Commentary: APA's Efforts to Eliminate Disparities

In 2004 OMNA established an aggressive agenda to eliminate mental health disparities in keeping with the steering committee recommendations and the APA strategic plan. The agenda has three major goals: to establish APA as the leader in efforts to eliminate mental health disparities among underserved groups and to ensure high-quality mental health care for all Americans; to increase diversity in psychiatry; and to increase understanding and delivery of culturally appropriate care to diverse populations. To accomplish these goals, OMNA has undertaken and expanded upon a number of initiatives that have direct impact on eliminating disparities. OMNA offers fellowships and mentoring to help psychiatric residents become future leaders in the provision of culturally competent mental health and substance abuse care and to undertake research on diverse populations. OMNA provides travel scholarships and summer internships in psychiatry to medical students from diverse backgrounds.

In 2004 OMNA produced and disseminated a videotape called "Real Psychiatry: Doctors in Action," which features four psychiatrists from diverse backgrounds in their work and family life to entice young people to consider careers in psychiatry.

OMNA has worked with Francis G. Lu, M.D., to disseminate information about standards that address cultural competence in psychiatry for medical student education. For example, APA's liaison committee on medical education has taken a leadership role by including explicit discussion of health care disparities, cultural competence, and diversity in its accreditation standards. Such standards provide guidance for decision making, admissions criteria, curriculum development, and other actions that will help to foster the development of a culturally diverse and culturally aware health care workforce. Faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. To promote this understanding all instruction must stress the need for students to be concerned with the total medical needs of their patients and the effects that social and cultural circumstances have on their health. To demonstrate compliance with this standard, schools should be able to document objectives related to the development of skills in cultural competence, indicate where in the curriculum students are exposed to such material, and demonstrate the extent to which the objectives are being achieved

In January 2005, OMNA staff, along with members of the Washington Psychiatric Society and the American Association of Community Psychiatrists, convened the first "OMNA on Tour" event in Washington, D.C., at Howard University Hospital. The event brought together people from various ethnicities, disciplines, and stakeholder groups—including psychiatrists, primary care physicians, consumers, substance abuse treatment providers, social service providers, legislators, policy makers, faith community leaders, representatives of governmental agencies, and employers—to discuss mental health disparities and how they are manifested in Washington, D.C., and to hear about models that show promise in addressing unmet mental health needs in diverse, underserved populations.

One of the models showcased was the Institute for Mental Health Ministry (IMHM), based in Baltimore and led by Michael Torres, M.D., an APA member and an ordained minister. IMHM helps to reduce stigma and increase psychiatric help seeking by combining mental health care with spiritual concepts. Many individuals from various cultures and faiths feel more comfortable seeking mental health care when it is informed by spiritual principles.

A goal of "OMNA on Tour" is to foster collaboration among various stakeholder groups, including psychiatrists, to take action against mental health disparities in an effort to improve overall health, well-being, and quality of life in diverse communities. More information about "OMNA on Tour" and about the models highlighted at the conference is available from the second author at [email protected].

This summary description of APA's efforts toward the goal of ending disparities is not intended to push aside criticisms of the profession or of APA. However, it is clear that these efforts are not enough and that more work needs to be done to achieve this critical goal.

Dr. Ruiz, who is president-elect of the American Psychiatric Association (APA), is professor and vice-chair in the department of psychiatry and behavioral sciences of the University of Texas Medical School, 1300 Moursund Street, Houston, Texas 77030 (e-mail, [email protected]). Dr. Primm is director of APA's department of minority and national affairs.