Thirteen years since a U.S. surgeon general’s report declared that African-Americans, Latinos, Asian-Americans and Native Americans receive lower quality mental health care in general than whites, there are still significant barriers to mental health services. These inequities include cost, stigma and poor quality, according to a special issue of Psychological Services, published by the American Psychological Association and authored by a multidisciplinary team of psychologists, physicians and other health care experts.
“Despite decades of research, recognition and treatment of mental illness and its comorbidities still remain a significant public health problem in the United States,” write the authors of the special issue’s leading article. “Ethnic minorities are identified as a population that is vulnerable to mental health disparities and face unique challenges pertaining to mental health care.”
The authors suggest that emphasizing culturally competent mental health screenings and treatments in primary care, rather than specialty settings, may be a promising approach to addressing mental health care disparities among racial and ethnic minorities.
“More than 50 percent of patients currently being treated receive some form of mental health services treatment from a primary care provider, and primary care is now the sole form of health care used by over 30 percent of patients with a mental disorder accessing the health care system,” they write. “Therefore, it is vital that mental health services are integrated with primary care services. A health care team that considers culture, shows respect and assesses and affirms patient differences will provide patients a comfortable, supportive environment to express their mental health concerns.”
The special issue contains 13 articles, including a review of research on care for depressed racial/ethnic minorities, a study of urban adults receiving mental health services after exposure to trauma and a study of depression treatment among Latino primary care patients.
Below is a sample of the articles, with a brief overview of the research:
“Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities Among Ethnic Minorities”
The authors propose a comprehensive, innovative, culturally centered integrated care model to address complexities within the health care system. Their recommendations for health care practitioners emphasize the importance of providing a holistic approach for physical, mental, emotional and behavioral problems among ethnic minorities in a primary care setting.
“Our multidisciplinary investigative team acknowledges the importance of providing culturally tailored integrative health care to holistically concentrate on physical, mental, emotional, and behavioral problems among ethnic minorities in a primary care setting. It is our intention that the proposed model will be useful for health practitioners, contribute to the reduction of mental health disparities, and promote better mental health and well-being for ethnic minority individuals, families, and communities,” wrote the authors, including Kisha Holden, PhD, MSCR, former Surgeon General David Satcher, MD, PhD, Brian McGregor, PhD, Poonam Thandi, MD, Edith Fresh, PhD, Kameron Sheats, PhD, Allyson Belton, MPH, and Gail Mattox, MD, of the Morehouse School of Medicine in Atlanta.
“A Critical Review of Culturally Sensitive Treatments for Depression: Recommendations for Intervention and Research”
Culturally adapted mental health treatments are more effective for racial and ethnic minorities than traditional psychotherapy, according to recent research. Despite these advances, mental health treatment disparities among racial and ethnic minorities still exist. This article reviewed 16 culturally sensitive treatments for depression and found that accommodating for language during therapy sessions was critical, in addition to using approaches that were problem-focused and direct.
“Culturally adapted treatments for depression appear effective in symptom reduction, and ethnic minority clients may be more likely to seek and stay in treatment if they consider the issues discussed in therapy relevant to their culture,” wrote authors Zornitsa Kalibatseva, MA, and Frederick T. L. Leong, PhD, of Michigan State University.
“Factors Associated With Mental Health Service Use in Urban, Impoverished, Trauma-Exposed Adults”
Patients are more likely to seek mental health services if they have social support and positive attitudes toward treatment seeking, according to this study. Questionnaires were completed by 135 adults living in an urban area with a lifetime history of traumatic stress exposure. Approximately 20 percent were receiving mental health services, primarily at outpatient mental health clinics.
Improving attitudes toward treatment seeking as well as identifying work difficulties may be important avenues for improving willingness to seek care and decreasing disparities in care for trauma-exposed adults, said the authors Bita Ghafoori, PhD, Dennis G. Fisher, PhD, Olga Koresteleva, PhD, and Madelyn Hong, BA, who are all with California State University, Long Beach. Implications for mental health policy and practice are also discussed.
“Uptake of Depression Treatment Recommendations Among Latino Primary Care Patients”
A survey of 90 Latino primary care patients whose physicians recommended they undergo treatment for depression found that those who had a good relationship with their doctor were more likely to follow up with the treatment three months later. Patients who were prescribed medication were more likely to follow up with treatment than those who were referred to psychotherapy.
“The primary care physician, the most familiar and trusted health care provider, together with the mental health specialist can facilitate access and de-mystify mental health care and the patient receives both continuity of care as well as guideline-adherent mental health care,” wrote the lead author, Rachel Zack Ishikawa, PhD, of Clark University.
“Mental Health Screening Among Newly Arrived Refugees Seeking Routine Obstetric and Gynecologic Care”
In this study, researchers implemented a mental health care screening tool in a population of refugee women from Iraq, Somalia, and Mynamar (also known as Burma). Past research has shown that refugee women face high rates of violence, trauma, PTSD, and other mental disorders, but these problems often go unaddressed. Of the 112 women who participated in the study, nearly a quarter screened positive for trauma-related mental health distress. Among those women with clinically significant emotional distress, 70 percent were not currently receiving mental health treatment and 50 percent had no plans or means to enroll in mental health services. Lack of insurance was the most common reason women were not enrolled in mental health care, cited by 53 percent of those not currently receiving services.
“Screening for mental disorders among refugee women will promote greater awareness and identify those individuals who would benefit from further mental health evaluation and treatment. Sustainable interdisciplinary models of care are necessary to promote health education, dispel myths, and reduce the stigma of mental health,” wrote first author Crista E. Johnson-Agbakwu, MD, MSc, of the Refugee Women’s Health Clinic in Phoenix, Arizona, and the Southwest Interdisciplinary Research Center at Arizona State University.
“An Innovative Community-Oriented Approach to Prevention and Early Intervention With Refugees in the United States”
This article presents a community-oriented prevention and early intervention model to help better identify and address unmet needs for mental health services among newly-arrived refugees, and to assist them in the process of adjusting to life in the U.S. As noted in the previous article summary, refugee populations often face unique mental health care needs as a result of traumatic experiences living in or escaping from their homelands; many also face difficulties as they settle in their new host countries.
However, “because of several access and utilization barriers, such as stigma, refugees are not apt to receive needed mental health services,” wrote lead author Kristel Heidi Nazzal, PhD. “Moreover, the traditional Western model of treatment can be culturally incongruent with refugee practices. Alternative, culturally sensitive, community-based approaches must be considered.”
Other articles include:
“Addressing Disparities in Mental Health Agencies: Strategies to Implement the National Standards for Culturally and Linguistically Appropriate Services in Mental Health“, by Crystal L. Barksdale, PhD, Health Determinants and Disparities Practice, SRA International Inc., Rockville, Maryland, and Johns Hopkins Bloomberg School of Public Health; Jennifer Kenyon, BA, Darci L. Graves, MPP, MA, and C. Godfrey Jacobs, Health Determinants and Disparities Practice, SRA International Inc., Rockville, Maryland.
“Translating Disparities Research to Policy: A Qualitative Study of State Mental Health Policymakers’ Perceptions of Mental Health Care Disparities Report Cards,” by Anne Valentine, MPH, and Darcie DeAngelo, MA, Cambridge Health Alliance; Margarita Alegría, PhD, and Benjamin L. Cook, PhD, Cambridge Health Alliance and Harvard Medical School.
“Building the Gateway to Success: An Appraisal of Progress in Reaching Underserved Families and Reducing Racial Disparities in School-Based Mental Health,” by Laurel Bear, PhD, and Rosalie Finer, PhD, Alhambra Unified School District; Sisi Guo, MA, and Anna S. Lau, PhD, University of California, Los Angeles.
“Guidelines for Establishing a Telemental Health Program to Provide Evidence-Based Therapy for Trauma-Exposed Children and Families,” by Andrea M. Jones, PhD, Kristen M. Shealy, EdM, Kathryn Reid-Quiñones, PhD, Angela D. Moreland, PhD, Tatiana M. Davidson, PhD, Cristina M. López, PhD, Simone C. Barr, PhD, and Michael A. de Arellano, PhD, Medical University of South Carolina.
“Working Together to Solve Disparities: Latina/o Parents’ Contributions to the Adaptation of a Preventive Intervention for Childhood Conduct Problems,” by Larissa N. Niec, PhD, Ignacio D. Acevedo-Polakovich, PhD, Emily Abbenante-Honold, PhD, Allison S. Christian, MA, and Miya L. Barnett, PhD, Central Michigan University; Gerardo Aguilar, Hispanic Center of Western Michigan; Samuel O. Peer, MA; Central Michigan University.
“Toward the Early Recognition of Psychosis Among Spanish-Speaking Adults on Both Sides of the U.S.-Mexico Border,” by Rachel Nichole Casas, PhD, University of Southern California and University of California, Los Angeles; Edlin Gonzales, MA, University of Southern California; Eréndira Aldana-Aragón, MA, University of Hawaii, Manoa; María del Carmen Lara-Muñoz, MD, PhD, Benemérita Universidad Autónoma de Puebla; Alex Kopelowicz, MD, University of California, Los Angeles; Laura Andrews, Mental Health America of San Diego County; Steven Regeser López, PhD, University of Southern California.
“Applying Behavior Change Theory to Technology Promoting Veteran Mental Health Care Seeking,” by Julia M. Whealin, PhD, Veterans Affairs Pacific Islands Health Care System, Honolulu, and University of Hawaii; Eric Kuhn, PhD, VA Palo Alto Health Care System, Palo Alto, California, and Stanford University; Robert H. Pietrzak, PhD, MPH, VA Connecticut Healthcare System, West Haven, Connecticut, and Yale University.