African Americans - Need for Mental Health Care

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African Americans - Need for Mental Health Care

Approximately 12% of the U.S. population -- 33.9 million people - identify themselves as African American.The African American population is increasing in diversity as immigrants arrive from many African and Caribbean countries. Over half of the Nation's African Americans population (53%) live in the South; 37% reside in the Northeast and Midwest combined; 10% live in the West. In 1997, nearly one-fourth of all African American earned more than $50,000 a year.

Yet, as a whole, when compared to other racial and ethnic groups living in the U.S., African Americans continue to be relatively poor. In 1999, about 22% of African American families lived in poverty, compared to 13% for the United States as a whole and 8% for non-Hispanic white Americans.

Need for Mental Health Care

Whether African Americans differ from whites in the rate of mental illness cannot be answered simply. For African Americans living in the community, overall rates of mental illness appear to be similar to those of non-Hispanic whites. Differences do arise when assessing the prevalence of specific illnesses. For example:

African Americans may be less likely to suffer from major depression and more likely to suffer from phobias than are non-Hispanic whites. Somatization is more common among African Americans (15%) than among whites (9%). Moreover, African Americans experience culture-bound syndromes such as isolated sleep paralysis, an inability to move while falling asleep or waking up, and falling out, a sudden collapse sometimes preceded by dizziness.

While non-Hispanic whites are nearly twice as likely as African Americans to commit suicide, suicide rates among young black men are as high as those of young white men. Moreover, from 1980 - 1995, the suicide rate among African Americans ages 10 to 14 increased 233%, compared to 120% of comparable non-Hispanic whites.

African Americans are over-represented in high-need populations that are particularly at risk for mental illnesses:

People who are homeless. While representing only 12% of the U.S. population, African Americans make up about 40% of the homeless population.
People who are incarcerated. Nearly half of all prisoners in State and Federal jurisdictions and almost 40% of juveniles in legal custody are African Americans.
Children in foster care and the child welfare system. African American children and youth constitute about 45% of children in public foster care and more than half of all children waiting to be adopted.
People exposed to violence. African Americans of all ages are more likely to be victims of serious violent crime than are non-Hispanic whites. One study reported that over 25% of African American youth exposed to violence met diagnostic criteria for post-traumatic stress disorder (PTSD). Among Vietnam War veterans, 21% of black veterans, compared to 14% of non-Hispanic white veterans, suffer from PTSD, apparently because of the greater exposure of blacks to war-zone trauma.

Availability of Mental Health Services

The public mental health safety net of hospitals, community health centers, and local health departments are vital to many African Americans, especially to those in high-need populations. African Americans account for only 2% of psychiatrists, 2% of psychologists, and 4% of social workers in the United States.

Access to Mental Health Services

Nearly 1 in 4 African Americans is uninsured, compared to 16% of the U.S. population. Rates of employer-based health coverage are just over 50% for employed African Americans, compared to over 70% for employed non-Hispanic whites. Medicaid covers nearly 21% of African Americans.

Use of Mental Health Services

Overall, only one-third of Americans with a mental illness or a mental health problem get care. Yet, the percentage of African Americans receiving needed care is only half that of non-Hispanic whites. One study reported that nearly 60% of older African American adults were not receiving needed services.

African Americans are more likely to use emergency services or to seek treatment from a primary care provider than from a mental health specialist. Moreover, they may use alternative therapies more than do whites.

African Americans of all ages are under represented in outpatient treatment but overrepresented in inpatient treatment. Few African American children receive treatment in privately funded psychiatric hospitals, but many receive treatment in publically funded residential treatment centers for emotionally disturbed youth.

Appropriateness and Outcomes of Mental Health Services

While few clinical trials have evaluated the response of African Americans to evidence-based treatment, the limited data available suggest that, for the most part, African Americans respond favorably to treatment. However, there is cause for concern about the appropriateness of some diagnostic and treatment procedures. For example, when compared to whites who exhibit the same symptoms, African Americans tend to be diagnosed more frequently with schizophrenia and less frequently with affective disorders.

In addition, one study found that 27% of blacks compared to 44% of whites received antidepressant medication. Moreover, the newer SSRI medications that have fewer side effects are prescribed less often to African Americans than to whites. Finally, even though data suggest that blacks may metabolize psychiatric medications more slowly than whites, blacks often receive higher dosages than do whites, leading to more severe side effects. As a result, they may stop taking medications at a greater rate than whites with similar diagnoses.

http://www.surgeongeneral.gov/library/mentalhealth/cre/fact1.asp

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