Annelle Primm, M.D., is taking "OMNA on Tour" to
Philadelphia and Memphis next. David Hathcox
Martha Knisley, director of the Department of Mental Health in
Washington, D.C., leads a discussion on local mental health issues. Other
panelists are (from left) Adeline Benovil, clinical manager of Woodley House,
a local psychiatric facility; Yvonne Smith, a spokesperson for NAMI-DC; and
Thomas Green Jr. M.D., a medical officer at St. Elizabeths Hospital. David
Annelle Primm, M.D., M.P.H., has vowed to take "OMNA on Tour"
to the "ebony towers and ivory towers of academia to the 'hoods and to
The new program, which will educate communities about the significance of
disparities in mental health and encourage them to take collaborative action,
is a major effort of APA's revitalized Office of Minority and National
Primm began work as OMNA's director in April 2004.
The power of collaboration in action was evident at the program's first
stop on January 22.
The American Association of Community Psychiatrists (AACP), the Howard
University Hospital department of psychiatry, and the Washington Psychiatric
Society joined OMNA in sponsoring the meeting. AACP was celebrating its 20th
The conference, AACP's winter conference as well as OMNA on Tour's launch,
was called, "Strengthening Collaboration and Advocacy to Achieve Mental
Health Equity and OMNA on Tour."
Howard University, a historically black, private university, hosted the
William Lawson, M.D., Ph.D., chair of the department of psychiatry at
Howard University College of Medicine, reminded the group about the
commonalities between the goals of community psychiatry and those of his
department to improve health care for "marginalized" people.
Primm, who called herself a "proud graduate of Howard University
College of Medicine," described OMNA's mission and major activities
She offered a definition of health care disparities and a survey of recent
research and other findings concerning their effect.
Racial and ethnic disparities in terms of access to health care exist
independently of a person's socioeconomic class, Primm said.
Those disparities lead to higher morbidity and mortality from leading
causes of death such as diabetes and cardiovascular disease.
In terms of mental health, she cited findings from "Mental Health:
Culture, Race, and Ethnicity," a report issued in 2001 by David Satcher,
M.D., when he was the U.S. surgeon general. Members of minority groups receive
poorer quality of care, are less likely to receive services, and are
underrepresented in mental health research.
The result is a vicious cycle in which socioeconomic problems and mental
illness, sometimes including substance abuse, interact to result in violence,
incarceration, and poor physical health. Those three factors then exacerbate
the original problems.
Primm said, "The timing is great for OMNA on Tour." The effort
brings together many issues and recommendations that recently have received
The New Freedom Commission on Mental Health, for example, recommended that
states address disparities as part of their comprehensive mental health plans
and promote the inclusion of people with diverse cultural backgrounds in the
mental health workforce.
The Substance Abuse and Mental Health Services Administration (SAMHSA)
issued a priorities matrix for 2003 that identified "cultural
competence/eliminating disparities" as a cross-cutting principle that
applies to all its work.
Primm told the audience that there are many successful models for
addressing disparities that "no one knows about."
The Institute for Mental Health Ministry through its PRAISE project, for
example, brings together the faith community and mental health professionals.
The institute, located in Baltimore and directed by psychiatrist Michael
Torres, M.D., offers a variety of educational, consultative, and clinical
The Clinical Research Investigator Support Program, developed and
adminstered by BDH Clinical Research Services Inc., is a nationwide network of
minority physicians whose mission is to increase minority participation in
clinical research. It has supported an array of clinical trials with racial
and ethnic minorities (physicians and patients) in depression, schizophrenia,
bipolar disorder, diabetes, and many other medical conditions.
The video "Black and Blue: Depression in the African-American
Community," which Primm developed, features first-person accounts of
African Americans who have dealt with depression and the associated
Disseminating information about models that work is an important goal of
OMNA on Tour.
In January, the daylong launch of OMNA on Tour offered five panel sessions
that together provided a comprehensive picture of problems resulting from
inequities and strategies for addressing them.
Primm said that the topics and presentations represented a smorgasbord from
which communities hosting OMNA on Tour could select. The variety in the
presentations also suggested the complexities of the issues related to
Several speakers mentioned that the United States is becoming a country in
which the majority of its citizens will be members of minority groups. They
argued for a sophisticated view of cultural competence that takes into account
the multiplicity of ethnic groups and nationalities.
Stephen Goldfinger, M.D., said, "Diversity in all too many places
means black and white." Brooklyn, where he is interim chair of the
department of psychiatry at the State University of New York Downstate Medical
Center, has the largest population of Russians outside Russia and the largest
population of Haitians outside Haiti. "That's true of 13 ethnic groups
in Brooklyn," he said.
Andres Pumariega, M.D., described research that demonstrates the
effectiveness of culturally specific interventions.
"We must revisit the cultural competence model for specific
populations," said Pumariega, director of child and adolescent
psychiatry at East Tennessee State University.
Jacqueline Feldman, M.D., linked access to mental health services to the
idea that patients and physicians might have different ideas about what
constitutes recovery. She asked patients at the University of Alabama at
Birmingham community mental health center how they defined recovery.
"It's not just not hearing voices. None said `I want my voices to go
away,' " said Feldman. "Instead, they want the same things we
Satya Chandragiri, M.D., medical director of the Eastern Oregon Psychiatric
Center, described how he promoted the recovery model at a psychiatric hospital
by taking "small steps" that encouraged patients'
Several speakers took a broad view of the problem of disparities and
advocated for major health care and social reforms. Fred Osher, M.D., is
director of the Center for Behavioral Health, Justice, and Public Policy at
the University of Maryland School of Medicine. He opened his presentation by
saying that it is a "shame and tragedy" that more than 44 million
Americans lack health insurance. He pointed out that members of minority
groups are more likely to be uninsured (see chart on page 13). He urged"
universal health care" and asked, "Who do we partner with
to get it?"
Kenneth Thompson, M.D., said, "Provision of health care is a tiny,
tiny piece of what makes people healthy." He urged psychiatrists to
consider ways that social development policies affect health and to learn how
to create political will. Thompson is an associate professor of psychiatry at
the University of Pittsburgh.
Anita Everett, M.D., senior medical adviser at SAMHSA, said that effective
advocacy requires understanding how legislators see their mission. "They
all may not feel a need to be altruistic, but they will agree on the duty to
create equal opportunity. Paint a picture of how addressing disparities
creates a level playing field."
Each stop of OMNA on Tour will include presentations about local issues.
Martha Knisley, commissioner of the Washington, D.C., Department of Mental
Health, told the audience about the challenges of building a community mental
health system after D.C. residents gained the right to elect their city
"It's a tough system to work in," she said. "We've tried
to learn from the mistakes of others and use the best practices we could
Primm urged audience members to spread the word about the availability of
OMNA on Tour presentations. Stops now are planned for Philadelphia and
More information about OMNA on Tour is available by e-mailing Primm