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Post by Former NIMH Director Thomas Insel: Reducing Disparities in Mental Health Equity: Closing the Gaps

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Soon after the first Surgeon General’s Report on Mental Health was published in 1999, a supplement entitled “Mental Health: Culture, Race, and Ethnicity” detailed what was known of the relationship between race and mental illness and mental health care in the United States. This supplement identified critical needs for further investigation into these relationships and for the provision of culturally sensitive mental health care.  As noted in the report, health care must continually adapt to meet the needs of the ever-changing population that it serves. Mental health care has no exception from this requirement. While one of America’s greatest strengths is its racial and cultural diversity, this diversity produces complex mental health care issues due to the heterogeneity of the population to be served.

To study the cultural and racial influences on mental health, NIMH initiated the Collaborative Psychiatric Epidemiology Surveys (CPES), including the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS). The NCS-R was a nationally-representative survey of 9,282 individuals including face-to-face structured diagnostic interviews. The NSAL focused on black Americans, including 6,199 African Americans, Caribbean blacks, and white individuals. The NLAAS included interviews with 4,649 Latino and Asian Americans.  Taken together, these studies yield an unprecedented map of mental illness in America. Among many intriguing findings, perhaps what is most striking are not the variations in prevalence but the variations in care. Thus, for mental illness in America, the challenge is health equity; that is, achieving equal and optimal health care for all populations.

To better understand the context of mental health inequities, the new NIMH Office for Research on Disparities and Global Mental Health recently convened a summit of leaders from academic and research centers, community organizations, and government agencies with expertise ranging from genetics, epidemiology, medical anthropology, and cultural neuroscience to psychiatric education, service delivery, and policies. In addition to making recommendations for research priorities, the group’s lively discussion also highlighted a need to rethink traditional study designs and measures. Some suggestions included focusing more on incidence and burden rather than prevalence; enhancing communication and engagement between researchers, community members, and clinicians, as well as between government agencies with similar goals; and developing a workforce capable of studying the complex, interdisciplinary nature of mental health inequities.

Clearly, there is much work that remains to be done in reducing and reversing disparities in mental health care. But the wealth of knowledge and innovation that currently exists in the mental health community is encouragement enough to be bold in our research undertakings and, together with our like-minded colleagues at other NIH institutes, SAMHSA, and AHRQ to strive towards closing the gap in mental health care.