An impassioned group of addiction specialists, mental health advocates,
clergy, consumers, and family members gathered in Los Angeles in July to
tackle a problem complex in nature and broad in scope: co-occurring disorders
in diverse populations.
The daylong meeting, held at the California Endowment in downtown Los
Angeles, was the fifth and largest of APA's OMNA on Tour series, launched in
2005 by APA's Office of Minority and National Affairs (OMNA) to engage
communities to eliminate racial and ethnic disparities in mental health
OMNA on Tour gathers mental health experts in Los Angeles to strategize
on reducing health care disparities and co-occurring disorders. From left are
participants Altha Stewart, M.D., Carl Bell, M.D., Annelle Primm, M.D., and
Donald Vereen Jr., M.D.
Credit: Eve Bender
More than 200 people representing a multitude of racial and ethnic
backgrounds and professional disciplines attended the Los Angeles meeting.
Presenters and attendees shared insights on the impact of co-occurring
mental illness and substance abuse in underserved populations and shared
strategies for treatment, prevention, and recovery.
"Through OMNA on Tour, we visit areas with highly diverse populations
and engage communities in discussions about mental health disparities and
their manifestations," said OMNA director Annelle Primm, M.D., M.P.H.,
at the meeting. "Our aim is to foster collaborations and showcase local
and national models designed to eliminate mental health
OMNA on Tour meetings have been held in Philadelphia, New Orleans,
Washington, D.C., and Arlington Heights, Ill.
Representatives from local chapters of the National Alliance on Mental
Illness are present at each meeting, and July's was no exception—the
morning program was moderated in part by Nancy Carter, executive director of
NAMI Urban Los Angeles.
Primm emphasized that concentrating on particular regions of the country
affords the opportunity to respond to each community's unique needs and
develop tailored programs that take into account specific strengths and
Los Angeles, she noted, has a higher proportion of foreign-born residents
than the rest of California or the United States as a whole.
In developing a strategy to eliminate mental health disparities, it is
crucial to consider cultural environments in which co-occurring disorders
exist and to include people from outside of the mental health arena in the
discussion, Primm said. In many communities of color, alcohol and illicit
drugs are readily available, which complicates life for minorities with unmet
mental health needs and often "leads to a cascade of negative events,
including homelessness, incarceration, and death," she said.
The meeting began with a dose of reality offered by one of the keynote
speakers. "We're never going to be rid of mental health
disparities," said Carl Bell, M.D., adding that prevention is the
fastest way to reduce mental health disparities among underserved
Bell is president and CEO of the Community Mental Health Council and
Foundation in Chicago and director of public and community psychiatry and a
clinical professor of psychiatry and public health at the University of
Illinois at Chicago.
Bell emphasized the importance of identifying children who are at risk for
developing mental illness or becoming addicted to drugs and providing them
with what have become known as protective factors—mentorship, social
support, a sense of safety and security, and social skills. "Risk
factors are not predictive factors due to protective factors," he told
attendees—a phrase that became a mantra of sorts for the meeting.
Addiction researcher and public health expert Donald Vereen Jr., M.D.,
M.P.H., also stressed the importance of prevention. Vereen is director of
community-based public health in the Dean's Office of Public Health Practice
at the University of Michigan School of Public Health.
After explaining some of the events and changes in the brain that occur
during and after addiction to drugs, Vereen concluded that "we should be
protecting our kids' brains. We need to protect our children from making bad
choices by providing them with positive experiences."
Part of the meeting showcased innovative mental health and addiction
programs that are fostering recovery in minority populations. One such program
is Family Oasis, a counseling project for Asian and Pacific-Islander youth and
their families in San Francisco.
The program, which receives federal funding from the Center for Substance
Abuse Treatment (CSAT), was established in 1985 and serves more than 2,700
clients a year, according to David Mineta, deputy director of Asian American
Recovery Services Inc., also in the San Francisco area.
Mineta explained that denial and unwillingness to recognize substance abuse
problems is a major barrier to treatment in Asian-American and
Pacific-Islander families, so clinicians working in the program are careful to
respect family values and validate family members' experiences and emotional
pain. Another strategy is to "reduce shame around seeking help through
reflective listening and validation," Mineta noted.
Joe Powell, a chemical-dependency counselor who once struggled with
addiction to drugs and alcohol and has been sober for more than 20 years,
touted the value of peer counseling and involving the
community—including schools, churches, and social programs—in
recovery for minorities with mental illness and substance abuse. Add
evidence-based and culturally competent care, he noted, and recovery is even
Powell is executive director for the Association of Persons Affected by
Addiction, a Dallas-based organization that has also received CSAT funding for
its work with survivors of Hurricane Katrina who were relocated to Dallas.
"The quality of recovery is related to the quality of
relationships" between people with co-occurring disorders and the
community, he stressed.
Ray Daw, a member of the Navajo Nation, noted that programs designed to
treat Native-American populations with co-occurring disorders often
incorporate traditional healing practices with psychoeducation and a focus on
understanding trauma that has occurred on different levels. Daw is on the
board of directors of the Takini Network, a nonprofit organization developed
in 1992 by Maria Yellow Horse Brave Heart, Ph.D., to promote healing among
Native-American clients with histories of trauma. He is also a member of the
Substance Abuse and Mental Health Services Administration's Co-Occurring
Disorders Center for Excellence and co-chair of the National Institute on Drug
Abuse's Native-American Workgroup.
Daw also embraced the concept of prevention as embodied by the Edventures
Group, in which clinicians and teachers work with at-risk Native-American
youth to improve school attendance, academic performance and reduce behavioral
problems. Daw is regional director of the program, which serves youth in six
Arizona middle and high schools. Siamak Khadjenoury launched the Edventures
program in 2003.
At the end of the day, presenters and attendees exchanged contact
information and vowed to stay in touch to continue to share knowledge about
ways to reduce mental health disparities in underserved populations.
"It is my hope that we will be empowered by the information presented
today and that together, we can change lives of people with co-occurring
disorders for the better," said Primm. ▪