Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

A powerful account of how cultural anxieties about race shaped American notions of mental illness The civil rights era is largely remembered as a time of sit-ins, boycotts, and riots. But a very different civil rights history evolved at the Ionia State Hospital for the Criminally Insane in Ionia, Michigan. In The Protest Psychosis, psychiatrist and cultural critic Jonathan Metzl tells the shocking story of how schizophrenia became the diagnostic term overwhelmingly applied to African American protesters at Ionia—for political reasons as well as clinical ones. Expertly sifting through a vast array of cultural documents, Metzl shows how associations between schizophrenia and blackness emerged during the tumultuous decades of the 1960s and 1970s—and he provides a cautionary tale of how anxieties about race continue to impact doctor-patient interactions in our seemingly postracial America. This book was published with two different covers. Customers will be shipped the book with one of the two covers.

The field of health psychology has grown dramatically in the last decade, with exciting new developments in the study of how psychological and psychosocial processes contribute to risk for and disease sequelae for a variety of medical problems. In addition, the quality and effectiveness of many of our treatments, and health promotion and disease prevention efforts, have been significantly enhanced by the contributions of health psychologists (Taylor, 1995). Unfortunately, however, much of the theo rizing in health psychology and the empirical research that derives from it continue to reflect the mainstream bias of psychology and medicine, both of which have a primary focus on white, heterosexual, middle-class American men. This bias pervades our thinking despite the demographic heterogeneity of American society (U. S. Bureau of the Census, 1992) and the substantial body of epidemiologic evidence that indicates significant group differences in health status, burden of morbidity and mortality, life expectancy, quality of life, and the risk and protective factors that con tribute to these differences in health outcomes (National Center for Health Statistics, 1994; Myers, Kagawa-Singer, Kumanyika, Lex, & M- kides, 1995). There is also substantial evidence that many of the health promotion and disease prevention efforts that have proven effective with more affluent, educated whites, on whom they were developed, may not yield comparable results when used with populations that differ by eth nicity, social class, gender, or sexual orientation (Cochran & Mays, 1991; Castro, Coe, Gutierres, & Saenz, this volume; Chesney & Nealey, this volume).

This book addresses the unique sociocultural and historical systems of oppression that have alienated African-American and other racial minority patients within the mental healthcare system. This text aims to build a novel didactic curriculum addressing racism, justice, and community mental health as these issues intersect clinical practice. Unlike any other resource, this guide moves beyond an exploration of the problem of racism and its detrimental effects, to a practical, solution-oriented discussion of how to understand and approach the mental health consequences with a lens and sensitivity for contemporary justice issues. After establishing the historical context of racism within organized medicine and psychiatry, the text boldly examines contemporary issues, including clinical biases in diagnosis and treatment, addiction and incarceration, and perspectives on providing psychotherapy to racial minorities. The text concludes with chapters covering training and medical education within this sphere, approaches to supporting patients coping with racism and discrimination, and strategies for changing institutional practices in mental healthcare. Written by thought leaders in the field, Racism and Psychiatry is the only current tool for psychiatrists, psychologists, administrators, educators, medical students, social workers, and all clinicians working to treat patients dealing with issues of racism at the point of mental healthcare.

Schizophrenia has been investigated predominantly from psychological, psychiatric and neurobiological perspectives. This text examines it from a philosophical point of view.

There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.

Ethnicity and Psychopharmacology addresses the most relevant theoretical and clinical aspects of ethnopsychopharmacology, with the aim of advancing this growing field well into the twenty-first century. Detailed are the pharmacogenetic, pharmacokinetic, and pharmacodynamic mechanisms involved in differing responses to drug treatment among various ethnic groups living in the United States. Readers will learn an integrative approach in which ethnic and cultural diversity and biological diversity are taken into account and treatment is tailored to specific individual characteristics. Dr. Ruiz's extensive research experience and years of leadership in public psychiatry along with his distinguished panel of contributors combine to make this book an authoritative resource. Psychiatric practitioners, educators, and investigators, as well as other mental health professionals, primary care physicians and medical students, will gain a better understanding of treating patients from different cultures.