Among the many barriers to appropriate treatment that people with mental illness must negotiate, those arising from cultural differences can make a profound difference in the quality of care a person receives. To supplement the groundbreaking 1999 report on mental health, the U.S. Surgeon General in 2001 issued Mental Health: Culture, Race, and Ethnicity, in which the disparities in mental health treatment are documented and discussed. The main message of the supplemental report is: "culture counts." It states, "The cultures that patients come from shape their mental health and affect the kinds of mental health services they use. Likewise, the cultures of the clinician and the service system affect diagnosis, treatment, and the organization and financing of services. Cultural and social influences are not the only influences on mental health and service delivery, but they have been historically underestimated - and they do count. Cultural differences must be accounted for to ensure that minorities, like all Americans, receive mental healthcare tailored to their needs." ^[1]   Failure to provide mental health services in a culturally sensitive context almost certainly results in higher numbers of people with mental illness from racial, cultural, and ethnic minorities in our nation's jails and prisons.

The Surgeon General's supplemental report collects many of the studies that have demonstrated both the particular needs of different cultural and ethnic groups, and the availability, utilization, and effectiveness of mental health services for the different groups. It is clear that African Americans, Native Americans and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanic Americans may all present symptoms of distress or mental illness according to certain idioms of distress that are particular to their cultures. Members of each of these groups may also be more likely to seek and accept alternative therapies than are their white counterparts. In many cases, these alternative therapies are seen as much more acceptable or consistent with cultural norms than the dominant modes of treatment practiced in the mental health system might be. Within each of these broad groups there exist narrower cultural subgroups, making it difficult for outsiders to approach a person showing symptoms of mental illness with any certainty about how offers of treatment, for example, will be understood or accepted.

There is a great deal of data that demonstrate the unevenness with which mental illness falls on members of the cultural minority groups. The public system has, to date, been guilty of undertreatment of some mental illnesses in some cultures and what might be called overtreatment of others. The thrust of the Surgeon General's supplemental report and of much that has been published about mental health care for members of different cultures is that policymakers and practitioners must take the time to understand mental illness and treatment in cultural terms so that suffering within various cultural groups that goes either undetected or improperly treated can be abated.

Recommendations:

a.

Recruit members of minority communities for clinical and administrative positions in which there is regular client contact.

b.

Provide training in cultural issues to all staff members in contact with clients.

c.

Develop targeted outreach programs to make services available to members of minority communities.