The Committee on Racial and Ethnic Diversity's mandate is to facilitate recruitment, integration, and promotion of minority candidates within the APsaA. The committee believes that psychoanalysis can be enhanced in important ways by encompassing the full diversity of the population of this country in the clinical and scientific practice of psychoanalysis. We were invited to represent the committee at the Sixteenth Annual Rosalynn Carter Symposium on Mental Health Policy, held November 8–9, 2000, at the Carter Center in Atlanta.
This annual symposium highlights issues in mental health in a coordinated effort to affect mental health policy decisions and to publicize national mental health concerns. The topic of the 2001 symposium is “Youth in Crisis — Uniting for Action: Report of the Surgeon General's Conference on Children's Mental Health.”
Last year's day-and-a-half-long symposium brought together mental health professionals, consumers of mental health services, and advocates for consumers from all over the United States. The participants were culturally and ethnically diverse, fully representative of the 2000 symposium's theme, “Reducing Disparities: Ethnic Minorities and Mental Health.” They came from the legal community, from the mental health and public health communities, from national foundations, and from many other organizations. Members of federal, state, and county agencies; urban and rural agencies; academics in departments of psychology, psychiatry, pastoral studies, and social work; and professional organizations like the American Psychoanalytic Association were also present.
David Satcher, Surgeon General of the United States, opened the symposium as the keynote speaker. He outlined the significant-barriers that often keep ethnic minorities from accessing needed mental health care:
Lack of access.
Stigma of mental illness.
Distrust of mental health systems and mental health professionals.
The failure of mental health professionals and organizations to promote mental health and change the focus away from mental illness.
Lack of parity in health plans for providing mental health care.
Lack of culturally competent mental health providers.
Cultural competence can be defined as the skill that enables one to deliver professional services with an understanding of how culture mediates human behavior and to transform that knowledge into mental health interventions that support and sustain a patient's functioning within the appropriate cultural and community contexts.
Satcher voiced particular concern for the apparent failure of mental health professionals, systems, and organizations to work actively and across systems to develop prevention and intervention programs for children and their families.
He challenged the group to address these problems. In three panel sessions that followed his speech, solutions that were suggested included the following:
Develop national strategies to address the stigma of mental illness, promote mental health, and reduce barriers to mental health services.
Improve the supply of mental health services by developing partnerships that provide comprehensive services.
Display more creativity and sensitivity in developing programs addressing the needs of ethnic American consumers.
Address the need for more mental health research so that appropriate intervention strategies can be developed.
The first panel focused on the supplement to the Surgeon General's Report on Mental Health: Ethnic Disparities and Mental Health, with presentations on African, Asian, Hispanic, and Native Americans, including a presentation on Alaska natives. Each section author expressed similar concerns across ethnicity, echoing the problems outlined by the Surgeon General. All noted that each ethnic group was underrepresented in receiving mental health services. All urged that mental health issues be included as critical to primary health care for ethnic minorities. (The full text of the Surgeon General's report and the executive summary of the supplement can be read at .)
The second panel, “Towards Culturally Competent Mental Health Care and Access,” addressed cultural and ethnic issues that serve as barriers to mental health services.
Purnima Mehta, M.D., former chair of CORED, is an adult and child psychoanalyst in private practice in Troy, Mich. She also chairs the South Asian American Liaison Committee of the Michigan Psychoanalytic Foundation.
Carrie Banks Patterson, M.S.W., C.S.W., B.C.D., a child and adolescent consultant for Detroit-Wayne County Community Mental Health Agency, is a CORED member and a founding member of APsaA's Psychotherapist Associates.
The panelists reported on distrust of mental health professionals, misdiagnosis, failure to take into account culture in assessing and evaluating ethnic minorities, issues of language as a barrier to access for those with limited English proficiency, and racism. One panelist addressed the inequality facing rural Americans needing mental health services.
The third panel, “Dissemination of Report Findings and Partnerships for Taking Action,” addressed the need to recognize that improving mental health is good for all Americans. Panelists stressed the importance of reaching out to partner with like-minded institutions, organizations, and agencies as well as with unlikely associates in, for example, the business and legal communities. More important is the need to avoid turf issues and to avoid working only in “silos,” unable to move outside one's own background or stance to reach across systems and collaborate with other communities and professionals. The panelists were united in urging that in developing partnerships, high priority must be given to ensuring that treatment programs are placed where there is easy access as well as a commitment to the community they serve.
By the end of the symposium, several themes emerged that should resonate with psychoanalysis:
Mental health is fundamental.
Mental health is diagnosable.
Recovery is possible, and treatment works.
We must educate the community at large so that Americans recognize symptoms of mental dysfunction and seek help.
We need to train individuals both to do research and to provide mental health services.
“Cultural competence issues must be forth-rightly addressed, and training in cultural competence must be integral in training for all mental health professions.”
The symposium highlighted several themes of cultural competence that the APsaA should more fully explore among our membership. Within our organization, we need to explore specific ways this relates to psychoanalytic organizations, practice, and education. Symposium speakers stressed that cultural competence issues must be forth-rightly addressed, and training in cultural competence must be integral in training for all mental health professions.
The Committee on Racial and Ethnic Diversity (CORED) has focused on some of the issues highlighted in the Surgeon General's report. The cultural emphasis on the individual, both the patient and the therapist, is crucial. Often issues of prejudice, racism, differences, domination, linguistics, diversities, and immigration are considered undeserving of study by the majority of students of human behavior. This fallacy in thinking can divide and fragment us, and therefore compromises our most valuable skill — our analytic self — and prevents us from developing cultural competence.
In the past three years, the APsaA, through the work of CORED, has made numerous attempts to expand analysts' cultural competence: the visiting analyst program, the public forum, discussion groups, film discussions, and liaison with the non-government organizations of the United Nations. We are confident that CORED will continue to grow in this direction under Michele Morgan's leadership.