Minorities are overrepresented among the Nation's vulnerable, high-need groups, such as homeless and incarcerated persons. These subpopulations have higher rates of mental disorders than people living in the community. Taken together, the evidence suggests that the disability burden from unmet mental health needs is disproportionately high for racial and ethnic minorities relative to whites.
The supplement consists of an overview of the collective mental health care needs of minority populations, followed by separate studies of each of four minority populations, including a historical perspective and analysis of the geographic distribution, family structure, education, income and physical health status of the group as a whole.
For example, African Americans are more likely to suffer from a broad range of physical diseases than are white Americans. Rates of heart disease, diabetes, prostate and breast cancer, infant mortality, and HIV/AIDS are all substantially greater for this group than for white Americans.
According to the report, American Indians "are five times more likely to die of alcohol(Drug information on alcohol)-related causes than whites, but they are less likely to die from cancer and heart disease." The Pima tribe in Arizona, for example, has one of the highest rates of diabetes in the world. The incidence of end-stage renal disease, a known complication of diabetes, is higher among American Indians than for both white Americans and African Americans.
Satcher uses historical and sociocultural factors to analyze the particular mental health care needs of each minority group. Then, specific mental health care needs for both adults and children are discussed and attention is given to high-need populations and culturally-influenced syndromes within the group. Each chapter includes a discussion of the availability of care, the appropriateness of available treatments, diagnostic issues and best practices relating to the group.
Some factors relating to mental illness appear to be common to most ethnic and racial minorities. In general, according to the report, minorities "face a social and economic environment of inequality that includes greater exposure to racism, discrimination, violence and poverty. Living in poverty has the most measurable effect on the rates of mental illness. People in the lowest stratum of income...are about two to three times more likely than those in the highest stratum to have a mental disorder."
Stresses caused by racism and discrimination "place minorities at risk for mental disorders such as depression and anxiety." In addition, the report states, "The cultures of racial and ethnic minorities alter the types of mental health services they use. Cultural misunderstandings or communication problems between patients and clinicians may prevent minorities from using services and receiving appropriate care." Health care practitioners who are not attuned to racial differences may not be aware of unique physical conditions as well. For example, because of differences in their rates of drug metabolism, some AA/PIs may require lower doses of certain drugs than those prescribed for white Americans. African Americans also are found to metabolize antidepressants more slowly than white Americans and may experience serious side effects from inappropriate dosages.
Specific analyses for each ethnic group included a wide range of findings, including those outlined below.