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
Mistrust
The reasons why racial and ethnic minority groups are less apt to seek help
appear to be best studied among African Americans. By comparison with whites,
African Americans are more likely to give the following reasons for not seeking
professional help in the face of depression: lack of time, fear of
hospitalization, and fear of treatment (Sussman et al., 1987). Mistrust among
African Americans may stem from their experiences of segregation, racism, and
discrimination (Primm et al., 1996; Priest, 1991). African Americans have
experienced racist slights in their contacts with the mental health system,
called “microinsults” by Pierce (1992). Some of these concerns are justified on
the basis of research, cited below, revealing clinician bias in overdiagnosis of
schizophrenia and underdiagnosis of depression among African Americans.
Lack of trust is likely to operate among other minority groups, according to
research about their attitudes toward government-operated institutions rather
than toward mental health treatment per se. This is particularly pronounced for
immigrant families with relatives who may be undocumented, and hence they are
less likely to trust authorities for fear of being reported and having the
family member deported. People from El Salvador and Argentina who have
experienced imprisonment or watched the government murder family members and
engage in other atrocities may have an especially strong mistrust of any
governmental authority (Garcia & Rodriguez, 1989). Within the Asian community,
previous refugee experiences of groups such as Vietnamese, Indochinese, and
Cambodian immigrants parallel those experienced by Salvadoran and Argentine
immigrants. They, too, experienced imprisonment, death of family members or
friends, physical abuse, and assault, as well as new stresses upon arriving in
the United States (Cook & Timberlake, 1989; Mollica, 1989).
American Indians’ past experience in this country also imparted lack of trust of
government. Those living on Indian reservations are particularly fearful of
sharing any information with white clinicians employed by the government. As
with African Americans, the historical relationship of forced control,
segregation, racism, and discrimination has affected their ability to trust a
white majority population (Herring, 1994; Thompson, 1997).
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