Cover Story

This fall, U.S. Surgeon General David Satcher will build on the success of last year's highly publicized report on mental health by issuing another chapter, this time highlighting the ethnic, racial and cultural aspects of mental health, he announced at APA's 2000 Annual Convention in Washington, D.C., Aug. 4­8.

"Issues related to culture and language and interpersonal relationships are very important in mental health," said Satcher, who spoke at the closing session of the Public Interest Miniconvention on Valuing Diversity. "We need a system that reflects diversity and creates an environment where people are trusted enough to seek care as early as possible."

Trust in the health-care system--one in which minority health-care providers are low in numbers--is one of several barriers that keep minorities from seeking health care, Satcher said.

"It's very clear that an environment of insecurity and distrust--which affects minorities whether they've had experiences like the Tuskegee study or they're just insecure about their plight in this country--makes it less likely [that they] will admit they have a mental heath problem," Satcher told a standing-room-only crowd.

A lack of insurance is also a formidable barrier to racial and ethnic minorities receiving mental health care, Satcher said.

"We spend $1.3 trillion on health care, yet we have almost 45 million people who are uninsured and many are ethnic minorities," he said.

One in three Hispanics and one in four African-Americans are uninsured, he noted. Further, African- Americans and Hispanics make up 25 percent of the U.S. population, yet 70 percent of the people living in underserved communities are African-American and Hispanic. People who live in underserved communities are less likely to have a primary-care physician who could diagnoses a mental health problem early, he said.

The stigma of mental illness also prevents some minorities from seeking help. One way to overcome that stigma, said Satcher, is to educate people about the nature of the disease and help them see they're not alone. One in five Americans suffers from some form of mental illness each year, he said. Americans also need to understand that if mental illness is diagnosed early, it can be treated and, much like early diagnosis of cancer, treatment saves lives.

To help overcome these barriers, the Surgeon General noted he wants to develop an increased partnership with APA around mental health. The association and the Surgeon General collaborated on last year's mental health report and a national strategy to prevent suicide.

"We hope to do the things that need to be done to change the environment from one of stigmatization to one of support, caring and acceptance, from one of discrimination in access to mental health services to one of parity of access," he said.

Satcher, who received a standing ovation, opened the floor for questions after his remarks. In answer to one question, Satcher said he would support prescription privileges for psychologists if they have the proper training, but did not elaborate on what that training would entail.

"If we can demonstrate that psychologists have the training to prescribe, then they should be allowed to prescribe," he said.

Further Reading

The Surgeon General's initial report on mental health, "Mental Health: A Report of the Surgeon General," can be found at