Research ethics for mental health science involving ethnic minority children and youths.

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inmate Perceptions of Mental Health Services.

With the increasing rise in the U.S. prison population, meeting the mental health needs of inmates before, during, and after incarceration remains an obstacle. What are the mental health experiences of inmates? For what types of problems are inmates willing to seek help, and what are the barriers to their service utilization? This study investigated inmates' attitudes and perceptions toward mental health services and examined whether these attitudes and perceptions vary with respect to ethnic group membership or among inmates of differing security levels. Implications of these findings for psychologists, including psychologists not employed in correctional settings, are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overcoming obstacles in providing mental health treatment to older adults: Getting in the door.

Older adults significantly underutilize mental health services relative to their numbers in the population. Barriers that impede their access include physical, financial, cognitive, emotional, and attitudinal issues. This article discuss strategies for overcoming these barriers including physical adaptations such as in-home psychotherapy and telephone sessions, use of support groups, strong community outreach, and liaisons with other professionals. Adaptations that help to increase older adults' use of mental health services are discussed, including education about treatment, nontraditional "pursuit" of clients, and use of alternative terminology. Informed consent is discussed as a special issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Engaging Latinos through the integration of cultural values and motivational interviewing principles.

A rapidly growing Latino population challenges the U.S. mental health system. Despite a high service need, significant disparities in access to care have resulted in patterns of low utilization and frequent dropout. Furthermore, natural ambivalence as individuals access a traditionally underutilized source of support may further compromise the effective therapeutic engagement of Latinos. Thus, practitioners and researchers seek to identify means by which to enhance service delivery for this historically underserved population. Following the demonstrated efficacy of motivational interviewing with highly ambivalent client populations and drawing on the authors' clinical experiences with monolingual Spanish-speaking Latinos in a community mental health setting, this article describes the application of motivational interviewing principles to 3 Latino cultural values and offers clinical practice recommendations to help create a client-centered and culturally congruent therapeutic milieu. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with Mexican-American clients.

Addresses issues crucial in serving mental health needs of Mexican-American clients. Topics include demographics, language, acculturation, social support, etiquette, and other information useful in developing initial hypotheses and treatment goals. The various topics and possible interventions are discussed within the framework of 3 case vignettes. The author's goal is to increase the reader's sensitivity to cultural differences, help clinicians avoid potential stumbling blocks, and make existing programs more accessible by overcoming barriers which discourage or exclude potential Mexican-American clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Award for Distinguished Early Career Contributions to Psychology in the Public Interest: Keith Humphreys.

Keith Humphreys, recipient of the Award for Distinguished Early Career Contributions to Psychology in the Public Interest, is cited for creatively combining a scientist’s commitment to rigor, a clinician’s emphasis on high-quality mental health care, and a policy analyst’s understanding of how to address and resolve social problems. His work as a program evaluator and policy analyst has informed important legislation that has enhanced access to and quality of mental health services for U.S. veterans within the Department of Veterans Affairs. Moreover, he has been a prime mover in shaping the Iraqi Ministry of Health’s effort to create a modern and equitable system of mental health care for the Iraqi community. A biography and selected bibliography of Humphreys' works are provided. In addition, Humphreys' paper, entitled "Responding to the psychological impact of war on the Iraqi people and U.S. veterans: Mixing icing, praying for cake," a version of which Hymphreys delivered at the American Psychological Association's annual convention, is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial discrimination and psychological distress: The impact of ethnic identity and age among immigrant and United States-born Asian adults.

The association between racial and ethnic discrimination and psychological distress was examined among 2,047 Asians (18 to 75 years of age) in the National Latino and Asian American Study, the first-ever nationally representative study of mental health among Asians living in the United States. Stratifying the sample by age in years (i.e., 18 to 30, 31 to 40, 41 to 50, 51 to 75) and nativity status (i.e., immigrant vs. U.S.-born), ethnic identity was tested as either a protective or exacerbating factor. Analyses showed that ethnic identity buffered the association between discrimination and mental health for U.S.-born individuals 41 to 50 years of age. For U.S.-born individuals 31 to 40 years of age and 51 to 75 years of age, ethnic identity exacerbated the negative effects of discrimination on mental health. The importance of age and immigrant status for the association between ethnic identity, discrimination, and well-being among Asians in the United States is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions of mental illness and judgments about help seeking among Japanese-American and White American students.

Perceived causes of mental illness and help-seeking preferences among Japanese-American and White American college students (72 men and 72 women in each ethnic group) were compared in order to investigate the reported underuse of mental health services by Japanese Americans. Results of a 2 (ethnicity of S)?×?2(severity of disorder)?×?2(gender of person with disorder)?×?2(gender of S) multivariate analysis of variance (MANOVA) revealed that Japanese-American students were more likely than White American students to attribute mental illness to social causes, to resolve problems on their own, and to seek help from family members or friends or both. Possible barriers to use of services by this sample of Japanese Americans include both a preference for informal resources and the stigmatization of mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to mental health care utilization for U.S. Cambodian refugees.

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment-seeking patterns.

Whites in community samples use mental health services at a much higher rate than African Americans (Kessler et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White), there were no race differences in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory), but race differences in the level and types of symptoms were evident. In addition, although Whites were more likely to report preincarceration treatment, there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time), racial disparities in treatment utilization may be reduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Envisioning and accessing new roles for professional psychology.

To support psychology's continued evolution as a profession, it is important to conceptualize roles that psychologists can play in the future and create pathways for developing and accessing them. This article considers a variety of roles that may become central to professional psychology in the future. Important opportunities appear to exist in the areas of psychological management of health and disease, serious mental illness, and public policy. Psychology faces both internal and external barriers to accessing these roles in larger numbers. Strategies related to public education, policy and advocacy, marketing, and training are recommended for overcoming them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supply dynamics of the mental health workforce: implications for health policy

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.     

Clinical work with limited English proficiency clients: A phenomenological exploration.

Because of an increasing number of immigrants to the United States, many clinicians are faced with challenges and opportunities presented in working with clients through language interpreters. This article describes a phenomenological investigation focused on the processes related to therapy with limited English proficiency (LEP) clients through interpreters. The focus of the study was on clinicians' perceptions regarding professional and personal factors influencing services with LEP individuals, as well as contextual aspects of this work. In addition to highlighting specific characteristics and training needed for clinicians and interpreters who work with LEP clients, the readers will also learn about systemic changes that could improve the provision of mental health care to these clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emerging Hispanic population: a foundation for cancer prevention and control

Although making up only 9% of the U.S. population and concentrated in urban areas of a few states, Hispanics are found throughout the country and represent a mix of historical and cultural backgrounds. This diverse group cuts across racial and ethnic lines, with origins in various countries of Europe and North, Central, and South America. The Hispanic population has several distinguishing demographic characteristics, including its rapid growth rate, relative youth, and low educational and socioeconomic levels. However, considerable differences exist among Hispanic groups, particularly in median age, household size, education, and family income. The majority of Hispanics face barriers to health care access, including a lack of health insurance coverage, underrepresentation in health care fields, and cultural and language differences. These distinct demographic characteristics and barriers have a direct impact on the risk of cancer in Hispanics and on the development of prevention and control strategies. The purpose of this review is to examine the demographic and socioeconomic characteristics of Hispanics and issues of access to health care among this population within the context of cancer prevention and control.     

Mental health of minority women: Some special issues.

Discusses problems encountered in providing mental health services to ethnic minority women with respect to the limitations of pertinent theory and research, the potential pitfalls inherent in gender and ethnic/racial stereotypes, the social and economic consequences of racism and sexism, and the joint impact of all of these factors on the mental health status of minority women. In addition, some common structural barriers to adequate mental health care that arise from sex, race, and class biases reflected in therapeutic institutions are pointed out. General guidelines are established to assist professionals in providing sensitive and appropriate services. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic disparities in therapist effectiveness: A conceptualization and initial study of cultural competence.

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mental disorders and access to medical care in the United States

OBJECTIVE: The authors examined the barriers to receipt of medical services among people reporting mental disorders in a representative sample of U.S. adults. METHOD: The sample was drawn from adults who responded to the 1994 National Health Interview Survey (N=77,183). The authors studied the association between report of a mental disorder and 1) access to health insurance and a primary provider, and 2) actual receipt of medical care. Multivariate techniques were used to model problems with access as a function of mental disorders, controlling for demographic, insurance, and health variables. RESULTS: While people who reported mental disorders showed no difference from those without mental disorders in likelihood of being uninsured or of having a primary care provider, they were twice as likely to report having been denied insurance because of a preexisting condition or having stayed in their job for fear of losing their health benefits. Among respondents with insurance, those who reported mental illness were no less likely to have a primary care provider but were about two times more likely to report having delayed seeking needed medical care because of cost or having been unable to obtain needed medical care. CONCLUSIONS: People who reported mental disorders experienced significant barriers to receipt of medical care. Efforts to measure and improve access to health care for this population may need to go beyond simply providing insurance benefits or access to general medical providers.