Executive Summary Contents
MENTAL HEALTH: CULTURE, RACE, AND ETHNICITY
A Supplement to
Mental Health: A Report of the Surgeon General
DEPARTMENT OF HEALTH AND HUMAN SERVICES
U.S. Public Health Service
America is home to a boundless array of cultures, races,
and ethnicities. With this diversity comes incalculable
energy and optimism. Diversity has enriched our Nation
by bringing global ideas, perspectives, and productive
contributions to all areas of contemporary life. The
enduring contributions of minorities, like those of all
Americans, rest on a foundation of mental health.
Mental health is fundamental to overall health and
productivity. It is the basis for successful contributions
to family, community, and society. Throughout the lifespan,
mental health is the wellspring of thinking and
communication skills, learning, resilience, and selfesteem.
It is all too easy to dismiss the value of mental
health until problems appear. Mental health problems
and illnesses are real and disabling conditions that are
experienced by one in five Americans. Left untreated,
mental illnesses can result in disability and despair for
families, schools, communities, and the workplace. This
toll is more than any society can afford.
This report is a Supplement to the first ever Surgeon
General's Report on Mental Health, Mental Health: A
Report of the Surgeon General (U.S. Department of
Health and Human Services [DHHS], 1999). That
report provided extensive documentation of the scientific
advances illuminating our understanding of mental
illness and its treatment. It found a range of effective
treatments for most mental disorders. The efficacy of
mental health treatment is so well documented that the
Surgeon General made this single, explicit recommendation
for all people: Seek help if you have a mental
health problem or think you have symptoms of a mental
The recommendation to seek help is particularly
vital, considering the majority of people with diagnosable
disorders, regardless of race or ethnicity, do not
receive treatment. The stigma surrounding mental illness
is a powerful barrier to reaching treatment. People
with mental illness feel shame and fear of discrimination
about a condition that is as real and disabling as any
other serious health condition.
Overall, the earlier Surgeon General's report provided
hope for people with mental disorders by laying
out the evidence for what can be done to prevent and
treat them. It strove to dispel the myths and stigma that
surround mental illness. It underscored several overarching
points about mental health and mental illness (see
box). Above all, it furnished hope for recovery from
But in the Preface to the earlier report, the Surgeon
General pointed out that all Americans do not share
equally in the hope for recovery from mental illness:
Even more than other areas of health and medicine,
the mental health field is plagued by disparities
in the availability of and access to its
services. These disparities are viewed readily
through the lenses of racial and cultural diversity,
age, and gender (DHHS,1999, p.vi).
Mental Health: A Report of the Surgeon General
Mental health and mental illness require the broad focus of a public health approach.
Mental disorders are disabling conditions.
Mental health and mental illness are points on a continuum.
Mind and body are inseparable.
Stigma is a major obstacle preventing people from getting help.
Themes of the Report
Messages from the Surgeon General
Mental health is fundamental to health.
Mental illnesses are real health conditions.
The efficacy of mental health treatments is well documented.
A range of treatments exists for most mental disorders.
This Supplement was undertaken to probe more
deeply into mental health disparities affecting racial and
ethnic minorities. Drawing on scientific evidence from
a wide-ranging body of empirical research, this
Supplement has three purposes:To understand better the nature and extent of
mental health disparities;
To present the evidence on the need for mental
health services and the provision of services to
meet those needs; and
To document promising directions toward the
elimination of mental health disparities and the
promotion of mental health.
This Supplement covers the four most recognized
racial and ethnic minority groups in the United States.
According to Federal classifications, African
Americans (blacks), American Indians and Alaska
Natives, Asian Americans and Pacific Islanders and
white Americans (whites) are races. Hispanic American
(Latino) is an ethnicity and may apply to a person of any
race (U.S. Office of Management and Budget [OMB],
1978). For example, many people from the Dominican
Republic identify their ethnicity as Hispanic or Latino
and their race as black.
The Federal Government created these broad racial
and ethnic categories in the 1970s for collecting census
and other types of demographic information.1 Within
each of the broad categories, including white
Americans, are many distinct ethnic subgroups. Asian
Americans and Pacific Islanders, for example, include
43 ethnic groups speaking over 100 languages and
dialects. For American Indians and Alaska Natives, the
Bureau of Indian Affairs currently recognizes 561
tribes. African Americans are also becoming more
diverse, especially with the influx of refugees and
immigrants from many countries of Africa and the
Caribbean. White Americans, too, are a profoundly
diverse group, covering the span of immigration from
the 1400's to the 21st century, and including innumerable
cultural, ethnic, and social subgroups.
Each ethnic subgroup, by definition, has a common
heritage, values, rituals, and traditions, but there is no
such thing as a homogeneous racial or ethnic group
(white or nonwhite). Though the data presented in this
Supplement are often in the form of group averages, or
sample means (standard scientific practice for illustrating
group differences and health disparities), it should
be well noted that each racial or ethnic group contains
the full range of variation on almost every social, psychological,
and biological dimension presented. One of
the goals of the Surgeon General is that no one will
come away from reading this Supplement without an
appreciation for the intrinsic diversity within each of the
recognized racial or ethnic groups and the implications
of that diversity for mental health.
Clearly, the four racial and ethnic minority groups
that are the focus of this supplement are by no means
the only populations that encounter disparities in mental
health services. However, assessing disparities for
groups such as people who are gay, lesbian, bisexual,
and transgender or people with co-occurring physical
and mental illnesses is beyond the scope of this
Supplement. Nevertheless, many of the conclusions of
this Supplement could apply to these and other groups
currently experiencing mental health disparities.
1 The Office of Management and Budget has recently separated Asian
Americans from Native Hawaiians and other Pacific Islanders (OMB,
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