In the Public Interest

On Feb. 6, the health and mental health communities were invited to a reception at the Natcher Conference Center at the National Institutes of Health campus in Bethesda, Md., to say their goodbyes to Dr. David Satcher, U.S. Surgeon General, as he was leaving after four years of extraordinary work.

Those of us in attendance from APA (Drs. Ray Fowler, Cynthia Belar, Ellen Garrison and I) were particularly pleased to be invited because Dr. Satcher and his staff worked very closely with the association on a variety of health and mental health issues. The reception was well-attended and the occasion was upbeat--the nation had gained so much from this surgeon general during his four years in office, but the mental health community had perhaps gained the most.

During Dr. Satcher's tenure, his office published 13 reports, and a 14th on mental retardation was in press when he left office on Feb. 13. The reports covered a wide range of topics: suicide prevention, smoking among ethnic minorities, youth violence, responsible sexual behavior, obesity, and women and smoking. Behavioral issues figure prominently in the interventions and call for additional research by social and behavioral scientists in further understanding of them.

However, my favorite reports are those that dealt with mental health: Mental Health: A Report of the Surgeon General and Mental Health: Culture, Race and Ethnicity. The report on mental health was the first ever on the topic by the Surgeon General's Office, which since 1964 had published 48 reports, 31 of them on smoking and related issues. It was truly a landmark report, breaking new ground and elevating mental health issues into the realm of public health.

Among other things, the report indicated to the nation that mental health and concerns about it were endemic to the nation and that there were effective, accessible, evidence-based treatments available. However, it was also noted that stigma and shame continue to operate as barriers, effectively keeping people away from the care provided by psychologists and other mental health providers.

The supplement to the mental health report, released last year, on culture, race and ethnicity was even more of a landmark. What put it on my favorites list in addition to its treatment of these sensitive issues, was that psychologists (Drs. Steven Lopez, Lonnie Snowden and Stanley Sue) served as science editors and Dr. Jeanne Miranda as senior science editor for the volume. Whereas the mental health report probably was more informative for the public than for the mental health community, Mental Health: Culture, Race and Ethnicity provided a learning experience for the public and professionals alike. The idea that "culture counts" is a strong message to all of us as more and more African Americans, Asian Americans, Hispanic Americans and American Indians avail themselves of care for mental and emotional disorders. Among these groups, stigma and shame also operate to limit entry into care and these barriers are exacerbated by the failure of large segments of the mental health community to provide competent care and the small numbers of ethnic minority providers available to assist.

Of course, we were pleased when the Surgeon General's Office called and asked if it was possible for the supplemental report to be released nationally at the APA Convention in San Francisco. We agreed to do it, filled a room to standing-room-only, and our members were the first to hear the surgeon general present this remarkable report using time and time again the phrase "culture counts."

Soon there will be another person serving as surgeon general, it is hoped that he or she will build on Dr. Satcher's initiatives. This, of course, brings to mind a saying that I will paraphrase slightly, "Someone will be selected to do the job, but no one will be able to take his place." The first African-American man to serve as surgeon general was not just a caretaker. He forged new ground, generated new ideas, and left his mark on the office. Perhaps this is just one more indication that "culture counts."