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Health Care Disparities and Health Care Policy PaperEthnic and Racial Disparities in Mental HealthBarbara LentzFerris State UniversityEthnic and Racial Disparities in Mental Health PolicyAccording to the National Institute on Minority Health and Health Disparities (NIMHD) (2010), racial and ethnic minorities are the fastest growing communities in the United States today. However, ethnic and racial minority populations remain underserved in the mental health care system (Primm et al., 2010). According to the Center for Disease Control and Prevention (CDC) (2011), minorities are more likely to experience a mental disorder than their white counterparts, and are less likely to seek treatment. “The 2001 U.S. Surgeon General’s supplemental report : Mental Health: Culture, Race, and Ethnicity, clearly articulated that mental health disparities exist within the African American, Asian American, Pacific Islander, Hispanic/Latinos, Native American, and Alaska Native populations” (U.S. Department of Health and Human Services, 2001).Racial and ethnic minorities experience disparities in mental health treatment in both access to, and quality of mental health care. Many minorities encounter inadequate detection of psychiatric conditions by their primary care giver which leads to underreferral of these patients to psychiatric care. Common assessment tools are known to be culturally biased in their criteria, for example: African Americans often score higher in the mistrust and paranoia measurements, which results in a misdiagnosis of a mental illness (Atdjian, & Vega, 2005). “Racism and discrimination are stressful events that adversely affect health and mental health. They place minorities at risk for mental disorders such as depression and anxiety” (U.S. Department of Health and Human Services, 2001). Physical diseases are another mental health disparity that this population faces. Many physical illness are linked to mental disorders including obesity, diabetes, cancer, cardiovascular diseases, human immunodeficiency virus (HIV), hepatitis, sexual dysfunction, musculoskeletal, and pain disorders ( De Hert et al., 2011). Lastly, there is a need for more knowledge on the effective use of medications with patients from racial and ethnic minorities about the differences in metabolism of medications, and the issues related to medication adherence (Atdjian & Vegas, 2005).Social determinants to mental health disparities in ethnic and racial populations are income, housing, education, access to resources, and incarceration (Primm et al., 2010). “Racial/ethnic minorities are overrepresented among people who live in poverty, are homeless, or incarcerated” (Primm et al., 2010 p.4). Thirty-four percent of the ethnic population did not finish school and many have English as a second language so language barriers play a role in these disparities also (Atdjian & Vegas, 2005. p.12). According to Primm et al., (2010), racial and ethnic populations make up 57% of the incarcerated populations and more than half have a recent history of mental illness (p. 4). Minorities have less access to mental health services due in part to lack of health insurance or health insurance that does not have mental health coverage. The rate of uninsured minorities in America is about 37% which is twice that for whites (U.S Department of Health and Human Services 2001). Policies that address these social determinants can therefore address the mental health disparities in minorities.Some policies that have influenced these disparities were created by numerous federally funded public polices and state laws mandating mental health benefits. The mental health “parity” act prohibits insurance or health care service plans from discriminating between coverage offered for mental health as compared to other physical illnesses (National Conference of State Legislature, 2011). Unfortunately, this law only applies to insurance companies that offer mental health coverage. It does not require insurance companies to have to provide coverage. Section 8 housing assistance program is determined by Congressional funding and is offered by vouchers that low income people can apply to up to 30% of their rent to enable people to find housing and possibly out of poverty stricken areas (Alegria, M., Perez, D., & Williams, S., 2003). The impact of this policy on mental health disparities is promising but there has been draw backs concerning the lack of children’s integration within the new neighborhood schools, and the lack of social connection in the new community (Alegria et al., 2003).The Individual with Disabilities Education Act (IDEA) required that schools provide educational programs for all children with disabilities, including those with emotional or behavioral disorders (Alegria et al., 2003). “Under IDEA, children with disabilities are entitled to free, appropriate public education in the least restrictive environment, and transition services must be available to improve their lives after finishing schooling” (Alegria et al.,2003,p.57). According to Alegria et al., (2003). African American and Latinos are disproportionably represented in special education and in special classrooms for emotional and behavioral disorders (p.57). The number of students with disabilities graduating from school with disabilities is 57.4% compared to the 71.3% rate for the total student population which is one indicator of the success of the program (Alegria et al., 2003, p.58). The only problem with this is that the employment outcome for minority students with disabilities is remarkably lower than whites (Alegria et al., 2003).Minorities are more likely to be poor. “The Earned Income Tax Credit is a policy intended to reduce the impact of poverty among low income families” (Alegria et al., 2003, p. 59). It is a tax credit that subsidizes low wage workers allowing them to receive money from the government if the credit is greater than tax obligations. Use of this tax credit has helped improve economic and social mobility by enabling families to make ends meet. However, lack of information about the program and education on how to obtain and fill out the required forms have been common barriers to the effectiveness of the program (Alegria et al., 2003).There are other contributing factors besides the social determinants which include social stigma, lack of compliance with treatment, and cultural barriers (CDC, 2011). Different cultures have different expectations of their members for example: the Asian culture is typically a hierarchy rule defined by obligation and duty with the man in the dominate role and African American men deal with the “strong black man” expectation of their culture. This outlook makes it difficult for them to admit to having a mental illness and causes them to be less likely to seek treatment. The cultural biases of those in power as well as the mental health care providers can influence the mental health status of this population by trusting their stereotypical beliefs. Many people believe that a certain populations are typically dishonest, lazy, uneducated, prone to violence, or criminals. These misconceptions can lead to feelings that these populations don’t deserve help. Also, if these populations do portray these kinds of behaviors a diagnosis of a mental illness is not the conclusion, when it could be the contributing factor. To eliminate these disparities, treatments need to be tailored to age, gender, race, and culture. Mental health service providers and those in power need to check their biases at the door, and treat everyone equally. Finally, reduction of financial barriers to treatment will reduce mental health disparities, as well as all health disparities. A wonderful vision for the future.ReferencesAlegria, M., Perez, D., & Williams, S. (2003). The role of public polices in reducing mental health disparities for people of color. Health Affairs, 22(5), 51-64 doi:10.1377/hlthaff.22.5.51Adrian, S., Vega, W.A. (2005). Disparities in mental health treatment in U.S. racial and ethnic minority groups: implications for psychiatrists. Psychiatric Services, Retrieved from for Disease Control and Prevention (2011), Eliminate disparities in mental health, retrieved from Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D., Asai, I., et al. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry, 10(1), 52–77. Retrieved from Conference of State Legislature (2011) Mental health benefits: state laws mandating or regulating Retrieved from Institute on Minority and Health Disparities (2010), Health disparities and mental health fact sheet, retrieved from , A. B., Vasquez, M. J. T., Mays, R. A., Sammons-Posey, D., McKnight-Eily, L. R., Presley-Cantrell, L. R., et al. (2010). The role of public health in addressing racial and ethnic disparities in mental health and mental illness. Prev Chronic Dis, 7(1), A20. Retrieved from . Department of Health and Human Services (2001), Culture, race and ethnicity, A Supplement to Mental Health, a Report of the Surgeon General, U.S. Department of Health and Human Services, Washington D.C. Retrieved from ................
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