文章基本信息

标题：Bias in Mental Health Assessment and Intervention: Theory and Evidence
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作者：Lonnie R. Snowden
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2003
卷号：93
期号：2
页码：239-243
语种：English
出版社：American Public Health Association
摘要：A recent surgeon general’s report and various studies document racial and ethnic disparities in mental health care, including gaps in access, questionable diagnostic practices, and limited provision of optimum treatments. Bias is a little studied but viable explanation for these disparities. It is important to isolate bias from other barriers to high-quality mental health care and to understand bias at several levels (practitioner, practice network or program, and community). More research is needed that directly evaluates the contribution of particular forms of bias to disparities in the area of mental health care. RACIAL AND ETHNIC DISPARITIES are as widespread in the diagnosis and treatment of mental illness as they are in other areas of health. In 2001, then–Surgeon General David Satcher issued the report Race, Culture, and Ethnicity and Mental Health , 1 in which he convincingly documented disparities in access and treatment that leave too many minority individuals untreated or improperly treated. One possible reason for disparities is that practitioners and mental health program administrators make unwarranted judgments about people on the basis of race or ethnicity. Their inappropriate expectations lead to inappropriate decisions and actions. In a strict sense, it is these unwarranted views, reactions to a person “on the basis of perceived membership in a single human category, ignoring other category memberships and other personal attributes,” 2 that constitute bias. Biased views can be held knowingly or unknowingly and can result in action or a failure to act. Taking account of racial and ethnic differences does not in itself constitute bias. Indeed, some critics argue that responding to racial and ethnic differences is essential, that mental health interventions must be varied to allow for differences in race, culture, and ethnicity. 3 They claim that appropriate treatment necessitates awareness of critical differences between minority individuals and others in beliefs and sensitivities related to mental health, in expression of symptoms, and in treatment preferences. From this perspective, to ignore racial and ethnic differences reflects a kind of bias. There may be greater reason for concern about bias in mental health than in other areas of health. Some continue to doubt the very existence of mental illness, believing that difficulties labeled as such, however troublesome, are no more than universal problems in everyday living. Consensus has increased about appropriate methods of diagnosis and treatment, but a large role remains for discretion. There is great variation in practice norms, and the advent of well-founded protocols 4 is recent. These protocols are far from achieving full acceptance. Decisionmakers other than mental health professionals, including business owners, neighbors, and the public at large, as well as police and courts, play an important role in assessing mental illness and in deciding whether troublesome behavior warrants treatment or punishment. 5 Mentally ill persons can be detained by the police and required to undergo treatment against their will, a practice with few counterparts elsewhere in health. Institutional and community decisionmakers also enjoy considerable discretion, and there is great opportunity for bias to intrude. It is useful as a starting point to consider disparities, examining the research literature for clues about bias. What is the evidence on disparities in mental health? What does it tell us about bias?