.
Scully urged CBC members to support the 2003 mental health parity legislation introduced in the Senate in January (S 10) in memory of the late Sen. Paul Wellstone. The bill is identical to the Mental Health Equitable Treatment Act introduced last year in Congress.
"We must also ensure that the public safety net protects those with mental illness who cannot afford to pay for their own care and lack private insurance," said Scully. He urged CBC members to support the APA-backed bill (HR 599) to repeal Medicare’s discriminatory 50 percent copayment requirement for mental health treatment.
"We advocate that mental health treatment should not be viewed differently from other medical treatment and that all Medicare beneficiaries pay the routine copayment of 20 percent," said Scully. A significant number of nonelderly disabled persons are insured through Medicare, and a significant portion of their disabilities are due to severe and persistent mental disorders, Scully explained.
"Finally, as we end discriminatory coverage of treatment of mental illness, we must be diligent in assuring access to high-quality mental health care for all Americans that is sensitive to differences in culture and ethnicity," said Scully.
Christian-Christensen told Psychiatric News that "very few people in this country have adequate access to mental health care, and rural and minority populations have even less access. The problem is compounded for children because of their vulnerability, dependence on others, and unique presentation of mental disorders."
Christian-Christensen vowed to continue to work on issues related to mental health, along with ensuring that children and adolescents are included in mental health legislation.
Ericka Goodwin, M.D., the APA 2003 Jeanne Spurlock Congressional Fellow, attended the CBC mental health conference on behalf of Christian-Christensen.
Goodwin told Psychiatric News that she chose to be a fellow in Christian-Christensen’s office because it offers a unique learning experience. "As a family medicine physician, Dr. Christian-Christensen has special insights into health issues. She also chairs the Congressional Black Caucus’s Health Braintrust, so I am exposed to many health policy issues. Working here also allows me to focus on the needs of minority and underserved populations, which is important to me."
The text of Scully’s remarks at the Congressional Black Caucus conference is posted at www.psych.org/pub_pol_adv/scullyremarks.cfm. ▪