Psychiatric News May 3, 2002
Volume 37 Number 9
© 2002 American Psychiatric Association
p. 2
APA Group Works to Remedy Minority Health Care Disparities
Kate Mulligan
An APA committee demonstrates resilience and ingenuity in efforts to advise APA on how to implement recommendations in the U.S. surgeon general’s report on disparities in access to psychiatric care.
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Altha Stewart, M.D.: "Most of us on the committee come from the field of public psychiatry. We’ve learned how to do more with less."
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Despite unprecedented and daunting challenges, APA’s Steering Committee for Eliminating Disparities in Access to Psychiatric Care has made progress in its development of strategies enabling APA to help implement the recommendations of "Mental Health: Culture, Race, and Ethnicity," a report issued by then U.S. Surgeon General David Satcher, M.D. (See box on page 38 for recommendations.)
APA President Richard K. Harding, M.D., appointed the committee on September 8, 2001, after presenting a Presidential Commendation at the fall component meetings to Satcher for his work on the report and as an advocate for people with mental illness (Psychiatric News, October 5, 2001).
At that time, Harding called Satcher "a personal hero of mine" and said, "Dr. Satcher, we are with you in our commitment and dedication to improving access to quality health care, . . .in fighting stigma that affects our patients and the professionals who care for them, . . .in eliminating disparities in psychiatric care for members of minority groups, and in using scientific rigor to arrive at credible recommendations."
The committee cochairs are Altha Stewart, M.D., and R. Dale Walker, M.D. Other committee members are Harding, Carl Bell, M.D., Edward Foulkes, M.D., Ph.D., Francis Lu, M.D., Patricia Isbell Ordorica, M.D., and Pedro Ruiz, M.D.
The surgeon general’s report received major attention from publications such as the New York Times and Washington Post, but before the committee could hold its first meeting, planes had crashed into the World Trade Center and the Pentagon, diverting the country’s attention from the issues Satcher had raised. Signs also began to appear of the devastating toll the terrorist attacks eventually would take on state and federal budgets for public services.
Committee members took a pragmatic and collaborative approach to their task. Stewart told Psychiatric News, "Remember, most of us on the committee come from the field of public psychiatry. We’ve learned how to do more with less."
They decided to integrate their proposed activities into the overall APA strategic plan. Stewart said, "APA’s leadership has always been responsive to member concerns and issues when they can be shown to be consistent with the organization’s mission."
APA’s five strategic goals are advocating for patients; advocating for the profession; supporting education, training, and career development; defining and supporting professional values; and enhancing the scientific basis of psychiatric care.
In support of these goals, the committee identified four key areas in which work on eliminating disparities should be focused: expanding the scientific base of psychiatry, increasing advocacy activities, promoting innovative integrated psychiatry and primary care programs, and expanding collaborative relationships with other professional and advocacy organizations.
In March Stewart presented a report to APA’s Board of Trustees on the committee’s work to date.
Harding told Psychiatric News, "I was pleased, but not surprised, by the ability of the committee members to produce such comprehensive and thoughtful work despite multiple pressures. Each member is well known throughout our organization for an ability to move ahead and get things done. I knew the committee could be trusted to assist and push APA to do the right thing in terms of addressing the very real problems Dr. Satcher raised in his report."
The importance of the committee’s work was affirmed by the issuance of a report on March 20 by the Institute of Medicine (IOM). "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" found that racial and ethnic minorities tend to receive health care of a lower quality than whites do, even when insurance status, income, age, and severity of conditions are comparable.
Alan Nelson, M.D., a former AMA president, said in a press release announcing the release of the IOM report, "The real challenge lies not in debating whether disparities exist—the evidence is overwhelming—but in developing and implementing strategies to reduce and eliminate them."
Committee members have developed objectives for each of the areas identified. Under advocacy, for example, they propose to work with APA minority committees to encourage support of the report’s recommendations by corporations, state and federal government, and relevant legislative bodies.
They have already taken steps to accomplish another objective: they are working with consumer and community groups to build trust and empower them with information about the effectiveness of treatment and possibility of recovery.
The National Alliance for the Mentally Ill invited committee members to speak at the plenary session of its annual convention, "Culture, Race, and Ethnicity: A Look at Disparities in Care."
Other objectives are to develop an annual meeting course on cultural competence; disseminate APA-developed minority curricula to educators and administrators; develop an initiative similar to APA’s business initiative directed to relevant government agencies; support recommendations in the NIMH strategic plan for reducing health disparities; and work with other professional and advocacy groups to address cultural and ethnic diversity in their future plans.
APA President-elect Paul S. Appelbaum, M.D., said, "With funding for psychiatric services being squeezed from all sides, there is a particular danger that minority groups will be disproportionately affected. A strategy aimed at reducing disparities in care for minorities is an important part of APA’s overall advocacy for adequate resources for all psychiatric care."
Satcher will receive APA’s Patient Advocacy Award at the 2002 annual meeting on May 23.
Stewart said, "He’s our champion. We’ve always known that issues concerning disparities in care are important, but as top doc Dr. Satcher sent that message to the whole country."
"Mental Health: Culture, Race, and Ethnicity" is posted on the Web at www.surgeongeneral.gov/library/mentalhealth/cre/default.asp. 
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Surgeon General’s Report
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