[NYAPRS Enews] Study: African Americans Find MH Assessments, Treatments Inadequate

[Harvey Rosenthal]

Mental Health Services Concern African Americans, Study Says

By Bernice Yeung  CaliforniaWatch.org July 17, 2012  

 

African Americans across the state have concerns that their mental
health assessment and diagnoses are inadequate, according to a
state-commissioned report
<http://www.aahi-sbc.org/Afi-Am_Population_Report_.php>  issued today.

These inaccurate psychiatric assessments are a "part of the problem that
leads to disparate outcomes," the report said.

"People felt like they did not have a good assessment (from their
provider) to understand what their particular issues are," said V. Diane
Woods,the founding president of the African American Health Institute of
San Bernardino County and primary author of the study. "And if you are
not getting a good assessment, you are not getting a good plan or care,
and it increases the probability that you will be placed on the wrong
medication."

This is an issue of concern for mental health professionals nationwide.

"Due to lack of cultural understanding, some clinicians may misdiagnose
African American patients," Annelle Primm, the American Psychiatric
Association's deputy medical director and director of its Office of
Minority and National Affairs, wrote in an email. "For instance, it is
well documented in the literature that African Americans have been
overdiagnosed with schizophrenia and underdiagnosed with illnesses like
major depression and bipolar disorder. Expressing 'healthy paranoia,'
regarded as a survival skill among African Americans, may prompt an
uninformed clinician unfamiliar with African American culture to
consider this as a symptom of schizophrenia or psychosis."

Based on 35 focus groups, 45 individual interviews, 635 surveys, and 10
public forums and meetings with residents and mental health
professionals from across the state, the report aimed to provide a more
complete picture of the African American community's experience with the
state's mental and behavioral health system, Woods said.

"Black people across the state wanted the population report to 'tell the
entire story' so others could understand the lived experiences with and
related to mental health issues," said Woods, who is also an assistant
research psychologist at UC Riverside.

Among the barriers to accessing mental health care described by study
participants is a lack of culturally proficient practitioners and
providers.

"I should have been in counseling a long time ago,'' Helen B. Rucker, a
Monterey County resident who is African American, told researchers.  "I
wish I had access to talk to someone about how I feel. But, there has
never been anyone I could talk to who understood what I was going
through."

Karen D. Lincoln, an associate professor of social work at the
University of Southern California, said that this dynamic can contribute
to disparities in treatment and diagnosis. "There is a white norm around
symptom presentation," Lincoln wrote in an email. "If you aren't looking
for the right symptoms or if the language being used to describe the
symptoms is unfamiliar to you, you can have disparities in diagnosis."

Community distrust is another barrier to accessing mental health care,
said Thomas A. Parham, a past president of the National Association of
Black Psychologists. 

"Historically, what has happened is African Americans are given more
institutionalization and drugs as the treatment of choice as opposed to
therapy," said Parham, who also serves as vice chancellor for student
affairs and an adjunct faculty member at UC Irvine. "You tend to have
misdiagnosis because clinicians are not culturally competent. It
diminishes confidence in the mental health system. It's not all a
function of the mental health system being unavailable; people also make
deliberate decisions not to access it because they don't trust them."

San Francisco's Paris Jonell Warr, 29, told researchers, for example,
that "I personally need help, and I have been trying to get it from the
mental health department. With my problem I've had since I was a child,
I went to a therapist; all he did was give me medication. I need to have
a good assessment of the problem. I am not getting the help I need."   

The researchers also examined some of the government funding streams
directed toward culturally tailored mental health programs for African
Americans in California. Last year they reviewed the prevention and
early intervention plans
<http://mhsoac.ca.gov/Counties/PEI/Prevention-and-Early-Intervention.asp
x>  submitted by each county through the 2004 Mental Health Services Act
<http://www.dmh.ca.gov/Prop_63/mhsa/> , which created a 1 percent tax on
millionaires to expand community-based services.

Because a disproportionate number of African Americans go to the
emergency room or are hospitalized for mental health conditions, access
to prevention and early intervention are especially relevant to this
population, said the American Psychiatric Association's Primm.

"When African Americans with unmet mental health needs don't have access
to appropriate services early enough and wait until they reach the
crisis point we have missed a window of opportunity and risk a poor
prognosis and outcome," Primm wrote in an email. "The margin of error
among African Americans is very narrow due to contextual factors such as
the social determinants of health and mental health: disproportionate
poverty and economically distressed communities, racism, mass
incarceration. ..."

Although many county plans mentioned African Americans as priority
populations, and Los Angeles and Alameda counties funded studies related
to African Americans, only four - Butte, San Bernardino, Riverside and
Monterey - counties outlined a plan to use Mental Health Services Act
funds for prevention and early intervention programs tailored to African
Americans.

The study describes programs tailored for African American as those that
"are designed specifically for the population utilizing principles and
concepts tested in scientific research and presented in peer-reviewed
literature." 

But some county officials said that they had since added tailored
programs. Sacramento County, which has one of the highest African
American populations in the state, has provided $135,000 in Mental
Health Services Act funding to a tailored suicide prevention program
this fiscal year; the program will receive an additional $100,000 in
these state dollars next fiscal year.

Toni Tullys, the quality management director of the Alameda County
Behavioral Health Care Services added that the prevention and early
intervention plans are one - but not the only - measure of a county's
commitment to addressing the mental health needs of African Americans.

Tullys said that in Alameda County, Mental Health Services Act
prevention and intervention funds are spent on underserved populations
and other programs. Because African Americans participate in mental
health services at high rates there, the county instead uses a different
stream of money from the Mental Health Services Act to offer $1.7
million in grants to innovative community organizations working with
African Americans clients and families.

The report also includes case studies of community programs that appear
to be effective, such as Monterey County's Village Project, which offers
culturally competent preventive, early intervention and clinical
services.

"These are tangible, realistic and viable responses," Woods said. "What
we are calling for is accountability across the state, that they no
longer have to work in the dark. They can't say that they don't know
what works with ethnic populations (when it comes to prevention and
early intervention)."

In addition to directing more funding to community-based mental health
organizations, the report recommends that the state support more data
gathering on minority mental health utilization and outcomes, and
analyze mental health screening tools used on African Americans, among
other suggestions.

The study on African Americans mental health disparities is one of five
state-commissioned demographic-specific studies conducted as part of the
California Reducing Disparities Project
<http://www.dmh.ca.gov/Multicultural_Services/CRDP.asp> , and these
reports will be compiled into a statewide strategic plan that will
inform how the state will spend $60 million in funds earmarked to
address mental health disparities.

http://californiawatch.org/dailyreport/mental-health-services-concern-af
rican-americans-study-says-17080

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