Poverty Greatly Raises The Risk Of Serious Mental Disorders

Minorities often get separate and unequal mental health care: They're less likely

than whites to receive needed treatment, and the care they do get is of lower finality, says a Surgeon General's report out Sunday.

Among the key causes of the "striking disparities" in care for U.S. whites and minorities are financial barriers, racism, mistrust of doctors and language problems. "Our failure to address these disparities is playing out in homeless shelters, in foster care in prisons and jails, " says Surgeon GeneralDavidSnatcher.

Poverty greatly raises the risk of serious mental disorders, so some minority groups are especially vulnerable. Blacks and Hispanics have about triple the poverty rale of whites. And 37% of Hispanics have no health insurance; more than double the rate for whites. Lack of private insurance throws mentally ill people at the mercy of a thinning "safety net" of public treatment centers. In many cities, such as Detroit, the net is so thin, "it's barely there," says psychologist James Jackson of the Institute for Social Research at University of Michigan-Ann Arbor.

Minority kids pose special concerns: Hispanic youth have significantly poorer mental health than whites, Satcher says. Some 45% of children in foster care are black, as are more than half awaiting adoption. Many have serious mental disorders, research suggests. Even when they can afford care, feelings of stigma may get in the way. "Within many Asian cultures, mental illness is heavily stigmatized. I know, because there's mental illness in my family, " says Richard Nakamura, deputy director at the National Institute of Mental Health. Mistrust of therapists isn't totally off the mark. There's evidence of racial and ethnic bias by counselors, the report says.

Minorities are more likely than whites to rely on their primary care doctors for detecting emotional disorders. But "it's an uphill battle to get treatment for mental problems under managed care, " says Ronald Kessler, a health policy expert at Harvard Medical School in Boston. "You have to be very sophisticated. Doctors are not likely to diagnose a mental disorder in the eight minutes they're allowed with the patient, " Kessler says. The report recommends integrating mental health and medical services.

Research on the mental health of minorities is sparse, because until the past few years, studies didn't indicate a subject's race or included mostly whites. In 1994, the National Institutes of Health started to require that its funded studies include minorities. Snatcher remains hopeful, partly because federal grants will soon be funding programs to target the disparities. "I'm very optimistic, but I don't believe it's going to be easy," he says.

by: emaly

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