Training and advocacy will help to resolve minority mental health
disparities, which are rooted in shortsighted political decisions, a shortage
of culturally diverse mental health providers, and a lack of education about
cultural issues by clinicians, among other factors. But only so much can be
done to reduce mental health disparities from behind a desk or even from a
crowded conference table.
That is why APA's Office of Minority and National Affairs (OMNA) has taken
its show on the road, so to speak.
APA's "OMNA on Tour" arrived in Philadelphia in March to
convene local and national experts and explore the barriers to quality mental
health care experienced by many racial and ethnic minorities; talk with local
politicians, advocates, consumers, and mental health professionals about
solutions to the problems; and showcase innovative community programs that
have reduced disparities in care for minority populations.
The tour was launched in January 2005 at Howard University Hospital in
Washington, D.C., and includes "the red states, the blue states, the
woods and the'hoods, the ebony and ivory towers, engaging a range of audiences
from teachers to preachers and people from the streets and corporate
suites," OMNA Director Annelle Primm, M.D., M.P.H., said at the
Philadelphia meeting in introductory remarks.
Discussions at tour stops are "customized to the demographics, needs,
cultures, and available resources in the area," she added.
Speakers at the daylong meeting in Philadelphia first addressed the
barriers to mental health care experienced by members of different racial and
ethnic minority groups and then discussed strategies to improve mental health
care for minorities.
Many Latinos, for instance, face trauma associated with immigration,
according to information presented to the more than 100 attendees at the
Andres Pumariega, M.D., observes that some Latino youth may be
vulnerable to mental health problems due to the stress of immigration.
Preimmigration stressors may include exposure to terrorism, war, and
political persecution in Latin American countries, according to Andres
Pumariega, M.D., who is chair of psychiatry at the Reading Hospital and
Medical Center and a clinical professor of psychiatry at Temple University
School of Medicine in Philadelphia.
Immigration often involves long and sometimes dangerous journeys to the
United States and separation from immediate and extended family.
Postimmigration stressors for children include multiple moves as parents
attempt to find work and avoid possible deportation.
Latino youth often succumb to the pressure to acculturate to avoid
marginalization, and when they do so, they may lose touch with "natural
protective beliefs and values" such as a longstanding cultural taboo
against suicide, Pumariega pointed out.
Conflicts may arise between Latino children who have acculturated and
parents who do not speak English and hold on to traditional beliefs, he noted.
Parent-child conflict, he noted, may increase the risk for various psychiatric
disorders in youth.
Improving mental health services for Latinos means increasing access to
treatment planning, case management, and linguistic support, Pumariega
There is also a lack of culturally and linguistically competent
Asian-American mental health providers in many places, according to Pioquinto
Voluntad, owner of Asian Pacific Management Consultants in Philadelphia.
Voluntad's company trains corporate leaders, hospital staff, and the people
working for the court system about the health disparities and needs of Asians
and others living in minority communities.
Those living in Asian communities require culturally competent providers
who understand the traditions and beliefs of Chinese, Vietnamese, Japanese,
Indonesian, and Cambodian patients, for instance. "Asians speak many
languages, and often mental health providers can't communicate with us,"
As part of a task force appointed by former Philadelphia Mayor and current
Pennsylvania Governor Ed Rendell, Voluntad helped to recruit culturally
competent masters-level therapists to work with Asian-American patients. As
part of that initiative, task force members partnered with educational
institutions to offer scholarships to minorities and developed grant proposals
to fund students' tuition.
Voluntad said that mental health clinicians should ready themselves for an
influx of refugees from Middle Eastern countries fleeing to the United States
to escape terrorism and war.
War can also have devastating consequences on U.S. soliders, many of whom
happen to be minorities, according to State Sen. Vincent J. Hughes
"Approximately 80 percent of soldiers fighting in Iraq and
Afghanistan [who met criteria for a mental disorder] acknowledged having
mental health problems, yet only 40 percent said they were interested in
receiving help" for those problems, Hughes
Annelle Primm, M.D., M.P.H., said that OMNA on Tour meetings are
customized to the demographics and cultures of each stop. At a meeting in
Philadelphia, state Sen. Vincent J. Hughes spoke about the mental health needs
of soldiers returning from Iraq and Afghanistan.
Only 26 percent ended up receiving mental health services, he added.
"It appears that modern career soldiers are concerned about the
stigma associated with mental health problems and the potential negative
impact [that treatment] might have on their careers," Hughes said.
In October 2004, Hughes helped organize a conference called "Breaking
the Silence," which sought to educate African Americans living in and
around Philadelphia about mental health problems and the services available to
them. More than 3,000 people attended the event. "We broke down barriers
to mental health services and helped people to feel more comfortable with
seeking help," he said.
Hughes also emphasized the importance of training spiritual leaders in
African-American communities about mental health issues. "We all have a
responsibility to be proactive about mental health disparities in the African
American community," said Hughes. ▪