2. Triple Whammy—HIV, Mental Disorders, African Americans
Mental Health Services Sector
With the growing racial and ethnic diversity of the US population, providers of mental healthcare services are challenged to offer treatment that is culturally and linguistically appropriate to the needs of the communities that they serve. Like all other population groups, African Americans have unique ways of identifying and describing any mental
health problems they experience and bring a cultural history of experiences in interacting with service providers to clinical encounters. This will require providers to develop and practice culturally competent skills that allow them to reach out to and effectively treat African American patients. For a full discussion of what comprises “culturally and linguistically appropriate services” (CLAS) and practical strategies for implementing them, please see the first curriculum in this series, “Understanding and Implementing the CLAS Standards.” [www.thinkculturalhealth.hhs.gov]
Underuse of Services
Underuse of mental health services among African Americans remains a serious challenge to the US healthcare system, and improvement will require initiatives from healthcare professionals, both individual and organizational. Primary care practitioners need to become more skilled in identifying African American patients who are experiencing serious mental health problems or disorders so that they can either provide appropriate treatment or refer them to specialists. Mental healthcare professionals should receive education and training regarding ethnic differences in idioms of distress and techniques for overcoming patients’ feelings of mistrust—and incorporate those into their therapeutic approach. Furthermore, programs that are designed to educate the public about mental health issues should develop efforts to facilitate among African American consumers the knowledge to recognize clusters of symptoms that signal mental health problems that need to be diagnosed and treated by mental healthcare professionals. All of these efforts need to take place in the context of developing ways to increase African Americans’ use of mental healthcare services and the quality of those services. The personal, financial, familial, and social costs to African American communities and to the United States are too serious not to invest in such efforts. [Neighbors 2007]
Beyond the questions of improving African American communities’ understanding of mental health issues and of how to improve access to and use of mental health services, a greater variety than ever of service providers is available, including public or private and broad-based or specialty care. Healthcare providers, whether they are medical or mental health practitioners, should be aware of the types of places to which they can refer patients who are experiencing mental health problems. These include: [Surgeon General Supplement, 2001]
- Individual and group mental health practices come in a wide range of forms—from sole practitioners to group practices—with professional mental health services being offered by psychiatrists, psychologists, social workers, and others.
- Specialty mental health facilities—eg, mental hospitals, residential treatment facilities, and psychiatric units of general hospitals—are dedicated to providing only mental health care, with services provided by psychologists, psychiatric nurses, psychiatrists, and psychiatric social workers. Specialty facilities also include community mental health centers, day treatment programs, and rehabilitation programs.
- The human services sector consists of social welfare, criminal justice, educational, religious, and charitable agencies, which provide services in various settings, eg, at home, community organizations, and others.
- The largely community-based voluntary support networks include self-help groups and organizations devoted to education, communication, and support. These are typically informal in nature and meant to help educate patients and families, reduce feelings of isolation, and offer referrals to professional treatment.
