Introduction

DEFINING MENTAL HEALTH DISPARITIES
The National Institutes of Health defines health disparities as “differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” Unlike health disparities, studies have shown that there are minimal true differences in incidence and prevalence rates of mental illness across racial and ethnic groups.1,2,3,4,5,6


Understanding mental health disparities moves beyond just psychiatric disorders to considering the range of mental health symptoms and behavioral issues7 and thinking both “broadly and boldly when tackling the difficult issue of cultural disparities in the public mental health system.”8 Rather, disparities in mental health are “obliquely reflected in such indices as degree of access, service utilization, quality and outcomes.”9
  • Mental health disparities include a lack of access to services, underutilization of psychiatric and psychological services, problems with treatment engagement and retention due to inappropriate services, over- and misdiagnosis of disorders like schizophrenia and depression, inappropriate and over use or prescribing of medications, and very high rates of substance use disorders and suicide.10,11

Before examining these issues of access and utilization and the consequences, it is necessary to first differentiate between mainstream mental health services and culturally-traditional mental health services. In this report,
  • Mainstream mental health services refers to mental health services with Western or North American-dominant culture perspectives, typically provided through public and private mental health providers and other systems not designated as mental health systems, but providing a significant amount of mental health care. Other systems include child welfare, schools, substance abuse and corrections.
  • Culturally-traditional or -specific mental health services refers to services provided from a relational world view perspective such as culturally-specific formal mental health services, traditional or indigenous healers, churches and faith-based organizations, and other community-based supports. Culturally-traditional services originate within a culture or society and are designed specifically for treating the members within a given cultural group.12,13,14,15 A significant body of literature demonstrates that communities of color turn to culturally-traditional sources to address mental health issues.16,17,18,19,20,21,22,23
    Therefore, understanding the differences between these services is essential in order to provide people with meaningful help within the existing system by including culturally-traditional and culturally-specific treatments into the mainstream infrastructure. This may be achieved by:
  • enhancing the cultural appropriateness of the mainstream system24,25,26,27,28,29,30
  • providing alternatives to mainstream services31 through culturally-traditional and –specific providers
  • establishing linkages between the mainstream mental health system and culturally-traditional and specific providers and community supports, through the use of cultural brokers and inclusion of community leaders in systems integration and improvement efforts.32,33