Disparities in Psychiatric Care: Clinical and Cross-Cultural Perspectives

The book Disparities in Psychiatric Care, edited by Pedro Ruiz and Annelle Primm, addresses the changes needed in the U.S. mental health system, including universal health care, full coverage and parity of mental health care with general medical care, improved quality of care, and more humane care. Dr. Ruiz is professor and interim chair of the Department of Psychiatry and Behavioral Services, University of Texas Medical School at Houston. The idea for this book evolved from Dr. Ruiz's efforts during his 2006–2007 tenure as President of the American Psychiatric Association (APA). Dr. Primm is deputy medical director and director of APA's Office of Minority and National Affairs. The book will inspire residents, medical students, physicians, administrators, researchers, and policy makers to take immediate action to improve mental health care services for vulnerable populations.

The first two chapters address the importance of understanding the social and cultural context of individuals at every level of the service delivery system. Such understanding is the foundation for eliminating disparities in the American mental health system. The next 19 chapters provide a thorough overview of the complexities in understanding disparities in access to and quality of general mental health care of vulnerable populations (such as ethnic minority groups, the lesbian-gay-bisexual-transgender communities, immigrant and refugee groups, and addicted populations). These chapters demonstrate how psychiatric care for persons from racial and ethnic minority groups varies according to within- and between-group differences, including in gender, race, income, sexual orientation, linguistic barriers, and stigma.

The authors conclude that in considering treatment for various groups, it is necessary to understand their biological as well and their social vulnerabilities, including poor communication in clinical therapeutic situations, linguistic barriers, poverty, discrimination, and racism. In support, Primm and William B. Lawson state in one of the chapters that "much of the recent psychiatric research has focused on identifying [a] genetic basis of mental disorders. Identifying risk genes for mental disorders does not preclude extragenetic factors."

The next 12 chapters identify strategies to eliminate disparities in psychiatric care, including placing mental health on the public health priority agenda, developing culturally sensitive evaluations and therapeutic alliances, achieving cultural competence in quality assurance measures, conducting research in the integration of psychiatric and primary care, analyzing the financial impact of managed care, using complementary and alternative medicine, recognizing the role of religion and spirituality in healing and recovery, and conducting additional cost-effectiveness studies.

Ruiz and Primm conclude with an urgent call for social action to eliminate disparities for the sake of all Americans: "The status quo is no longer viable. The current health/mental health care system of the country borders on being unethical." Similarly, contributors Robert Bransfield and Douglas Bransfield state, "Mental health parity is an equalization of mental health benefits and is an ethnic commitment to enhancing humane values, while lack of parity is an exploitation of human vulnerability that erodes our stature as a compassionate society with humanitarian priorities."