2. Triple Whammy—HIV, Mental Disorders, African Americans
Patterns of Access to Healthcare Services
In 2001, the US Surgeon General published Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. The Supplement aimed to paint an in-depth picture of the types of mental health problems experienced by diverse racial and ethnic groups, how their cultures feel about mental disorders, and how members of diverse populations access—or do not access—healthcare services that treat mental disorders. In the broadest terms, the Supplement “documents the existence of striking disparities for minorities in mental health services and the underlying knowledge base. Racial and ethnic minorities have less access to mental health services than do whites.” [Surgeon General Supplement-2001]
The Supplement goes on to stress that the mental healthcare disparities experienced by racial and ethnic minorities are associated with significant loss in both overall health and productivity. In fact, a study by Murray and Lopez found that the impact of disability from mental disorders is second only to that of cardiovascular disease.[Murray 1996] These findings were reinforced by another analysis by Druss and colleagues, which reported that one-third of disabled persons in the United States 18 to 55 years of age who lived in their communities experienced a mental disorder that contributed to their disability. [Druss 2000] These and many other studies underscore the disproportionately high burden from unmet mental healthcare needs among racial and ethnic minority populations, relative to the white population.
The principal barriers to greater access to mental healthcare services identified in the Supplement include:
- Costs of care
- Societal stigma surrounding mental disorders
- Fragmented organization of mental health services in the United States
- Practitioners’ lack of awareness of cultural issues, bias, or inability to speak a client’s language
- Clients’ fears and mistrust of treatment
- Historical and current struggles with racism and discrimination, with their effects on mental health and socioeconomic and political status
Data from the 2010 census document the income disparities among the diverse racial and ethnic populations in the United States and their relation to health insurance status. [Census Income 2010] The prevalance of mental disorders is strongly associated with lower income, employmnt status, health insurance coverage, and access to mental health services.
Data from the Federal Reserve Board’s 2007 Survey of Consumer Finances provide the following portrait of disparities in net worth among the 3 largest racial groups in the United States:
Percentage of Households Having Zero or Negative Net Worth, 2007 (%)
[Federal Reserve 2007]
(Ages 18 to 64)
|
White, Non-Hispanic |
African American |
Hispanic |
Married or cohabiting |
15 |
28 |
31 |
Single female |
23 |
46 |
45 |
Single male |
23 |
33 |
38 |
