APA `Tour' Spreads Word On MH Disparities

Annelle Primm, M.D., M.P.H., has vowed to take “OMNA on Tour” to the “ebony towers and ivory towers of academia to the 'hoods and to the woods.”

The new program, which will educate communities about the significance of disparities in mental health and encourage them to take collaborative action, is a major effort of APA's revitalized Office of Minority and National Affairs.

Primm began work as OMNA's director in April 2004.

The power of collaboration in action was evident at the program's first stop on January 22.

The American Association of Community Psychiatrists (AACP), the Howard University Hospital department of psychiatry, and the Washington Psychiatric Society joined OMNA in sponsoring the meeting. AACP was celebrating its 20th anniversary.

The conference, AACP's winter conference as well as OMNA on Tour's launch, was called, “Strengthening Collaboration and Advocacy to Achieve Mental Health Equity and OMNA on Tour.”

Howard University, a historically black, private university, hosted the meeting.

William Lawson, M.D., Ph.D., chair of the department of psychiatry at Howard University College of Medicine, reminded the group about the commonalities between the goals of community psychiatry and those of his department to improve health care for “marginalized” people.

Primm, who called herself a “proud graduate of Howard University College of Medicine,” described OMNA's mission and major activities (see box).

She offered a definition of health care disparities and a survey of recent research and other findings concerning their effect.

Racial and ethnic disparities in terms of access to health care exist independently of a person's socioeconomic class, Primm said.

Those disparities lead to higher morbidity and mortality from leading causes of death such as diabetes and cardiovascular disease.

In terms of mental health, she cited findings from “Mental Health: Culture, Race, and Ethnicity,” a report issued in 2001 by David Satcher, M.D., when he was the U.S. surgeon general. Members of minority groups receive poorer quality of care, are less likely to receive services, and are underrepresented in mental health research.

The result is a vicious cycle in which socioeconomic problems and mental illness, sometimes including substance abuse, interact to result in violence, incarceration, and poor physical health. Those three factors then exacerbate the original problems.

Primm said, “The timing is great for OMNA on Tour.” The effort brings together many issues and recommendations that recently have received national visibility.

The New Freedom Commission on Mental Health, for example, recommended that states address disparities as part of their comprehensive mental health plans and promote the inclusion of people with diverse cultural backgrounds in the mental health workforce.

The Substance Abuse and Mental Health Services Administration (SAMHSA) issued a priorities matrix for 2003 that identified “cultural competence/eliminating disparities” as a cross-cutting principle that applies to all its work.

Primm told the audience that there are many successful models for addressing disparities that “no one knows about.”

The Institute for Mental Health Ministry through its PRAISE project, for example, brings together the faith community and mental health professionals. The institute, located in Baltimore and directed by psychiatrist Michael Torres, M.D., offers a variety of educational, consultative, and clinical services.

The Clinical Research Investigator Support Program, developed and adminstered by BDH Clinical Research Services Inc., is a nationwide network of minority physicians whose mission is to increase minority participation in clinical research. It has supported an array of clinical trials with racial and ethnic minorities (physicians and patients) in depression, schizophrenia, bipolar disorder, diabetes, and many other medical conditions.

The video “Black and Blue: Depression in the African-American Community,” which Primm developed, features first-person accounts of African Americans who have dealt with depression and the associated stigma.

Disseminating information about models that work is an important goal of OMNA on Tour.

In January, the daylong launch of OMNA on Tour offered five panel sessions that together provided a comprehensive picture of problems resulting from inequities and strategies for addressing them.

Primm said that the topics and presentations represented a smorgasbord from which communities hosting OMNA on Tour could select. The variety in the presentations also suggested the complexities of the issues related to disparities.

Several speakers mentioned that the United States is becoming a country in which the majority of its citizens will be members of minority groups. They argued for a sophisticated view of cultural competence that takes into account the multiplicity of ethnic groups and nationalities.

Stephen Goldfinger, M.D., said, “Diversity in all too many places means black and white.” Brooklyn, where he is interim chair of the department of psychiatry at the State University of New York Downstate Medical Center, has the largest population of Russians outside Russia and the largest population of Haitians outside Haiti. “That's true of 13 ethnic groups in Brooklyn,” he said.

Andres Pumariega, M.D., described research that demonstrates the effectiveness of culturally specific interventions.

“We must revisit the cultural competence model for specific populations,” said Pumariega, director of child and adolescent psychiatry at East Tennessee State University.

Jacqueline Feldman, M.D., linked access to mental health services to the idea that patients and physicians might have different ideas about what constitutes recovery. She asked patients at the University of Alabama at Birmingham community mental health center how they defined recovery.

“It's not just not hearing voices. None said `I want my voices to go away,' ” said Feldman. “Instead, they want the same things we do.”

Satya Chandragiri, M.D., medical director of the Eastern Oregon Psychiatric Center, described how he promoted the recovery model at a psychiatric hospital by taking “small steps” that encouraged patients' independence.

Several speakers took a broad view of the problem of disparities and advocated for major health care and social reforms. Fred Osher, M.D., is director of the Center for Behavioral Health, Justice, and Public Policy at the University of Maryland School of Medicine. He opened his presentation by saying that it is a “shame and tragedy” that more than 44 million Americans lack health insurance. He pointed out that members of minority groups are more likely to be uninsured (see chart on page 13). He urged“ universal health care” and asked, “Who do we partner with to get it?”

Kenneth Thompson, M.D., said, “Provision of health care is a tiny, tiny piece of what makes people healthy.” He urged psychiatrists to consider ways that social development policies affect health and to learn how to create political will. Thompson is an associate professor of psychiatry at the University of Pittsburgh.

Anita Everett, M.D., senior medical adviser at SAMHSA, said that effective advocacy requires understanding how legislators see their mission. “They all may not feel a need to be altruistic, but they will agree on the duty to create equal opportunity. Paint a picture of how addressing disparities creates a level playing field.”

Each stop of OMNA on Tour will include presentations about local issues. Martha Knisley, commissioner of the Washington, D.C., Department of Mental Health, told the audience about the challenges of building a community mental health system after D.C. residents gained the right to elect their city officials.

“It's a tough system to work in,” she said. “We've tried to learn from the mistakes of others and use the best practices we could find.”

Primm urged audience members to spread the word about the availability of OMNA on Tour presentations. Stops now are planned for Philadelphia and Memphis.

More information about OMNA on Tour is available by e-mailing Primm at [email protected].▪