Preface

from the Surgeon General U.S. Public Health Service

Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General's report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders.

The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs.

A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.

Just as health disparities are a cause for public concern, so is our diversity a national asset. This Supplement carries with it a call to the people of the United States to understand and appreciate our many cultures and their impact on the mental health of all Americans. The main message of this Supplement — that culture counts — should echo through the corridors and communities of this Nation. In today's multi-cultural reality, distinct cultures and their relationship to the broader society are not just important for mental health and the mental health system, but for the broader health care system as well.

This Supplement encourages racial and ethnic minorities to seek help for mental health problems and mental illnesses. For this advice to be meaningful, it is essential that our Nation continues on the road toward eliminating racial and ethnic disparities in the accessibility, availability, and quality of mental health services. Researchers are working to fill gaps in the scientific literature regarding the exact roles of race, culture, and ethnicity in mental health, but much is already known. The mental health system must take advantage of the direction and insight offered by the research presented in this Supplement. Because State and local governments have primary oversight of public mental health spending, they have a clear and important role in assuring equal access to high quality mental health services for racial and ethnic minorities. Just as important, we need to redouble our efforts to support communities, especially consumers, families, and community leaders, in welcoming and demanding effective treatment for all. When it is easy for minorities to seek and use treatment, our vision of eliminating mental health disparities becomes a reality.

Finally, as noted in the previous report, it is inherently better to prevent an illness from occurring in the first place than to need to treat it once it develops. Just as other areas of medicine have promoted healthy lifestyles and thereby have reduced the incidence of conditions such as heart disease and some cancers, so now is the time for mental health providers, researchers, and policy makers to focus more on promoting mental health and preventing mental and behavioral disorders. Following this course will yield incalculable benefits, not only in terms of societal costs, but also in the significant decrease of human suffering.

David Satcher, M.D., Ph.D. Surgeon General

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