Cultural Sensitivity Called Key Element of Quality Care

Culture counts in the diagnosis and treatment of mental illness. And culture is a critical factor in widely documented disparities in access to, and quality of, medical care for racial and ethnic minorities in the United States, said APA President Michelle Riba, M.D., in her opening address at APA's 56th Institute on Psychiatric Services last month in Atlanta.

“The culture that patients come from shapes their mental health and the type of services they use,” Riba said. “Likewise, the culture of the clinician and the service system affects diagnosis and treatment and the organization and financing of those services. Cultural differences must be accounted for to ensure that minorities, like all Americans, receive mental health care tailored to their needs.”

This year's institute, whose theme was “Mental Health Disparities in the Community,” included lectures and symposia on Hispanic-American perspectives on mental health care; race, substance abuse, and bipolar disorder; psychoanalysis and Eastern cultures; and disparities in children's mental health.

In her opening speech, Riba gave a broad overview of how disparities affect individual patient care at the community level and outlined how advances in psychosomatic medicine—a special interest of Riba's—may contribute to reducing and eliminating racial and ethnic disparities in mental health care.

She also cited specific areas in which APA, through its Department of Minority and National Affairs, is seeking to address the issue of health care disparities.

The APA president cited chronic underfunding of public health systems—in which racial and ethnic minorities disproportionately receive medical care—as one essential factor in the disparities in quality and access to care.

“Over the years, many states have faced major financial crises that are having a ripple effect on mental health services at the community level,” she said. “As states take drastic measures to control growth in Medicaid expenditures, mental health care funding becomes ever more vulnerable. Community mental health systems have grown increasingly dependent on Medicaid with more than 60 percent of monies for public mental health services funded by Medicaid.

“Since minorities are major users of public health systems, access to quality care is often encumbered by lack of quality services and lack of cultural competency in treating diverse patients.”

Riba said advances in psychosomatic medicine and the recent approval of psychosomatic medicine as a subspecialty by the Accreditation Council for Graduate Medical Education (ACGME) have positive implications for all Americans, but may prove especially helpful in reducing mental health disparities.

Many patients in the public health system suffer from both psychiatric and other types of medical problems, Riba said. “Heart disease and stroke are leading causes of death for all racial and ethnic groups, and these conditions are often compounded by depression and substance abuse.”

She cited especially the work of APA's Council on Psychosomatic Medicine in seeking support for access to care and reimbursement for treatment of psychosomatic conditions.

Finally, Riba cited areas in which advances are being made to address racial and ethnic disparities in health care, including mental health care. At the academic level, she said, the ACGME has required training programs to provide supervised experience treating patients throughout the life cycle and from diverse cultural backgrounds.

Particularly important, Riba said, is the need to increase the proportion of under-represented racial and ethnic minorities among the health professions. “We have an opportunity as a profession to make a difference through the recruitment of more minority medical students and through culturally competent education and research,” she said.

Riba also cited APA's Department of Minority and National Affairs and drew special attention to a new project in the department designed to raise the national profile of APA in efforts to reduce and eliminate health care disparities.

The department's director, Annelle Primm, M.D., will visit regions of the country that have the highest proportion of underserved minorities. “APA district branches, primary care physicians, legislators, social service providers, and others we hope will engage in discussions on mental health disparities,” Riba said.

Riba also cited new and ongoing projects by the Department of Minority and National Affairs including minority medical student and resident fellowships and internships, development of a speaker's bureau of minority psychiatrists, support for a minority research conference, support for culturally competent medical school curricula, and dissemination of a new recruitment video, titled“ Real Psychiatry: Doctors in Action,” which was previewed at the IPS meeting. (The next issue of Psychiatric News will carry a feature about the new video.) ▪