Lardlad95
20th August 2002, 02:44
Mental Health System fails minorities
First Affirmative Inherency Brief.
1. The current health care system limits minority access to mental health care treatment.
a. Minorities have less access to mental health facilities.
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“Disparities exist in access, utilization and quality of mental health services for racial and ethnic minorities.”
b. Lack of culturally competent mental health services makes access challenging.
Jamie Garcia, Guest Columnist Seattle Post Intelligencer, Saturday January 6, 2001
Mental illness does not discriminate, but our mental health system does. In Fact one in every five families is affected by a severe mental illness, regardless of ethnicity. But Barriers to treatment, include stigma and lack of culturally competent services often make mental illness more challenging for communities of color to access services.
2. Mistrust by patients and clinical biases are barriers to the receipt of treatment.
a. Minority Patients are less likely to trust a white doctor
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“The reasons why racial and ethnic minority groups are less apt to seek help appear to be best studied among African Americans. By comparison with whites, African Americans are more likely to give the following reasons for not seeking professional help in the face of depression: lack of time, fear of hospitalization, and fear of treatment (Sussman et al., 1987). Mistrust among African Americans may stem from their experiences of segregation, racism, and discrimination (Primm et al., 1996; Priest, 1991). African Americans have experienced racist slights in their contacts with the mental health system, called “microinsults” by Pierce (1992). Some of these concerns are justified on the basis of research, cited below, revealing clinician bias in overdiagnosis of schizophrenia and underdiagnosis of depression among African Americans.
Lack of trust is likely to operate among other minority groups, according to research about their attitudes toward government-operated institutions rather than toward mental health treatment per se. This is particularly pronounced for immigrant families with relatives who may be undocumented, and hence they are less likely to trust authorities for fear of being reported and having the family member deported. People from El Salvador and Argentina who have experienced imprisonment or watched the government murder family members and engage in other atrocities may have an especially strong mistrust of any governmental authority (Garcia & Rodriguez, 1989). Within the Asian community, previous refugee experiences of groups such as Vietnamese, Indochinese, and Cambodian immigrants parallel those experienced by Salvadoran and Argentine immigrants. They, too, experienced imprisonment, death of family members or friends, physical abuse, and assault, as well as new stresses upon arriving in the United States (Cook & Timberlake, 1989; Mollica, 1989).
American Indians’ past experience in this country also imparted lack of trust of government. Those living on Indian reservations are particularly fearful of sharing any information with white clinicians employed by the government. As with African Americans, the historical relationship of forced control, segregation, racism, and discrimination has affected their ability to trust a white majority population (Herring, 1994; Thompson, 1997).”
b. Minorities are more likely to be diagnosed using patient’s symptoms rather than laboratory tests.
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“Advocates and experts alike have asserted that bias in clinician judgment is one of the reasons for overutilization of inpatient treatment by African Americans. Bias in clinician judgment is thought to be reflected in overdiagnosis or misdiagnosis of mental disorders. Since diagnosis is heavily reliant on behavioral signs and patients’ reporting of the symptoms, rather than on laboratory tests, clinician judgment plays an enormous role in the diagnosis of mental disorders. The strongest evidence of clinician bias is apparent for African Americans with schizophrenia and depression. Several studies found that African Americans were more likely than were whites to be diagnosed with schizophrenia, yet less likely to be diagnosed with depression (Snowden & Cheung, 1990; Hu et al., 1991; Lawson et al., 1994).
In addition to problems of overdiagnosis or misdiagnosis, there may well be a problem of underdiagnosis among minority groups, such as Asian Americans, who are seen as “problem-free” (Takeuchi & Uehara, 1996). The presence and extent of this type of clinician bias are not known and need to be investigated.”
3. Minorities are less likely to be able to afford quality treatment.
a. Cost and poverty create the chances of getting a mental illness and prevent treatment.
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“Cost is yet another factor discouraging utilization of mental health services (Chapter 6). Minority persons are less likely than whites to have private health insurance, but this factor alone may have little bearing on access. Public sources of insurance and publicly supported treatment programs fill some of the gap. Even among working class and middle-class African Americans who have private health insurance, there is underrepresentation of African Americans in outpatient treatment (Snowden, 1998). Yet studies focusing only on poor women, most of whom were members of minority groups, have found cost and lack of insurance to be barriers to treatment (Miranda & Green, 1999). The discrepancies in findings suggest that much research remains to be performed on the relative importance of cost, cultural, and organizational barriers, and poverty and income limitations across the spectrum of racial and ethnic and minority groups.”
b. Poverty enhances chances of contracting a serious mental illness.
Jamie Garcia, Guest Columnist Seattle Post Intelligencer, Saturday January 6, 2001
“Poverty greatly raises the risk of serious mental health disorders, so some minorities are especially vulnerable. Blacks and Hispanics have about triple the poverty rate of whites.
First Affirmative Inherency Brief.
1. The current health care system limits minority access to mental health care treatment.
a. Minorities have less access to mental health facilities.
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“Disparities exist in access, utilization and quality of mental health services for racial and ethnic minorities.”
b. Lack of culturally competent mental health services makes access challenging.
Jamie Garcia, Guest Columnist Seattle Post Intelligencer, Saturday January 6, 2001
Mental illness does not discriminate, but our mental health system does. In Fact one in every five families is affected by a severe mental illness, regardless of ethnicity. But Barriers to treatment, include stigma and lack of culturally competent services often make mental illness more challenging for communities of color to access services.
2. Mistrust by patients and clinical biases are barriers to the receipt of treatment.
a. Minority Patients are less likely to trust a white doctor
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“The reasons why racial and ethnic minority groups are less apt to seek help appear to be best studied among African Americans. By comparison with whites, African Americans are more likely to give the following reasons for not seeking professional help in the face of depression: lack of time, fear of hospitalization, and fear of treatment (Sussman et al., 1987). Mistrust among African Americans may stem from their experiences of segregation, racism, and discrimination (Primm et al., 1996; Priest, 1991). African Americans have experienced racist slights in their contacts with the mental health system, called “microinsults” by Pierce (1992). Some of these concerns are justified on the basis of research, cited below, revealing clinician bias in overdiagnosis of schizophrenia and underdiagnosis of depression among African Americans.
Lack of trust is likely to operate among other minority groups, according to research about their attitudes toward government-operated institutions rather than toward mental health treatment per se. This is particularly pronounced for immigrant families with relatives who may be undocumented, and hence they are less likely to trust authorities for fear of being reported and having the family member deported. People from El Salvador and Argentina who have experienced imprisonment or watched the government murder family members and engage in other atrocities may have an especially strong mistrust of any governmental authority (Garcia & Rodriguez, 1989). Within the Asian community, previous refugee experiences of groups such as Vietnamese, Indochinese, and Cambodian immigrants parallel those experienced by Salvadoran and Argentine immigrants. They, too, experienced imprisonment, death of family members or friends, physical abuse, and assault, as well as new stresses upon arriving in the United States (Cook & Timberlake, 1989; Mollica, 1989).
American Indians’ past experience in this country also imparted lack of trust of government. Those living on Indian reservations are particularly fearful of sharing any information with white clinicians employed by the government. As with African Americans, the historical relationship of forced control, segregation, racism, and discrimination has affected their ability to trust a white majority population (Herring, 1994; Thompson, 1997).”
b. Minorities are more likely to be diagnosed using patient’s symptoms rather than laboratory tests.
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“Advocates and experts alike have asserted that bias in clinician judgment is one of the reasons for overutilization of inpatient treatment by African Americans. Bias in clinician judgment is thought to be reflected in overdiagnosis or misdiagnosis of mental disorders. Since diagnosis is heavily reliant on behavioral signs and patients’ reporting of the symptoms, rather than on laboratory tests, clinician judgment plays an enormous role in the diagnosis of mental disorders. The strongest evidence of clinician bias is apparent for African Americans with schizophrenia and depression. Several studies found that African Americans were more likely than were whites to be diagnosed with schizophrenia, yet less likely to be diagnosed with depression (Snowden & Cheung, 1990; Hu et al., 1991; Lawson et al., 1994).
In addition to problems of overdiagnosis or misdiagnosis, there may well be a problem of underdiagnosis among minority groups, such as Asian Americans, who are seen as “problem-free” (Takeuchi & Uehara, 1996). The presence and extent of this type of clinician bias are not known and need to be investigated.”
3. Minorities are less likely to be able to afford quality treatment.
a. Cost and poverty create the chances of getting a mental illness and prevent treatment.
David M. Satcher MD, Ph.D., US Surgeon General. Mental Health: Culture, Race, Ethnicity. 1999
“Cost is yet another factor discouraging utilization of mental health services (Chapter 6). Minority persons are less likely than whites to have private health insurance, but this factor alone may have little bearing on access. Public sources of insurance and publicly supported treatment programs fill some of the gap. Even among working class and middle-class African Americans who have private health insurance, there is underrepresentation of African Americans in outpatient treatment (Snowden, 1998). Yet studies focusing only on poor women, most of whom were members of minority groups, have found cost and lack of insurance to be barriers to treatment (Miranda & Green, 1999). The discrepancies in findings suggest that much research remains to be performed on the relative importance of cost, cultural, and organizational barriers, and poverty and income limitations across the spectrum of racial and ethnic and minority groups.”
b. Poverty enhances chances of contracting a serious mental illness.
Jamie Garcia, Guest Columnist Seattle Post Intelligencer, Saturday January 6, 2001
“Poverty greatly raises the risk of serious mental health disorders, so some minorities are especially vulnerable. Blacks and Hispanics have about triple the poverty rate of whites.