Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Cultural Diversity and Mental Health Services
The U.S. mental health system is not well equipped to meet the
needs of racial and ethnic minority populations. Racial and ethnic minority
groups are generally considered to be underserved by the mental health services
system (Neighbors et al., 1992; Takeuchi & Uehara, 1996; Center for Mental
Health Services [CMHS], 1998). A constellation of barriers deters ethnic and
racial minority group members from seeking treatment, and if individual members
of groups succeed in accessing services, their treatment may be inappropriate to
meet their needs.
Awareness of the problem dates back to the 1960s and 1970s, with the rise of the
civil rights and community mental health movements (Rogler et al., 1987) and
with successive waves of immigration from Central America, the Caribbean, and
Asia (Takeuchi & Uehara, 1996). These historical forces spurred greater
recognition of the problems that minority groups confront in relation to mental
health services.
Research documents that many members of minority groups fear, or feel ill at
ease with, the mental health system (Lin et al., 1982; Sussman et al., 1987;
Scheffler & Miller, 1991). These groups experience it as the product of white,
European culture, shaped by research primarily on white, European populations.
They may find only clinicians who represent a white middle-class orientation,
with its cultural values and beliefs, as well as its biases, misconceptions, and
stereotypes of other cultures.
Research and clinical practice have propelled advocates and mental health
professionals to press for “linguistically and culturally competent services” to
improve utilization and effectiveness of treatment for different cultures.
Culturally competent services incorporate respect for and understanding of,
ethnic and racial groups, as well as their histories, traditions, beliefs, and
value systems (CMHS, 1998). Without culturally competent services, the failure
to serve racial and ethnic minority groups adequately is expected to worsen,
given the huge demographic growth in these populations predicted over the next
decades (Takeuchi & Uehara, 1996; CMHS, 1998; Snowden, 1999).
This section of the chapter amplifies these major conclusions. It explains the
confluence of clinical, cultural, organizational, and financial reasons for
minority groups being underserved by the mental health system. The first task,
however, is to explain which ethnic and racial groups constitute underserved
populations, to describe their changing demographics, and to define the term
“culture” and its consequences for the mental health system.
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