Executive Summary Contents
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Main Findings
Mental Illnesses are Real, Disabling
Conditions Affecting All Populations,
Regardless of Race or Ethnicity
Major mental disorders like schizophrenia, bipolar disorder,
depression, and panic disorder are found worldwide,
across all racial and ethnic groups. They have
been found across the globe, wherever researchers have
surveyed. In the United States, the overall annual prevalence
of mental disorders is about 21 percent of adults
and children (DHHS, 1999). This Supplement finds
that, based on the available evidence, the prevalence of
mental disorders for racial and ethnic minorities in the
United States is similar to that for whites.
This general finding about similarities in overall
prevalence applies to minorities living in the community.
2 It does not apply to those individuals in vulnerable,
high-need subgroups such as persons who are homeless,
incarcerated, or institutionalized. People in these groups
have higher rates of mental disorders (Koegel et al.,
1988; Vernez et al., 1988; Breakey et al., 1989; Teplin,
1990). Further, the rates of mental disorders are not sufficiently
studied in many smaller racial and ethnic
groups - most notably American Indians, Alaska
Natives, Asian Americans, and Pacific Islander groups
- to permit firm conclusions about overall prevalence
within those populations.
This Supplement pays special attention to vulnerable,
high-need populations in which minorities are overrepresented.
Although individuals in these groups are
known to have a high-need for mental health care, they
often do not receive adequate services. This represents a
critical public health concern, and this Supplement identifies
as a course of action the need for earlier identification
and care for these individuals within a coordinated
and comprehensive service delivery system.
2 Most epidemiological studies using disorder-based definitions of mental illness
are conducted in community household surveys. They fail to include
nonhousehold members, such as persons without homes or persons residing
in institutions such as residential treatment centers, jails, shelters, and hospitals.
Striking Disparities in Mental Health
Care Are Found for Racial and Ethnic
Minorities
This Supplement documents the existence of several disparities
affecting mental health care of racial and ethnic
minorities compared with whites:
Minorities have less access to, and availability of,
mental health services.
Minorities are less likely to receive needed mental
health services.
Minorities in treatment often receive a poorer
quality of mental health care.
Minorities are underrepresented in mental health
research.
The recognition of these disparities brings hope that
they can be seriously addressed and remedied. This
Supplement offers guidance on future courses of action
to eliminate these disparities and to ensure equality in
access, utilization, and outcomes of mental health care.
More is known about the disparities than the reasons
behind them. A constellation of barriers deters minorities
from reaching treatment. Many of these barriers
operate for all Americans: cost, fragmentation of services,
lack of availability of services, and societal stigma
toward mental illness (DHHS, 1999). But additional barriers
deter racial and ethnic minorities; mistrust and fear
of treatment, racism and discrimination, and differences
in language and communication. The ability for consumers3
and providers to communicate with one another
is essential for all aspects of health care, yet it carries
special significance in the area of mental health because
mental disorders affect thoughts, moods, and the highest
integrative aspects of behavior. The diagnosis and treatment
of mental disorders greatly depend on verbal communication
and trust between patient and clinician.
More broadly, mental health care disparities may also
stem from minorities' historical and present day struggles
with racism and discrimination, which affect their
mental health and contribute to their lower economic,
social, and political status. The cumulative weight and
interplay of all barriers to care, not any single one alone,
is likely responsible for mental health disparities.
3 Although a number of terms identify people who use or have used mental
health services (e.g., mental health consumer, survivor, ex-patient, client),
the terms "consumer" and "patient" will be used interchangably throughout
this Supplement.
Disparities Impose a Greater Disability Burden on Minorities
This Supplement finds that racial and ethnic minorities
collectively experience a greater disability burden from
mental illness than do whites. This higher level of burden
stems from minorities receiving less care and poorer
quality of care, rather than from their illnesses being
inherently more severe or prevalent in the community.
This finding draws on several lines of evidence.
First, mental disorders are highly disabling for all the
world's populations (Murray & Lopez, 1996; Druss et
al., 2000). Second, minorities are less likely than whites
to receive needed services and more likely to receive
poor quality of care. By not receiving effective treatment,
they have greater levels of disability in terms of
lost workdays and limitations in daily activities. Further,
minorities are overrepresented among the Nation's most
vulnerable populations, which have higher rates of mental
disorders and more barriers to care. Taken together,
these disparate lines of evidence support the finding that
minorities suffer a disproportionately high disability
burden from unmet mental health needs.
The greater disability burden is of grave concern to
public health, and it has very real consequences. Ethnic
and racial minorities do not yet completely share in the
hope afforded by remarkable scientific advances in
understanding and treating mental disorders. Because of
disparities in mental health services, a disproportionate
number of minorities with mental illnesses do not fully
benefit from, or contribute to, the opportunities and
prosperity of our society. This preventable disability
from mental illness exacts a high societal toll and affects
all Americans. Most troubling of all, the burden for
minorities is growing. They are becoming more populous,
all the while experiencing continuing inequality of
income and economic opportunity. Racial and ethnic
minorities in the United States face a social and economic
environment of inequality that includes greater
exposure to racism and discrimination, violence, and
poverty, all of which take a toll on mental health.
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