Posted on Sun, September 24, 2006 -- Mental illnesses hit blacks harder
They are less likely to use care, more likely in Ohio to be treated in institutions
By Katherine Spitz --Beacon Journal medical writer
Health care isn't just about heart disease and cancer and diabetes -- the ``physical'' ailments.
One in five Americans has some type of mental disorder -- defined as a
change in mood, thought or behavior, causing distress and/or problems in
day-to-day functioning.
Nationwide, mental illnesses cause a disability rate second only to
heart disease, according to a 1999 report by the U.S. Surgeon General.
For people of color, the effect of mental illness is particularly
devastating. The Surgeon General's report found that most minority
groups are less likely than whites to use mental health services and,
when people of color do get mental health help, that care is more likely
to be of poorer quality than white clients' care.
Institutionalization in Ohio
Dr. Michael Hogan, director of the Ohio Department of Mental Health, is
well aware of the disparities in mental health care. He chaired the
President's New Freedom Commission on Mental Health, a 2002-03
investigation of the nation's mental health delivery system.
Hogan said Ohio officials have been looking at discrepancies in the
delivery of mental health care since 1988. And, for more than a decade,
it has been obvious that mentally ill black Ohioans are much more likely
to be treated in institutions than their white counterparts.
Although the statewide level of institutionalization has been
decreasing, he said, the ratio of different treatment has remained the
same.
In 2005, for example, 34 percent of the Ohioans hospitalized for mental
illnesses were African-Americans, who are only about 11 percent of the
state's population.
More diagnoses of psychosis
Also, Hogan said, African-American men are more likely to be diagnosed
with a psychotic disorder such as schizophrenia rather than a mood
disorder such as depression or anxiety.
All mental disorders can be crippling, but schizophrenia is considered
the most severe. Drugs used to treat it often have considerable side
effects, and the diagnosis can carry with it a stigma.
``In my view, there's no scientific evidence of genetic differences that
explain differences in the rates of mental illness,'' Hogan said.
The Ohio Department of Mental Health recently funded an organization,
Multiethnic Advocates for Cultural Competence, that is to conduct
hearings throughout the state to get a better sense of problems in the
delivery of mental health care to minorities.
``The issues are really complicated,'' Hogan said. ``Problems persist everywhere.''
Stigma, other cultural barriers
People of color may hesitate to seek mental health care for the same
reasons their white counterparts do -- a feeling of embarrassment or
shame.
But for a person of color, that feeling of stigma can be acute, said Dr.
Angela Neal Barnett, a professor of psychology at Kent State
University. It's even worse if that person is male.
``Mental health issues are seen as weakness in males,'' Neal Barnett said. ``But being Caucasian gives you some latitude.''
There are other barriers to getting good mental health care, she said.
Minorities may exhibit different symptoms for common mental illnesses.
``Research is showing that African-American men may show they are depressed by watching TV excessively,'' Neal Barnett said.
But this isn't a symptom listed in therapists' Diagnostic and Statistical Manual, the standard for evaluating mental disorders.
Language also can be a barrier to effective treatment. Neal Barnett said
the great majority of mental-health experts are white and may not know
how a mental problem is typically referred to in a minority cultural
circle.
For instance, Neal Barnett said, if a therapist tries to evaluate
whether a client is anxious, the client, depending on his or her race
and socioeconomic status, may not understand what ``Are you anxious?''
means. But if a therapist asks, ``How are your nerves?'' the black
client might readily understand the question.
Symptoms also can occur within a cultural context and be incorrectly diagnosed.
Dr. Juanita Martin, director of the University of Akron's Counseling
Center, said many African-Americans place a high value on religion and
spirituality.
Martin said such a person could go to a therapist and say, ``I was feeling down, but God said to me.... ''
A white therapist hearing that comment might decide that the client has a diagnosable mental health problem.
``I've had people come to me with a diagnosis of thought disorder,''
Martin said, ``but the person is just thinking in terms of their
spiritual beliefs.''
SOURCE:-
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