CHAPTER 1

Introduction

Origins and Purposes of the Supplement

This Supplement, Mental Health: Culture, Race, and Ethnicity, is an outgrowth of the 1999 report, Mental Health: A Report of the Surgeon General, the first Surgeon General’s report ever issued on mental health and mental illness. That report (hereinafter called the SGR) called attention to several overarching points that resonate throughout this Supplement (Box 1–1). Through extensive documentation of the scientific literature, the report found that mental disorders are real and disabling conditions for which there are a range of effective treatments. It found that the efficacy of mental health treatment is well documented. On the basis of these findings, the Surgeon General made a single, explicit recommendation for everyone: Seek help if you have a mental health problem or think you have symptoms of a mental disorder. This Supplement affirms this vital recommendation and the major findings in which it is firmly anchored.

Overall, the SGR provided hope for people with, or at risk for, mental disorders by presenting the evidence for what can be done to prevent and treat mental illness. It also provided hope for recovery from mental illness. In his Preface, however, the Surgeon General pointed out that all Americans do not share this hope equally:

Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age, and gender. (DHHS, 1999, p. vi)

Box 1–1: Mental Health: A Report of the Surgeon General

Themes of the Report
● Mental health and mental illness require the broad focus of a public health approach.
● Mental disorders are disabling conditions.
● Mental health and mental illness are points on a continuum.
● Mind and body are inseparable.
● Stigma is a major obstacle preventing people from getting help.

Messages from the Surgeon General
● Mental health is fundamental to health.
● Mental illnesses are real health conditions.
● The efficacy of mental health treatments is well documented.
● A range of treatments exists for most mental disorders.

This Supplement was undertaken to probe more deeply into mental health disparities affecting racial and ethnic minorities. Drawing on scientific evidence from a wide-ranging body of empirical research, the Supplement has three purposes:

(1) To understand better the nature and extent of mental health disparities,

(2) To present the evidence on the need for mental health services and on the provision of services to meet those needs, and

(3) To document promising directions toward the elimination of mental health disparities and the promotion of mental health.

This Supplement covers the four most recognized racial and ethnic minority groups in the United States. According to Federal classifications, African Americans (blacks), American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and white Americans (whites) are races. Hispanic American (Latino) is an ethnicity and may apply to a person of any race (U.S. Office of Management and Budget [OMB], 1978). For example, many people from the Dominican Republic identify their ethnicity as Hispanic or Latino and their race as black.

The U.S. Office of Management and Budget created these four categories for the collection of census and other types of information by Federal agencies. One limitation is that each category groups together an extremely heterogeneous array of ethnic groups. For example, the Bureau of Indian Affairs currently recognizes 561 American Indian and Alaska Native tribes. Further, the broad category labels are imprecise: People who are indigenous to the Americas, for example, may be called Hispanic if they are from Mexico but American Indian if they are from the United States. Despite these well recognized limitations, these categories are used for this Supplement because they serve as standard nomenclature for data collection and research.⁶

This Supplement employs the term “racial and ethnic minorities” to refer collectively to people who identify as African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanic Americans. The term “minority” is used to signify the groups’ limited political power and social resources, as well as their unequal access to opportunities, social rewards, and social status. The term is not meant to connote inferiority or to indicate small demo-graphic size.

The four major groups covered by this Supplement accounted for about 30 percent of the U.S. population in 2000. They are projected to account for almost 40 per-cent by 2025.⁷Figure 1–1 illustrates the growth in population size across racial and ethnic groups. The demo-graphic surge in minority populations projected over the next two decades is expected to accompany continuing economic gaps between rich and poor. These gaps progressively narrowed from 1947 to 1968 but then reversed course: Income inequality rose over a 25-year period, from 1968 to 1993 (U.S. Census, 2000). These trends swelled the ranks of rich and poor, and reduced the size of the middle class. From 1993 to 1998, changes in income inequality leveled off, but significant disparities still exist.⁸Income status is relevant to mental health because of the strong association between lower income and higher rates of mental health problems and disorders (Chapter 2), and because of the association between health insurance and the ability to pay for mental health services (Brown et al., 2000).

Figure 1-1 illustrates the U.S. Population by Race and Hispanic Origin Census figures for 1990 and 2000, and provides projected figures for 2025.

⁶ In recognition of the limitations of the broad groupings, a major revision occurred with the 2000 census. The revision allows individuals to identify with more than one group (OMB, 2000). The U.S. Census Bureau anticipates that this change will result in approximately 63 different categories of racial and ethnic identifications.

⁷ Wherever possible, this Supplement uses the most recent data from the 2000 census. However, because of the recency of results, more specialized analyses have yet to be performed. Therefore, this Supplement also draws on analyses of previous census data.

⁸ Reasons behind growth in income inequality include the reduction in blue-collar jobs in manufacturing and less reliance on uneducated workers (Mishel & Bernstein, 1992). Also, there was a shift to technical service, information technology, and management (Drucker, 1993; U.S. Census Bureau, 2000).