Minority Mental Health and Wellness: A Perspective from Health Care Systems

  • Siran M. Koroukian

Disparities in the use of mental health services and outcomes by ethnic and/or minority status have been well documented. Recent efforts by health care systems in developed countries have aimed at enhancing cultural and linguistic competence to better address the mental health needs of growing ethnic and minority populations. This chapter presents a brief overview of the disparities in mental health service use; describes a framework discussing barriers to access and utilize mental health services in this population; and presents the recommendations offered by the Office of Minority Health with respect to the provision of culturally and linguistically sensitive health services, as it discusses their relevance in addressing each of the barriers.


In the past several decades, developed countries witnessed a great influx of immigrants, creating a significant level of diversity in the population and an increasing representation of ethnic and minority individuals. According to...


Mental Health Mental Health Service Mental Health Care Cultural Competence Mental Health Provider 
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  1. Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D.,et al. (2002). Inequalities in use of specialty mental health services among Latinos, African Americans, and Non-Latino Whites. Psychiatric Services, 53(12), 1547–1555.PubMedCrossRefGoogle Scholar
  2. Alegria, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A.,et al. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Medical Care, 46(3), 247–256.PubMedCrossRefGoogle Scholar
  3. Ali, O. M., Milstein, G., & Marzuk, P. M. (2005). The Imam’s role in meeting the counseling needs of Muslim communities in the United States. Psychiatric Services, 56(2), 202–205.PubMedCrossRefGoogle Scholar
  4. Allen, J. D., Kennedy, M., Wilson-Grover, A., & Gilligan, T. D. (2007). African-American men’s perceptions about prostate cancer: Implications for designing educational intervention. Social Science & Medicine, 64, 2189–2200.CrossRefGoogle Scholar
  5. Anderson, L. M., Scrimshaw, S. C., Fullilove, M. T., Fielding, J. E., Normand, J., & the Task Force on Community Preventive Services. (2003). Culturally competent healthcare systems. A systematic review. American Journal of Preventive Medicine, 24(3S), 68–79.PubMedCrossRefGoogle Scholar
  6. Atdjian, S., & Vega, W. A. (2005). Disparities in mental health treatment in U.S. racial and ethnic minority groups: Implications for psychiatrists. Psychiatric Services, 56(12), 1600–1602.PubMedCrossRefGoogle Scholar
  7. Barker, P. R., Epstein, J. F., Hourani, L. L., Gfroerer, J., Clinton-Sherrod, A. M., West, N., et al. (2004). Patterns of mental health services utilization among adults, 2000 and 2001. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Last accessed March 9, 2008; Available at k-2k1mentalhealthW.pdf
  8. Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R.,et al. (1998). Management of pain in elderly patients with cancer. SAGE Study Group. Systematic assessment of geriatric drug use via epidemiology. Journal of the American Medical Association, 279(23), 1877–1882.PubMedCrossRefGoogle Scholar
  9. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118, 293–302.PubMedGoogle Scholar
  10. Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhurga, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7(Jan. 31), 15.PubMedCrossRefGoogle Scholar
  11. Blanco, C., Patel, S. R., Jiang, H., Lewis-Fernandez, R., Schmidt, A. B., Liebowitz, M. R., et al. (2007). National trends in ethnic disparities in mental health care. Medical Care, 45(11), 1012–1019.PubMedCrossRefGoogle Scholar
  12. Bolton, J. (2002). The third presence: A psychiatrist’s experience of working with non-English speaking patients and interpreters. Transcultural Psychiatry, 39(1), 97–114.CrossRefGoogle Scholar
  13. Cates, J. A. (2005). Facing away: Mental health treatment with the Old Order Amish. American Journal of Psychotherapy, 59(4), 371–383.PubMedGoogle Scholar
  14. Centers for Disease Control and Prevention. (2004). Self-reported frequent mental distress among adults – United States, 1993–2001. Morbidity and Mortality Weekly Report, 53(41), 963–966.Google Scholar
  15. Cheng, E. M., Chen, A., & Cunningham, W. (2007). Primary language and receipt of recommended health care among Hispanics in the United States. Journal of General Internal Medicine, 22(Suppl 2), 283–288.PubMedCrossRefGoogle Scholar
  16. Chevannes, M. (2002). Issues in educating health professionals to meet the diverse needs of patients and other service users from ethnic minority groups. Journal of Advanced Nursing, 39(3), 290–298.PubMedCrossRefGoogle Scholar
  17. Chow, J. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93, 792–797.PubMedCrossRefGoogle Scholar
  18. Cooper, G. S., Yuan, Z., Landefeld, C. S., & Rimm, A. A. (1996). Surgery for colorectal cancer: Race-related differences in rates and survival among Medicare beneficiaries. American Journal of Public Health, 86(4), 582–586.PubMedCrossRefGoogle Scholar
  19. Cooper, G. S., & Koroukian, S. M. (2004). Racial disparities in the use of and indications for colorectal procedures in Medicare beneficiaries. Cancer, 100(2), 418–424.PubMedCrossRefGoogle Scholar
  20. Cook, B. L., McGuire, T., & Miranda, J. (2007). Measuring trends in mental health care disparities. Psychiatric Services, 58(12), 1533–1540.PubMedCrossRefGoogle Scholar
  21. Corrigan, P. W. (2006). Impact of Consumer-Operated Services on empowerment and recovery of people with psychiatric disabilities. Psychiatric Services, 57(10), 1493–1496.PubMedCrossRefGoogle Scholar
  22. Daumit, G. L., Crum, R. M., Guallar, E., Powe, N. R., Primm, A. B., Steinwachs, D. M.,et al. (2003). Outpatient prescriptions for atypical antipsychotics for African Americans, Hispanics, and Whites in the United States. Archives of General Psychiatry, 60, 121–128.PubMedCrossRefGoogle Scholar
  23. Dobalian, A., & Rivers, P. A. (2008). Racial and ethnic disparities in the use of mental health services. Journal of Behavioral Health Services Research, 35(2): 128–141.Google Scholar
  24. de Jong, J. T. V. M., & van Ommeren, M. (2002). Toward a culture-informed epidemiology: Combining qualitative and quantitative research in transcultural contexts. Transcultural Psychiatry, 39(4), 422–433.CrossRefGoogle Scholar
  25. de Jong, J. T. V. M., & van Ommeren, M.(2005). Mental health services in a multicultural society: Interculturization and its quality surveillance. Transcultural Psychiatry, 42(3), 437–456.PubMedCrossRefGoogle Scholar
  26. Dovidio, J. F., Brigham, J. C., Johnson, B. T., & Gaertner, S. L. (1996). Stereotyping, prejudice, and discrimination: Another look. In N. Macrae, C. Stangor, & M. Hewstone (Eds.), Stereotypes and stereotyping. New York: Guilford.Google Scholar
  27. Fleck, D. E., Keck, P. E. Jr., Corey, K. B., Strakowski, S. M. (2005). Factors associated with medication adherence in African American and white patients with bipolar disorder. Journal of Clinical Psychiatry, 66(5), 646–652.PubMedCrossRefGoogle Scholar
  28. Gabard, D. L. (2007). Increasing minority representation in health care professions. Journal of Allied Health, 36(3), 165–175.PubMedGoogle Scholar
  29. Gilmer, T. P., Ojeda, V. D., Folsom, D. P., Fuentes, D., Garcia, P., & Jeste, D. V. (2007). Initiation and use of public mental health services by persons with severe mental illness and limited English proficiency. Psychiatric Services, 58(12), 1555–1562.PubMedCrossRefGoogle Scholar
  30. Gornick, M. E., Eggers, P. W., Reilly, T. W., Mentnech, R. M., Fitterman, L. K., Kucken, L. E., et al. (1996). Effects of race and income on mortality and use of services among Medicare beneficiaries. New England Journal of Medicine, 335(11), 791–799.PubMedCrossRefGoogle Scholar
  31. Harman, J. S., Edlund, M. J., & Fortney, J. C. (2004). Disparities in the adequacy of depression treatment in the United States. Psychiatric Services, 55(12), 1379–1385.PubMedCrossRefGoogle Scholar
  32. Hauenstein, E. J., Petterson, S., Merwin, E., Rovnyak, V., Heise, B., & Wagner, D. (2006). Rurality, gender, and mental health treatment. Family and Community Health, 29(3), 169–185.PubMedGoogle Scholar
  33. Hauenstein, E. J., Petterson, S., Rovnyak, V., Merwin, E., Heise, B., & Wagner, D. (2007). Rurality and mental health treatment. Administration and Policy Mental Health, 34(3), 255–267.CrossRefGoogle Scholar
  34. Herbeck, D. M., West, J. C., Ruditis, I., Duffy, F. F., Fitek, D. J., Bell, C. C.,et al. (2004). Variations in use of second-generation antipsychotic medication by race among adult psychiatric patients. Psychiatric Services, 55(6), 677–684.PubMedCrossRefGoogle Scholar
  35. Herrick, C. A., & Brown, H. N. (1998). Underutilization of mental health services by Asian Americans residing in the United States. Issues in Mental Health Nursing, 19, 225–240.PubMedCrossRefGoogle Scholar
  36. Heurtin-Roberts, S., Snowden, L., & Miller, L. (1997). Expressions of anxiety in African Americans: Ethnography and the epidemiological catchment area studies. Culture, Medicine, and Psychiatry, 21, 337–363.CrossRefGoogle Scholar
  37. Hinton, D. E., Pich, V., & Pollack, M. H. (2005). Panic attacks in traumatized Southeast Asian refugees. Mechanisms and treatment implications. In A. M. Georgiopoulos & J. F. Rosenbaum (Eds.), Perspective in cross-cultural psychiatry (pp. 37–62). Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
  38. Institute of Medicine (2003). Unequal treatment. Confronting racial and ethnic disparities in health care. Washington, D.C. The National Academies Press.Google Scholar
  39. Ito, K. L., & Maramba, G. G. (2002). Therapeutic beliefs of Asian American therapists: View from an ethnic-specific clinic. Transcultural Psychiatry, 39(1), 33–73.CrossRefGoogle Scholar
  40. Johnson, J. L., & Cameron, M. C. (2001). Barriers to providing effective mental health services to American Indians. Mental Health Services Research, 3(4), 215–223.PubMedCrossRefGoogle Scholar
  41. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshelman, S.,et al. (1994). Lifetime and 12-month prevalence of DSM-III-R disorders in the United States. Archives of General Psychiatry, 51(1), 8–19.PubMedGoogle Scholar
  42. Kimerling, R., & Baumrind, N. (2005). Access to specialty mental health services among women in California. Psychiatric Services, 56(6), 729–734.PubMedCrossRefGoogle Scholar
  43. Kirmayer, L. J., Groleau, D., Guzder, J., Blake, C., & Jarvis, E. (2003). Cultural consultation: A model of mental health service for multicultural societies. Canadian Journal of Psychiatry, 48(3), 145–153.Google Scholar
  44. Kirmayer, L. J. (2006). Beyond the “New Cross-cultural Psychiatry”: Cultural biology, discursive psychology and the ironies of globalization. Transcultural Psychiatry, 43(1), 126–144.PubMedCrossRefGoogle Scholar
  45. Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2007). Racial and ethnic disparities in SSRI availability in substance abuse treatment. Psychiatric Services, 58(1), 55–62.PubMedCrossRefGoogle Scholar
  46. Koranyi, E.K. (1979). Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population. Archives of General Psychiatry; 36: 414–419.Google Scholar
  47. Kuno, E., & Rothbard, A. B. (2002). Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. American Journal of Psychiatry, 159(4), 567–572.PubMedCrossRefGoogle Scholar
  48. Lagomasino, I. T., Dwight-Johnson, M., Miranda, J., Zhang, L., Liao, D., Duan, N.,et al. (2005). Disparities in depression treatment for Latinos and site of care. Psychiatric Services, 56(12), 1517–1523.PubMedCrossRefGoogle Scholar
  49. Lasser, K. E., Himmelstein, D. U., Woolhandler, S. J., McCromick, D., & Bor, D. H. (2002). Do minorities in the United States receive fewer mental health services than Whites? International Journal of Health Services, 32(3), 567–578.PubMedCrossRefGoogle Scholar
  50. Leong, F. T. L., & Lau, A. S. L. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research, 3(4), 201–214.PubMedCrossRefGoogle Scholar
  51. Marshall, G. N., Berthold, M., Schell, T. L., Elliott, M. N., Chun, C., & Hambarsoomians, K. (2006). Rates and correlates of seeking mental health services among Cambodian refugees. American Journal of Public Health, 96(10), 1829–1835.PubMedCrossRefGoogle Scholar
  52. McGuire, T. G., Alegria, M., Cook, B. L., Wells, K. B., & Zaslavsky, A. M. (2006). Implementing the Institute of Medicine definition of disparities: An application to mental health care. Health Services Research, 41(5), 1979–2005.PubMedCrossRefGoogle Scholar
  53. Minsky, S., Vega, W., Miskimen, T., Gara, M., & Escobar, J. (2003). Diagnostic patterns in Latino, African American, and European American psychiatric patients. Archives of General Psychiatry, 60(6), 637–644.PubMedCrossRefGoogle Scholar
  54. Opolka, J. L., Rascati, K. L., Brown, C. M., Barner, J. C., Johnsrud, M. T., & Gibson, P. J. (2003). Ethnic differences in use of antipsychotic medication among Texas Medicaid clients with schizophrenia. Journal of Clinical Psychiatry, 64(6), 635–639.PubMedCrossRefGoogle Scholar
  55. Opolka, J. L., Rascati, K. L., Brown, C. M., & Gibson, P. J. (2003). Role of ethnicity in predicting antipsychotic medication adherence. Annals of Pharmacotherapy, 37(5), 625–630.PubMedCrossRefGoogle Scholar
  56. Opolka, J. L., Rascati, K. L., Brown, C. M., & Gibson, P. J. (2004). Ethnicity and prescription patterns for Haloperidol, risperidone, and olanzapine. Psychiatric Services, 55(2), 151–156.PubMedCrossRefGoogle Scholar
  57. Passel, J. S., & Cohn, D. (2008). U.S. population projections: 2005–2050. Washington, DC: Pew Research Center, Social & Demographic Trends. Last accessed April 7, 2008; Available at
  58. Pear, R. (2008). House Approves Bill on Mental Health Parity. The New York Times. Last accessed April 9, 2008; Available at .
  59. Puebla Fortier, J., Convissor, R., & Pacheco, G. (1999). Assuring cultural competence in health care: Recommendations for national standards and an outcomes-focused research agenda: Recommendations for national standards and a national public comment process. Silver Spring, Maryland: Resources for Cross Cultural Health Care. Last accessed April 14, 2008; Available at
  60. Rogler, L. H., Malgady, R. G., & Rodriguez, O. (1989). Hispanics and mental health: A framework for research. Malabar, FL: Robert E. Krieger Publishing Company.Google Scholar
  61. Ronzio, C. R., Guagliardo, M. F., & Persaud, N. (2006). Disparity in location of urban mental service providers. American Journal of Orthopsychiatry, 76(1), 37–43.PubMedCrossRefGoogle Scholar
  62. Sentell, T., Shumway, M., & Snowden, L. (2007). Access to mental health treatment by English language proficiency and race/ethnicity. Journal of General Internal Medicine, 22(Suppl 2), 289–293.PubMedCrossRefGoogle Scholar
  63. Snowden, L. R. (1998). Racial differences in informal help seeking for mental health problems. Journal of Community Psychology, 26(5), 429–438.CrossRefGoogle Scholar
  64. Snowden, L. R., & Thomas, K. (2000). Medicaid and African American outpatient mental health treatment. Mental Health Services Research, 2(2), 115–120.PubMedCrossRefGoogle Scholar
  65. Snowden L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181–187.Google Scholar
  66. Steele, L. S., Glazier, R. H., & Lin, E. (2006). Inequity in mental health care under Canadian universal health coverage. Psychiatric Services, 57(3), 317–324.PubMedCrossRefGoogle Scholar
  67. Stockdale, S. E., Tang, L., Zhang, L., Belin, T. R., & Wells, K. B. (2007). The effects of health sector market factors and vulnerable group membership on access to alcohol, drug, and mental health care. Health Services Research, 42(3 Pt 1), 1020–1041.PubMedCrossRefGoogle Scholar
  68. Stromwall, L. K., & Hurdle, D. (2003). Psychiatric rehabilitation: An empowerment-based approach to mental health services. Health & Social Work, 28(3), 206–213.Google Scholar
  69. Stuart, G. W., Minas, I. H., Klimidis, S., & O’Connell, S. (1996). English language ability and mental health service utilization. Australian and New Zealand Journal of Psychiatry, 30(2), 270–277.PubMedCrossRefGoogle Scholar
  70. Sue, S., Fujino, D. C., Hu, L., Takeuchi, D. T., & Zane, N. (1991). Community mental health services for ethnic minority groups: A test of cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59(4), 533–540.PubMedCrossRefGoogle Scholar
  71. Sue, S., Zane, N., & Young, K. (1994). Research on psychotherapy on culturally diverse populations. In A. Bergin & S. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed.). New York: Wiley.Google Scholar
  72. Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879–885.PubMedGoogle Scholar
  73. Takeuchi, D. T., & Cheung, M. K. (1998). Coercive and voluntary referrals: How ethnic minority adults get into mental health treatment. Ethnicity & Health, 3(3), 149–158.CrossRefGoogle Scholar
  74. Ton, H., Koike, A., Hales, R. E., Johnson, J. A., & Hilty, D. M. (2005). A qualitative needs assessment for development of a cultural consultation service. Transcultural Psychiatry, 42(3), 491–504.PubMedCrossRefGoogle Scholar
  75. U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity – a supplement to mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.Google Scholar
  76. Vega, W. A., & Lopez, S. R. (2001). Priority issues in Latino mental health services research. Mental Health Services Research, 3(4), 189–200.PubMedCrossRefGoogle Scholar
  77. Wallace, A. E., Weeks, W. B., Wang, S., Lee, A. F., & Kazis, L. E. (2006). Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders. Psychiatric Services, 57(6), 851–856.PubMedCrossRefGoogle Scholar
  78. Walls, M. L., Johnson, K. D., Whitbeck, L. B., & Hoyt, D. R. (2006). Mental health and substance abuse services preferences among American Indian people of the Northern Midwest. Community Mental Health Journal, 42(6), 521–535.PubMedCrossRefGoogle Scholar
  79. Whitley, R., Kirmayer, L. J., & Groleau, D. (2006). Understanding immigrants’ reluctance to use mental health services: A qualitative study from Montreal. Canadian Journal of Psychiatry, 51(4), 205–209.Google Scholar
  80. Willging, C. E., Salvador, M., & Kano, M. (2006). Pragmatic help seeking: How sexual and gender minority groups access mental health care in a rural state. Psychiatric Services, 57(6), 871–874.Google Scholar
  81. Wood, A. J. J. (2001). Racial differences in the response to drugs – pointers to genetic differences. New England Journal of Medicine, 344(18), 1394–1396.PubMedCrossRefGoogle Scholar
  82. Yanos, P. T., Primavera, L. H., & Knight, E. L. (2001). Consumer-Run Service participation, recovery of social functioning, and the mediating role of psychological factors. Psychiatric Services, 52(4), 493–500.PubMedCrossRefGoogle Scholar
  83. Ying, Y. W., & Hu, L. T. (1994). Public outpatient mental health services: Use and outcome among Asian Americans. American Journal of Orthopsychiatry, 64(3), 448–455.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Case Western Reserve University, School of MedicineCleveland

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