Americans with mental illness have come a long way since the late 1800s when they were often warehoused and given inadequate care.

Well, not all Americans. . .and certainly far too few minorities.

This was the thrust of a Congressional briefing held in Washington, D.C., in October, titled "Addressing Depression in Minority Communities" and held in conjunction with National Depression Screening Day. It was sponsored by the Mental Health America (NMHA), the Congressional Black Caucus, the Congressional Group on Mental Health and Health Issues, and Rep. Ciro Rodriquez (D-Tex.), cochair of the Congressional Hispanic Caucus Task Force on Health.

First, there is little doubt that the need for mental health treatment among minorities is great, speakers at the briefing concurred. For instance, Rep. Julia Carson (D-Ind.) is concerned about depressed African-American teenagers who would rather sleep in abandoned buildings than live with crack-addicted mothers abused by boyfriends. Moreoever, Kermit Crawford, Ph.D., director of the Multicultural Mental Health Research Center at Boston University, reported that 46 percent of female Hispanic Americans are depressed, and of all American minorities, Native Americans have the highest depression rate of all—50 percent.

Second, the mental health needs of American minorities may be even greater than statistics suggest, speakers said. For instance, the suicide rate of Caucasian Americans has been traditionally presented as higher than that of African Americans, pointed out Alvin Poussaint, M.D., a Boston psychiatrist and coauthor of the book Lay My Burden Down: Unraveling Suicide and the Mental Health Crisis in African Americans. Yet Poussaint questioned whether the numbers about African Americans reflect the truth. Poussaint does not believe that African Americans are as "happy go lucky" as many Caucasian Americans think. He cited his own brother as an example. His brother died from a heroin overdose. Was it an accident? Or suicide? Poussaint suspects the latter since his brother had been depressed and lacking a sense of self-worth for a long time before he died.

So why are the mental health needs of minorities so vast? One reason is the reluctance of many minority members to seek help, speakers pointed out.

And why don’t they seek help? One reason is attitude toward mental illness, they continued. For instance, the subject of depression tends to be taboo among many African Americans, Millicent Gorham, executive director of the National Black Nurses Association, said. Poussaint agreed: A number of African Americans view depression as a sign of moral weakness and, as a result, do not reach out for help.

But another reason many minority members do not seek help is that they fear authority figures, and that includes psychiatrists and their teams. That is the case for a number of Hispanic Americans, Gustavo Goldstein, M.D., a North Potomac, Md., psychiatrist, reported. And their reluctance, he said, essentially stems from bad experiences that they have had with authority figures while they still lived in Central or South America.

In fact, Goldstein attested, he truly understands their predicament because of his own experience along these lines. Back when Goldstein lived in Argentina, before he emigrated to the United States, a military coup took place in that country, and people started disappearing. Goldstein feared that he too might be snatched up, thrown into prison, or killed. And even now, in the United States, when a police car pulls up next to his car, he feels a tightening in his gut.

Still another reason the mental health needs of American minorities are so extensive is lack of access to care, speakers concurred. For example, many Hispanic Americans work in modest jobs or are unemployed and therefore do not have health insurance, Goldstein emphasized. Many African Americans do not get state-of-the-art mental health care, Crawford stressed. And sometimes facilities simply do not exist. Rep. Sheila Jackson Lee (D-Tex.) said that she has a vision of a person of color being able to walk down his or her street and find a community mental health center, something that happens only too rarely, even in white communities.

Fortunately, though, some efforts are being made to get more care to those minorities in need, speakers said. For instance, the National Black Nurses Association and the NMHA, with financing from Eli Lilly, are using volunteer nurses around the United States to screen minorities for depression. If people are found to be in need of help, Gorham explained, they will be sent to their primary care providers, and if they have no providers, treatment will be arranged for them. Rep. Marcy Kaptur (D-Ohio) reported that she and some colleagues in Congress are working on a bill that would provide intense mental health treatment in conjunction with Medicaid. For that, the NMHA is both excited and grateful, declared Michael Faenza, president and CEO of the NMHA.