National Alliance on Mental Illness
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Barriers to Mental Health Treatment by People of Color
By, Maria Jose Carrasco; Director, Multicultural Action Center
The significant progress made in discovering effective treatments for serious mental illness has unfortunately not translated into better services for people of color living with these illnesses. In fact, as the U.S. Surgeon General has reported, people from diverse communities—both adults and children—are less likely than whites to receive needed mental health care. When they do receive treatment, they often receive poorer-quality care (Surgeon General’s Report, 2000).
People from diverse communities often face additional barriers to treatment, such as discrimination and a lack of culturally competent mental health providers and services. It is crucial that a comprehensive plan to improve services and outcomes for people of color with mental illness address these surrounding circumstances as well as specific treatment and service issues. What follows are descriptions of some of the main barriers to mental health care treatment for people of color, and NAMI’s recommendations.
Racial and Ethnic Disparities in Mental Health Care
While the health status of all population groups has improved, the gaps between Caucasians and minorities persist, and in some cases, have become more pronounced. The Institute of Medicine’s 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, highlighted the fact that health disparities are prevalent not only in the treatment of illness but also in the delivery of care to people of color, and these disparities persist even after adjustments are made for economic status, education levels, age and insurance coverage. The mental health care arena is no exception to this reality. For example, a 2001 study indicated that people of color are less likely than Caucasians to receive the best available treatments for depression and anxiety (Young, A.S., et al., 2001).
Federal agencies and organizations that receive federal funds should collect race and ethnicity data, which will help identify major health disparities and their sources in order to implement effective solutions. Organizations such as NAMI should actively advocate for systems change and for more equal quality of and access to care. New legislation such as the recently proposed Healthcare Equality and Accountability Act of 2003 should be passed in order to reduce health disparities and improve the quality of care for racial and ethnic minorities. Action should be taken to expand health coverage, remove cultural and language barriers, improve workforce diversity, fund programs to reduce health disparities, improve data collection, promote accountability and strengthen health institutions that serve minority populations.
Lack of Cultural Competence in Service Delivery
As the surgeon general stated, "culture is a concept not limited to patients…clinicians view symptoms, diagnoses, and treatments in ways that sometimes diverge from their clients’ views, especially when the cultural backgrounds of the consumer and provider are dissimilar. This divergence of viewpoints can create barriers to effective care … Clinicians and service systems, naturally immersed in their own cultures, have been ill-equipped to meet the needs of patients from different backgrounds and, in some cases, have displayed bias in the delivery of care" (Surgeon General’s Report, 1999). Furthermore, the Institute of Medicine’s report Unequal Treatment concluded that "although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care."
A 2001 study reported that 51 percent of white health care providers believe that their patients do not adhere to medical treatments as a result of cultural or linguistic barriers. Of this same group, 56 percent reported having no form of cultural competency training (Institute of Medicine, 2002). For mental health consumers of color, access to mental health services and the quality of the services they receive are negatively affected by the lack of cultural competence in service delivery. Unfortunately, in many cases, the lack of knowledge of the consumer’s culture creates misunderstandings that result in inappropriate diagnosis, treatment, and/or adherence to treatment. Furthermore, a mental health provider who is not aware of the consumer’s culture is more likely to misdiagnose a psychiatric illness.
Mental health providers must adapt to meet the needs of people of color. Systems of care need to integrate the consumer’s culture into the treatment process. To establish a culturally competent system, all providers should receive education and training on cultural competence. This training should be part of their regular curriculum.
Governmental and private providers of mental health services should start by performing a cultural self-assessment, adopting cultural competence standards such as those proposed by the Center for Mental Health Services, embracing diversity and adapting their services at all levels to address the needs of diverse populations. Culturally competent service providers, regardless of their own cultural background, will be able to better understand and treat consumers of color.