Minorities Get Less Help for Mental Illness

Despite progress treating mental illnesses, afflicted members of racial and ethnic minority groups are more likely to receive inadequate treatment or none compared with whites, according to a U.S. surgeon general’s report issued Sunday in San Francisco that calls on minorities and local governments to close the health gaps.

The report is the first from the nation’s top doctor exclusively to address the disproportionate burden of mental illnesses shouldered by African Americans, Latinos, American Indians, Alaska Natives, Asian Americans and Pacific Islanders. It says mental disorders take a heavier toll on members of such communities, causing needless misery and often disrupting already precarious lives.

Among the reasons cited for the pervasive under-treatment of minorities are higher than average rates of poverty, less health insurance coverage, language barriers, biases among health workers, and sometimes cultural stigmas within groups against acknowledging disorders such as schizophrenia.

Though some mental health professionals praised the report as momentous, its release at a conference here of the American Psychological Assn. was not accompanied by official word of new government programs or funding. Solving the problem will fall largely to community professionals and state and local governments, which have “primary oversight of public mental health spending,” the report says.

Still, Dr. David Satcher, the surgeon general, said he was hopeful that the National Institutes of Mental Health and other federal agencies would develop and perhaps fund initiatives to address the problem.

“I expect to see new programs to come out of this,” he said in a news conference after a speech before a standing-room-only crowd. “This is one of the best investments we can make.”

He said he would like to see Congress increase federal spending on the problem. “The mental health area has been ignored,” he said.

Mark Gottlieb, a health physicist with the California Department of Health Services and past president of the National Depression and Manic Depression Assn., said the report was drastically needed. “What it does is get the motivation out there for people in the community to change,” he said. But he criticized it for not crediting consumer groups with having a larger role in reaching under-treated patients.

Though the report spotlights problems among members of minority groups, it points out that most Americans with mental disorders, regardless of race or ethnicity, receive too little treatment or none. Similarly, though some minority groups may have a higher than average risk of some disorders, they also have lower risks of others.

Blacks suffer from more phobias than non-Latino whites, but they appear to have less major depression, says the report. Also, blacks have half the overall suicide rate of non-Latino whites, though among young black men, the suicide rate is higher than that of whites and rising fast.

Among Latinos, mental disorders are generally no more common than among non-Latino whites, the report says. But mental illness may have a disproportionate effect on Latinos because they have the lowest health insurance rate of all the groups studied, with 40% uninsured.

Language is a key barrier for many Latinos. Only one in 20 Latino immigrants with a mental disorder seeks treatment from a qualified professional. The report cites one study that found 24% of Latinos with depression and anxiety received appropriate care, compared with 34% of whites.

Asian Americans, research shows, suffer no more mental disorders than do whites, but they were the least likely of the groups studied to seek treatment. Only 17% of afflicted Asian Americans and Pacific Islanders, whom the report tallies together, sought care. “Shame and stigma are believed to figure prominently” in the lower use rates, the report says.

Access to services was perhaps most limited among American Indians or Alaskan Natives, who are served by just one mental health professional for every 1,000 people. Alcohol abuse in those groups exacerbates mental illness, the report says.

Racism and intolerance can contribute directly to mental illness by heightening anxiety and depression, the report says. And prejudice also can make disorders worse by making people who already feel persecuted because of their ethnicity less likely to come forward, Satcher told reporters.

To address the problem, the report suggests general approaches such as doing more research and making community clinics more accessible. Appearing on the podium with the surgeon general were several health professionals and patient advocates, including Hoi Wong, who heads Asian family issues for the San Gabriel Valley branch of the National Alliance for the Mentally Ill.

“We need mental health clinics with bilingual staffs,” he said through an interpreter.