A summary of important health news from the past week.
After an open letter signed by 150 scientist came out last week urging the International Olympic Committee (IOC) to move or postpone this year's events because of the Zika outbreak, officials at the World Health Organization (WHO) are responding by downplaying the outbreak and noting that risk assessment plans are in place. There are no contingency plans as of now.
FDA Considering Pricey Implant As Treatment For Opioid Addiction
In response to recent opioid addiction rates, the Food and Drug Administration (FDA) is looking at an implant, called Probuphine, that slowly releases buprenorphine, which is currently available in other forms as a method of treatment. The primary benefit of the implants is that these will be more difficult to sell illegally. The implant consists of four small rods that are inserted into the skin.
A 49-year old woman in Pennsylvania is struggling with a highly antibiotic resistant infection, which originated as an urinary tract infection. The E. coli-based infection has a gene that makes the bacteria resistant to antibiotics, including Colistin, a drug that is used as a last resort for resistant infections.
Medicare’s Drug-Pricing Experiment Stirs Opposition
Medicare is proposing to change how drugs are payed for by trying to manage spending in Part B. One feature of the proposal is to set benchmark payments for "therapeutically similar" drugs. This proposal has been criticized a government price setting.
This week's Morbidity and Mortality Weekly Report (MMWR) podcast from the Centers for Disease Control and Prevention (CDC) focuses on the importance of seat belt use for the prevention of serious injury or death in motor vehicle crashes. Follow the links for the short and long versions of this podcast.
A Minute of Health (0:59)
A Cup of Health (3:27)
By: Harini Morisetty
The United States has a vast array of racial and ethnic populations built from a vibrant and rich history of a variety of cultures, religions, principles, morals, and backgrounds. However, cultural and ethnic differences can impact how different populations access healthcare, especially in regards to mental health care. In seeking psychiatric treatment, people can be stigmatized, which may deter treatment-seeking behaviors and magnify adverse health outcomes. If a provider is unable to appropriately treat someone due to a lack of knowledge regarding the patient’s cultural, physical, and emotional circumstances, the prescribed treatment plan may not be effective and may actually be detrimental to the person’s overall well-being.
The 2001 supplement to the Surgeon General’s Report titled “Mental Health: Culture, Race, and Ethnicity” highlights the importance culture, race, and ethnicity play in mental health treatment and care. This is the first time a formal document addressed culture in mental health care in the United States. Critics, however, point out that “if both the original report and the Supplement had appeared earlier, mental health might have joined diabetes, cancer, cardiovascular disease, infant mortality, HIV/AIDS, and immunization among the primary emphases of this initiative.”
According to the U.S. Census, the 2014 population was around 318,857,045 people. With about 75% of adult mental illnesses starting before the age of 24, 43.6 million adults, or 18% of the population, was living with a mental illness in 2014. According to the National Alliance on Mental Illness (NAMI), 2.4 million people live with schizophrenia, 6.1 million adults live with bipolar disorder, 16 million adults live with major depression, and 42 million adults live with an anxiety disorder. And yet about 60% of adults and half of children aged 8 to 15 do not get appropriate and needed mental health care. Further, African Americans and Hispanics utilized services at about half of the rate of White individuals, and Asian Americans utilized it at about a third of the rate. These rates are concerning as the National Institutes of Mental Health (NIMH) report that in 2014, 3.5% Hispanic, 4.4% White, 3.1% Black or African American, 2.4% Asian, 6.9% American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, and 8.9% two or more races experiences a serious mental illness, which totals to about 9.8 million people in the United States. The NIMH defines a serious mental illness as a mental, behavioral, or emotional disorder that is currently diagnosable or has been within the last year, sufficiently meets the diagnostic criteria from the DSM-IV, and results in serious functional impairment limiting major life activities.
A recent report based on data from the World Health Organization (WHO) describes how health disparities from mental health treatment result from several barriers experienced around the globe. If a patient does not perceive that they need care—which can be dictated by family beliefs, environment, or culture—they will not seek care. Physical access to care based on the environment and location also plays a role in how or when people are able to receive assistance, posing additional barriers. There is also a lack of agreement on definitive characteristics on what symptoms indicate a need for mental health care, which may cause individuals to feel that their condition is not as serious or they may not need treatment. Additionally, people may perceive their conditions in different ways. While one person experiencing symptoms of depression may view that as very serious and is in need of help, another person may view the same symptoms as insignificant with no need to seek care.
Although these barriers primarily stem from the patient or client, they can impact a provider’s ability or competence to treat the individual. Providers who do not fully understand their client’s lifestyle or belief system may not form the necessary level of trust to make a positive difference in the life of that patient. Similarly, a provider’s own beliefs and culture can interfere with the therapeutic relationship, which impacts health outcomes. Mental health care involves more than just therapy and should be inclusive of a patient’s whole life and belief system. According to the Surgeon General’s Report, some of the bias that patients experience may be a result of discrimination by clinicians or from seeking treatment from primary care providers or facilities not sufficiently trained in mental health care.
Additionally, minorities in the U.S. are not as likely to get mental health services that abide by national treatment guidelines. The authors of the Surgeon General’s Report address this issue, stating, “existing treatment guidelines should be used for all people with mental disorders, regardless of ethnicity or race. But to be most effective, treatments need to be tailored and delivered appropriately for individuals according to age, gender, race, ethnicity, and culture.” The national standards for care are not generalizable to all populations, races, and ethnic minorities. Adjustments and alterations need to be made based on each individual case. Cultural misinterpretations and miscommunications from the improper use of national mental health treatment standards can lead to adverse results for the patient or client, creating a gap in treatment seeking behaviors and overall practitioner competence. Health disparities between white and non-white individuals in need of mental health care in the United States are prominent. Better services, treatment modalities, facilities, training, and facilities are needed to move towards bridging the existing gaps in care.
Several recommendations have been made to address the lack of cultural competence in mental health care and services. Some personal suggestions, based on research, include ethnic matching in the therapeutic setting, culturally adapted evidence based practices, utilizing the socio-cultural frameworks, therapist training, and evaluations of community mental health centers. Based on review articles and evaluation studies, these recommendations have been incorporated into a variety of interventions and training programs, most of which have shown positive results and health outcomes for a diverse set of patients and clients, which provides hope for the future of mental health treatment. Until further research studies can be conducted on diverse populations, the current ethnic matching and evidence based practice interventions should be utilized in the therapeutic setting. These recommendations are only beginning strategies to improve mental health treatments and will hopefully lead to a better future for individuals receiving poor mental health care.
1. Manson, S. M. (2003). Extending the boundaries, bridging the gaps: Crafting mental health: Culture, race, and ethnicity, a supplement to the surgeon general's report on mental health. Culture, Medicine, and Psychiatry, 27, 395-408.
2. Center for Behavioral Health Statistics and Quality, (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA), SMA 15-4927. Retrieved April 18, 2016, from http://samhsa.gov/data/
3. Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., ... Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO world mental health surveys. Psychological Medicine, 44, 1303-1317. doi: 10.1017/S0033291713001943
4. Services, D. o. H. a. H. (2001). Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD.
 Some examples of interventions include: Castro, F. G., Jr., M. B., & Steiker, L. K. H. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213-239. doi: 10.1146/annurev-clinpsy-033109-132032; Copeland, V. C., & Butler, J. (2007). Reconceptualizing access: A cultural competence approach to improving the mental health of African American women. Social Work in Public Health, 23(2/3), 35-58. doi: 10.1080/1937191080214826; and Whealin, J. M., & Ruzek, J. (2008). Program evaluation for organizational cultural competence in mental health practices. Professional Psychology: Research and Practice, 39(3), 320-328. doi: 10.1037/0735-7028.39.3.320
 Including Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7(15), 15-25. doi: 10.1186/1472-6963-7-15; Bhui, K. S., Aslam, R. h. W., Palinski, A., McCabe, R., Johnson, M. R. D., Weich, S., ... Szczepura, A. (2015). Interventions to improve the therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: Systematic review. The British Journal of Psychiatry, 207, 95-103. doi: 10.1192/bjp.bp.114.158899; Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. American Psychological Association, 43(4), 531-548; and Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14, 99-116. doi: 10.1037/0033-322.214.171.1241.
Harini Morisetty is a recent graduate from Emory University Rollins School of Public Health in the department of Behavioral Science and Health Education. She is passionate about preventative health care and, more specifically, mental health. She has had numerous internships and work experiences in healthcare, which has cemented her interest in mental health and preventative medicine. She will soon be starting medical school to pursue a career that is focused on preventing chronic illness.
A summary of important health news from the past week.
An 'Added Sugar' Label Is On The Way For Packaged Food
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