These chapters subscribe to a common theme, namely a commitment to diversity in social behavior. While concerns for diversity have been raised on numerous occasions, with increasing frequency over the past four decades, little progress has passed in implementing such concerns in clinical practice. A disturbing anecdote comes to mind as a case in point. I recall visiting Bellevue Hospital in New York City for a meeting with the Chair of psychiatry. Being a white man, dressed in suit and tie, the receptionist greeted me with a forlorn look, downtrodden. Perhaps she didn’t like her job or the people who entered on a daily basis. Nonetheless, I couldn’t help thinking, what if I was a poor minority person, possible with limited English proficiency, in dire need of psychiatric care, who happened to stumble in for treatment? The less than welcoming reception may have prompted me to walk out, and even exacerbate my psychiatry problem. Experiences such as this are one reason why more than half of mental health service utilizations by ethnic minority clients are terminated following their first visit.
Another interesting anecdote comes to mind. Giving a lecture at Lincoln Center in an auditorium replete with clinicians engaged in practice, my challenge, a bold one so it seems, was for someone to articulate precisely how they would treat a Dominican patient differently from someone born in Cuba, Puerto Rico or Mexico, or elsewhere for that matter. The unanimous response referred to “socioeconomic status” as the discerning factor. Cubans could afford treatment more readily than others, and were more likely to be insured. Dominicans were darker skinned and typically had fewer financial resources. Puerto Ricans didn’t keep their appointments, tended to be non-compliant and drop out of treatment. Given my own experience one needn’t wonder why. Although at the time, there was little representation of the Mexican American population in New York City, their plight went unanswered. Clearly, despite the rhetoric surrounding cultural awareness and culturally competent treatment, observation of what is translated into clinical practice suggests that the transition of theory into action has not fully taken place.
Over two-thirds of Americans receive treatment for depression, anxiety, substance abuse, and related disorders. Comorbidity is rarely diagnosed. These trends are greatly exacerbated among members of ethnic, cultural, and linguistic minority groups. The authors contributing to this volume share their clinical acumen and experiences, rooted in their evidence-based research. Our purpose is to bring issues attending assessment and treatment of ethnic minorities closer to the fore. Some of the leading authors on the topic, in psychology and social work, present their well earned clinical and research experiences in this Volume. Case studies are presented which are instructive and intriguing. They bring together a richness of a multidisciplinary approach to the topic.
A recent 2010 article in the New York Times is an example of current thinking. This article described how Mexican Americans are less likely to receive talk therapy or treatment of any kind. On the other hand, curiously, Puerto Ricans are proportionately over diagnosed with depression and receive less than adequate care relative to other groups, The message was to reach out to minorities to engage themselves in psychotherapy. But without a thorough understanding of culture and its nuances on part of the mental health service providers, alienation, stigma, and culturally based impediments rule. Consequently, the authors of this volume provide experiences, guidelines, and recommendations for assessment and treatment of their ever increasing ethnic minority clientele.
Robert G. Malgady
New York University