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 world-wide, 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 over-represented. 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.
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.
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.
