CHAPTER 7

A Vision for the Future

Conclusions

Mental Health: Culture, Race, and Ethnicity presents compelling evidence that racial and ethnic minorities collectively experience a disproportionately high disability burden from unmet mental health needs. Despite the progress in understanding the causes of mental illness and the tremendous advances in finding effective mental health treatments, far less is known about the mental health of African Americans, American Indians and Alaska Natives, Asian American and Pacific Islanders, and Hispanic Americans.

The Nation has far to go to eliminate racial and ethnic disparities in mental health. While working toward this goal, the public health system must support the strength and resilience of America’s families. The demo-graphic changes anticipated over the next decades magnify the importance of eliminating differences in mental health burden and access to services. Ethnic minority groups are expected to grow as a proportion of the total U.S. population. Therefore, the future mental health of America as a whole will be enhanced substantially by improving the health of racial and ethnic minorities.

It is necessary to expand and improve programs to deliver culturally, linguistically, and geographically accessible mental health services. Financial barriers, including discriminatory health insurance coverage of treatment for mental illness, need to be surmounted. Programs to increase public awareness of mental illness and effective treatments must be developed for racial and ethnic minority communities, as must efforts to overcome shame, stigma, discrimination, and distrust. The time is right for a commitment to expand or redirect resources to support evidence-based, affordable, and culturally appropriate mental health services for racial and ethnic minorities, particularly in settings where those with the highest need are not being adequately served, such as jails, prisons, homeless shelters, and foster care.

Clinical practice guidelines and program standards for culturally competent mental health services should be subject to rigorous empirical study. If they are found to be effective for racial and ethnic minorities, such standards should be disseminated and implemented with fidelity. For state-of-the-art, evidence-based interventions, it is critical that quality improvement processes be inaugurated, so that clinicians and programs actually use them and use them appropriately.

Building capacity for research, training, and community leadership is essential to meet the needs of racial and ethnic minorities in the 21st century. Where gaps exist in the evidence base about the prevalence, perception, course, detection, and treatment of mental illness in racial and ethnic minority populations, individuals must be trained and supported to carry out systematic pro-grams of research. Where shortages of accessible services are evident, both mainstream and bilingual-bicultural providers and administrators must learn to create culturally appropriate and evidence-based systems of care. Where leadership is lacking in consumer and family groups, encouraging grassroots efforts will help to strengthen the voices of racial and ethnic minorities.

Accountability for making progress and providing state-of-the-art services will help to reduce disparities in the mental health and health care systems. This Supplement sets a foundation for national efforts to pro-vide racial and ethnic minorities affected by mental disorders with effective and affordable treatments tailored to their specific needs. Public reports throughout the decade will provide excellent opportunities to gauge successes, evaluate directions, and chart necessary changes. Addressing disparities in mental health is the right thing to do for all Americans.