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In this chapter, Woo, Walton, and Takeuchi examine and summarize some cultural issues in the treatment of racial and ethnic minorities with mental health problems. They review some key data on the use of mental health services by ethnic minorities including consideration of access to services, use of services, and service outcomes. Many geographic areas have been dramatically altered by the rising racial, ethnic, and cultural diversity of the United States, creating different and sometimes novel approaches to the prevention and treatment of mental health problems. The authors examine a range of efforts to address these needs at provider, agency, and community levels. They ask you to consider the following questions in reading the chapter. As a society, how broadly are we willing to recognize and respond to growing culturally diverse mental health needs? What efforts can be made to resolve the mental health disparities among racial and ethnic minorities?
The Changing Demographics of the United States
The US population has become increasingly racially, ethnically, and culturally diverse. At the turn of the twentieth century and continuing until the 1950s, racial and ethnic minority groups, primarily consisting of African Americans, represented approximately 10–12 percent of the adult population (US Census Bureau, 1975). The number of immigrants has grown since the US Immigration Act of 1965, which replaced the national origin quota system favoring prioritized and skilled labor needed by the economy and family unification (Gordon, 1998; Keely, 1971). Representing a radical departure from the population at the beginning of the 1990s, racial and ethnic minorities were projected to comprise 38 percent of the total population in the year of 2015 and to reach 56 percent in 2060: Hispanic white, 25 percent; black, 14 percent; American Indian and Alaska Native, 1 percent; Asian, 9 percent; Native Hawaiian and other Pacific Islander, 0.29 percent; two or more races, 6 percent (US Census Bureau, 2014a). Though there have been changes in the manner in which the US Census Bureau defined racial categories (e.g., the 2000 Census allowed respondents to choose more than one racial group and created a new racial category encompassing Native Hawaiian/Pacific Islander), the shift in the population characteristics encompasses a dramatic change in the US demography.
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