The poor mental health care of Asian Americans.

In August of 2001, Surgeon General David Satcher issued a landmark reporton mental health services for racial and ethnicminorities.1 Itshowed striking disparities in mental health care for these groups—lessaccess, availability, use, and poorer quality — that impose a greaterdisability burden on minorities. Specifically, Asian Americans and PacificIslanders have the lowest rate of mental health care use among the minoritypopulations, regardless of gender, age, and geographic location. Whatsolutions did Satcher propose? One of his six recommendations involved improving access to treatment. Oneof the methods suggested to improve access was integrating mental health andprimary care. This could be accomplished in two ways: first, by strengtheningthe capacity of primary care physicians to provide mental health servicesdirectly, and second, by encouraging the integration of primary care andmental health services. The rationale was to respond to the preference of someminorities to receive mental health care in the primary care setting. Reasonsfor this preference include the stigma and shame of mental illness and thefact that many patients would not seek specialist mental health servicesbecause they do not view their problems as psychiatric in nature. It is particularly important for primary care physicians to be alert tothese problems Primary care physicians see large numbers of patients with psychiatricsymptoms and disorders. Like psychiatrists, they prescribe psychotropicmedications. Given the especially low use of mental health services by AsianAmericans and Pacific Islanders, it is particularly important for primary carephysicians to be alert to these problems and disorders among patients fromthese populations. Knowing how to interview, assess, diagnose, and treat psychiatric symptomsand disorders can be challenging when caring for patients from culturallydiverse backgrounds, both similar to and different from the provider's. Thearticles in this issue of wjm give primary care physicians specifictools and methods to approach these tasks with Asian Americans and PacificIslanders in a culturally sensitive and responsive manner. The material isconsistent with and grows out of recent work in cultural psychiatry asembodied in the DSM-IV Outline for CulturalFormulation.2 The Institute of Medicine March 2002 report, Unequal Treatment:Confronting Racial and Ethnic Disparities in HealthCare,3reiterated for health care in general the same conclusions the Surgeon Generalmade for mental health: significant disparities exist in the quality of healthcare between racial and ethnic minorities and non-minorities. Analysis of theclinical encounter yielded evidence that stereotypes, bias, and uncertainty onthe part of the provider are important factors, among many other clinical andsystem factors, that contributed to these disparities. One recommendationcited in the report was to integrate cross-cultural education into thetraining of all current and future health professionals. Hopefully, this issue of wjm will help to educate healthprofessionals and so reduce racial disparities in mental health care andimprove health care in general for Asian Americans and Pacific Islanders.