The Department of Health and Human Services (HHS) released a document in April outlining strategies for reducing health disparities
among racial and ethnic minorities. Though only certain sections pertain to mental health specifically, many of the recommendations
and action steps outlined in the report impact mental health.
The Institute of Medicine also released a major report at about the same time on the unmet clinical and research needs of
another minority population in which unique factors have to be considered in health careâgay, lesbian, bisexual, and transgender
individuals (see LGBT Individuals Not Getting Equal Attention in Research).
The "HHS Disparities Action Plan to Reduce Racial and Ethnic Health Disparities: A Nation Free of Disparities in Health and
Health Care" charges the leadership of various centers and agencies under the HHS umbrella to implement steps to reduce health
disparities between now and 2015.
According to the report, disparities affecting racial and ethnic minorities continue to permeate many realms of health care,
the health care workforce, and data collection and research.
"Where people live, learn, work, and play affects their health as much as their access to health care," said Garth Graham,
M.D., M.P.H., deputy assistant secretary for minority health and director of the HHS Office of Minority Health, in a press
release announcing the action plan. "We have to confront the social, economic, and environmental factors that contribute to
health disparities if we are to fulfill the president's goal of âwinning the future.â"
Racial and ethnic minorities lag behind nonminority populations in many health outcome measures: they are less likely to get
the preventive care they need to stay healthy, more likely to suffer from serious illnesses such as diabetes and heart disease,
and, when they do get sick, are less likely to have access to quality health care, the report states.
With regard to mental illness, racial and ethnic minorities struggle with the same disadvantagesâmany lack insurance coverage
and thus access to culturally competent treatment and are less likely to be accurately diagnosed and treatedâas nonminority
patients with mental illness.
Goals of the HHS action plan address the need to expand access to health services for racial and ethnic minorities and build
on provisions of the 2010 Affordable Care Act related to insurance coverageâspecifically, to increase the proportion of racial
and ethnic minorities with health insurance and to provide protections for participants in Medicaid, Medicare, the Children's
Health Insurance Program, and other types of health insurance.
The plan also calls for more opportunities to increase the number of students from populations underrepresented in the health
professions, train more people in interpretation of medical terminology to help serve patients with limited English-language
skills, and train community workers to help racial and ethnic minorities navigate the health care system.
Additional goals include increasing the availability and quality of health-related data collected on racial and ethnic minority
Under the report's goal to increase the diversity and cultural competence of clinicians, the Substance Abuse and Mental Health
Services Administration (SAMHSA) is charged, through its newly funded Center for Integrated Health Solutions, with creating
a diverse workforce to provide mental health care in primary care and mental health settings.
In addition, using its National Network to Eliminate Disparities in Behavioral Health, SAMHSA will provide training to mental
health professionals treating minority populations via interventions focused on trauma and trauma-related disorders, according
to the plan. SAMHSA will also rely on its Historically Black Colleges and Universities Center for Excellence to increase diversity
of the workforce by training teams of clinicians, faculty, and students on best practices in mental health screening and interventions
for minorities with mental health problems.
Mental health experts and administrators working on behalf of minority populations are heartened by the government report.
"The good news is that the federal government is placing the goal of eliminating health disparities front and center," APA's
Office of Minority and National Affairs (OMNA) Director Annelle Primm, M.D., M.P.H., told Psychiatric News.
Primm emphasized that the report's goals are inclusive of and relevant to racial and ethnic minority populations with mental
illness. She also pointed out that the action plan's goals are aligned with those of OMNA and hopes that the combined efforts
of APA and HHS can result in significant improvements in the mental health of minority populations.
Francis Lu, M.D., who is a corresponding member of APA's Council on Minority Mental Health and Health Disparities, said that
the report's steps aimed at diversifying the primary care and mental health workforce as well as ensuring that services are
culturally competent are well aligned with the "Psychiatry and Primary Care Policy Brief" approved by APA's Board of Trustees
in December 2010.
"APA, in conjunction with allied organizations such as the American Association of Community Psychiatrists and the American
Association of Directors of Psychiatric Residency Training, can help shape the future direction of these initiatives in service
delivery and education through engagement and participation," Lu said.
According to Sandra Walker, M.D., chair of APA's Council on Minority Mental Health and Health Disparities, "Dr. Graham's observations
in the press release help to keep the action plan in a larger perspectiveâthe layers of complexity run deep in trying to understand
and reduce health disparities," she said. "Reversing inequities in health care is critical."
"HHS Disparities Action Plan to Reduce Racial and Ethnic Health Disparities: A Nation Free of Disparities in Health and Health
Care" is posted at <www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf>.