As a nation, we have only begun to come to terms with the reality and impact of mental illnesses on the health and well being of the American people. This groundbreaking publication makes clear that the tragic and devastating effects of mental illnesses touch people of all ages, colors, and cultures. And though Mental Health: A Report of the Surgeon General informed us that there are effective treatments available for most disorders, Americans do not share equally in the best that science has to offer. Through the process of conducting his comprehensive scientific review for this Supplement, and with recognition that mental illnesses are real, disabling conditions affecting all populations regardless of race or ethnicity, the Surgeon General has determined that disparities in mental health services exist for racial and ethnic minorities, and thus, mental illnesses exact a greater toll on their overall health and productivity.Diversity is inherent to the American way of life, and so is equal opportunity. Ensuring that all Americans have equal access to high quality health care, including mental health care, is a primary goal of the Department of Health and Human Services. By identifying the many barriers to quality care faced by racial and ethnic minorities, this Supplement provides an important road map for Federal, State, and local leaders to follow in eliminating disparities in the availability, accessibility, and utilization of mental health services.An exemplary feature of this Supplement is its consideration of the relevance of history and culture to our understanding of mental health, mental illness, and disparities in services. In particular, the national prevention agenda can be informed by understanding how the strengths of different groups' cultural and historical experiences might be drawn upon to help prevent the emergence of mental health problems or reduce the effects of mental illness when it strikes. This Supplement takes a promising first step in this direction.One of the profound responsibilities of any government is to provide for its most vulnerable citizens. It is now incumbent upon the public health community to set in motion a plan for eliminating racial and ethnic disparities in mental health. To achieve this goal, we must first better understand the roles of culture, race, and ethnicity, and overcome obstacles that would keep anyone with mental health problems from seeking or receiving effective treatment. We must also endeavor to reduce variability in diagnostic and treatment procedures by encouraging the consistent use of evidence-based, state-of-the-art medications and psychotherapies throughout the mental health system. At the same time, research must continue to aid clinicians in understanding how to appropriately tailor interventions to the needs of the individual based on factors such as age, gender, race, culture, or ethnicity.

The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities-including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives-are the fastest growing segments of the population and emerging as the nation's majority. Despite the rapid growth of racial and ethnic minority groups, their representation among the nation's health professionals has grown only modestly in the past 25 years. This alarming disparity has prompted the recent creation of initiatives to increase diversity in health professions. In the Nation's Compelling Interest considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies. Assessing the potential benefits of greater racial and ethnic diversity among health professionals will improve the access to and quality of healthcare for all Americans.

A thought-provoking and evocative account that considers both the policies we think of as "health policyand those that we don't, The Political Determinants of Health provides a novel, multidisciplinary framework for addressing the systemic barriers preventing the United States from becoming the healthiest nation in the world.

"Culture counts" has long been a rallying cry among health advocates and policymakers concerned with racial disparities in health care. A generation ago, the women's health movement led to a host of changes that also benefited racial minorities, including more culturally aware medical staff, enhanced health education, and the mandated inclusion of women and minorities in federally funded research. Many health professionals would now agree that cultural competence is important in clinical settings, but in what ways? Shattering Culture provides an insightful view of medicine and psychiatry as they are practiced in today's culturally diverse clinical settings. The book offers a compelling account of the many ways culture shapes how doctors conduct their practices and how patients feel about the care they receive. Based on interviews with clinicians, health care staff, and patients, Shattering Culture shows the human face of health care in America. Building on over a decade of research led by Mary-Jo Good, the book delves into the cultural backgrounds of patients and their health care providers, as well as the institutional cultures of clinical settings, to illuminate how these many cultures interact and shape the quality of patient care. Sarah Willen explores the controversial practice of matching doctors and patients based on a shared race, ethnicity, or language and finds a spectrum of arguments challenging its usefulness, including patients who may fear being judged negatively by providers from the same culture. Seth Hannah introduces the concept of cultural environments of hyperdiversity describing complex cultural identities. Antonio Bullon and Mary-Jo Good demonstrate how regulations meant to standardize the caregiving process—such as the use of templates and check boxes instead of narrative notes—have steadily limited clinician flexibility, autonomy, and the time they can dedicate to caring for patients. Elizabeth Carpenter-Song looks at positive doctor-patient relationships in mental health care settings and finds that the most successful of these are based on mutual "recognition"—patients who can express their concerns and clinicians who validate them. In the book's final essay, Hannah, Good, and Park show how navigating the maze of insurance regulations, financial arrangements, and paperwork compromises the effectiveness of mental health professionals seeking to provide quality care to minority and poor patients. Rapidly increasing diversity on one hand and bureaucratic regulations on the other are two realities that have made providing culturally sensitive care even more challenging for doctors. Few opportunities exist to go inside the world of medical and mental health clinics and see how these realities are influencing patient care. Shattering Culture provides a rare look at the day-to-day experiences of psychiatrists and other clinicians and offers multiple perspectives on what culture means to doctors, staff, and patients and how it shapes the practice of medicine and psychiatry.