Culture counts in the diagnosis and treatment of mental illness. And
culture is a critical factor in widely documented disparities in access to,
and quality of, medical care for racial and ethnic minorities in the United
States, said APA President Michelle Riba, M.D., in her opening address at
APA's 56th Institute on Psychiatric Services last month in Atlanta.
"The culture that patients come from shapes their mental health and
the type of services they use," Riba said. "Likewise, the culture
of the clinician and the service system affects diagnosis and treatment and
the organization and financing of those services. Cultural differences must be
accounted for to ensure that minorities, like all Americans, receive mental
health care tailored to their needs."
This year's institute, whose theme was "Mental Health Disparities in
the Community," included lectures and symposia on Hispanic-American
perspectives on mental health care; race, substance abuse, and bipolar
disorder; psychoanalysis and Eastern cultures; and disparities in children's
APA President Michelle Riba, M.D., performs the traditional bell-ringing
ceremony that opens each Institute on Psychiatric Services.
Photo: Ellen Dallager
In her opening speech, Riba gave a broad overview of how disparities affect
individual patient care at the community level and outlined how advances in
psychosomatic medicine—a special interest of Riba's—may contribute
to reducing and eliminating racial and ethnic disparities in mental health
She also cited specific areas in which APA, through its Department of
Minority and National Affairs, is seeking to address the issue of health care
The APA president cited chronic underfunding of public health
systems—in which racial and ethnic minorities disproportionately receive
medical care—as one essential factor in the disparities in quality and
access to care.
"Over the years, many states have faced major financial crises that
are having a ripple effect on mental health services at the community
level," she said. "As states take drastic measures to control
growth in Medicaid expenditures, mental health care funding becomes ever more
vulnerable. Community mental health systems have grown increasingly dependent
on Medicaid with more than 60 percent of monies for public mental health
services funded by Medicaid.
"Since minorities are major users of public health systems, access to
quality care is often encumbered by lack of quality services and lack of
cultural competency in treating diverse patients."
Riba said advances in psychosomatic medicine and the recent approval of
psychosomatic medicine as a subspecialty by the Accreditation Council for
Graduate Medical Education (ACGME) have positive implications for all
Americans, but may prove especially helpful in reducing mental health
Many patients in the public health system suffer from both psychiatric and
other types of medical problems, Riba said. "Heart disease and stroke
are leading causes of death for all racial and ethnic groups, and these
conditions are often compounded by depression and substance abuse."
She cited especially the work of APA's Council on Psychosomatic Medicine in
seeking support for access to care and reimbursement for treatment of
Finally, Riba cited areas in which advances are being made to address
racial and ethnic disparities in health care, including mental health care. At
the academic level, she said, the ACGME has required training programs to
provide supervised experience treating patients throughout the life cycle and
from diverse cultural backgrounds.
Particularly important, Riba said, is the need to increase the proportion
of under-represented racial and ethnic minorities among the health
professions. "We have an opportunity as a profession to make a
difference through the recruitment of more minority medical students and
through culturally competent education and research," she said.
Riba also cited APA's Department of Minority and National Affairs and drew
special attention to a new project in the department designed to raise the
national profile of APA in efforts to reduce and eliminate health care
The department's director, Annelle Primm, M.D., will visit regions of the
country that have the highest proportion of underserved minorities. "APA
district branches, primary care physicians, legislators, social service
providers, and others we hope will engage in discussions on mental health
disparities," Riba said.
Riba also cited new and ongoing projects by the Department of Minority and
National Affairs including minority medical student and resident fellowships
and internships, development of a speaker's bureau of minority psychiatrists,
support for a minority research conference, support for culturally competent
medical school curricula, and dissemination of a new recruitment video, titled"
Real Psychiatry: Doctors in Action," which was previewed at the
IPS meeting. (The next issue of Psychiatric News will carry a feature
about the new video.) ▪