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
Improving Treatment for Minority Groups
The previous paragraphs have documented underutilization of treatment, less
help-seeking behavior, inappropriate diagnosis, and other problems that have
beset racial and ethnic minority groups with respect to mental health treatment.
This kind of evidence has fueled the widespread perception of mental health
treatment as being uninviting, inappropriate, or not as effective for minority
groups as for whites. The Schizophrenia Patient Outcome Research Team
demonstrated that African Americans were less likely than others to have
received treatment that conformed to recommended practices (Lehman & Steinwachs,
1998). Inferior treatment outcomes are widely assumed but are difficult to
prove, especially because of sampling, questionnaire, and other design issues,
as well as problems in studying patients who drop out of treatment after one
session or who otherwise terminate prematurely. In a classic study, 50 percent
of Asian Americans versus 30 percent of whites dropped out of treatment early
(Sue & McKinney, 1975). However, the disparity in dropout rates may have abated
more recently (O’Sullivan et al., 1989; Snowden et al., 1989). One of the few
studies of clinical outcomes, a pre- versus post-treatment study, found that
African Americans fared more poorly than did other minority groups treated as
outpatients in the Los Angeles area (Sue et al., 1991). Earlier studies from the
1970s and 1980s had given inconsistent results (Sue et al., 1991).
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