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Mental Health Care: Why Some Get It And Some Don't


I'm Michel Martin and this is TELL ME MORE from NPR News. Coming up in money coach - look, you're a college student, you're hard-pressed for some cash and one of your classmates invites you to a, quote, amazing business opportunity. Is there a way to tell if it's the real deal and not just a scam? We'll take a closer look at some of these schemes or scams that seem to target college students in just a few minutes.

But, first, we want to take a closer look at that very disturbing story that happened in Washington, D.C. last week. This one involved the young woman who led police on a car chase near the White House. She had her baby in the car and the whole thing ended with police fatally shooting her. Her name was Miriam Carey and her family members say they still don't understand exactly what sparked it all, but they do acknowledge she was struggling with mental illness. Her sister, Amy Carey-Jones, talked about this on CNN with Anderson Cooper.


AMY CAREY-JONES: She seemed to be overwhelmed. A lot of stress. She had a lot of events occurring in her life. And she was diagnosed with depression and with the psychosis. We found out about it. She dealt with that and there was not moments of her walking around with delusions, that's not what was going on.

MARTIN: As we said, there's still a lot we don't know. But we thought this was a good time to talk again about access to mental health care, especially if that access is different for different groups of people. Joining us to talk more about this is Dr. Annelle Primm. She is the deputy medical director of the American Psychiatric Association. She's director of its Office of Minority and National Affairs. Needless to say, she's a board-certified psychiatrist. Thank you so much for joining us.

ANNELLE PRIMM: Thank you for having me.

MARTIN: We recognize you certainly haven't met or evaluated Miriam Carey. But what do you make of her story?

PRIMM: This is a very sad situation and my heart goes out to the family. It brings our attention to the issue of mental illness. And it's been reported that she had a mental illness. Depression was mentioned. Psychosis was mentioned. Even a head injury was mentioned. Loss of a job, single mother, all of these things. They give us an opportunity to focus on the issue of mental illness. They are real and we must pay more attention to it. And it gives us an opportunity to talk about this issue, particularly as it relates to the African-American community.

MARTIN: Well, what kind of conversation should we be having about this? I mean, you can see where people might have different opinions about this. Some people might say this is just another opportunity to expose people to stigma. So they wouldn't want, necessarily, people to focus on the race and ethnicity piece of this. Do you think that race and gender is relevant here?

PRIMM: I think race and gender is relevant because we know that African-Americans and other people of color who experience a mental illness are less likely to get access to services. And when they do, oftentimes, it's not the best quality care.

MARTIN: Which is the relevant piece here? Is it the gender piece, or the race and ethnicity piece?

PRIMM: All of the pieces are relevant. And, you know, in general, depression and other mental illnesses are important for us to talk about in the general population. Then if we look at women, we know that there's a higher risk for depression and anxiety disorders among women. In fact, some reports that women experience these disorders twice as much as men do. And then, when we look at African-American women and African-Americans in general, that, too, is an issue because of what I said about the disparities, lack of access.

But, generally speaking, illnesses like depression, for instance, occur pretty much at a similar rate as other racial and ethnic groups. But the difference is that among African-Americans, these illnesses tend to be more chronic and disabling and - because there's a less of a likelihood of people getting treatment and quality treatment. So, there are a lot of levels here that we could address.

MARTIN: But why are African-Americans less likely to get treatment?

PRIMM: There are a number of factors. A number of barriers. One is access. African-Americans are overrepresented among those who are uninsured. And if we want to focus on African-American women, they're overrepresented among the working poor who don't have insurance. You know, without insurance, many people don't have access to mental health services. But, you know, this is not just a socioeconomic issue, there are other barriers that get in the way of African-Americans of all socioeconomic levels receiving care. Some of the stigma that is connected to, you know, some of the cultural beliefs have kept mental illness pretty much in the shadows.

And, so, people feel uncomfortable because of the stigma and what some people call this double whammy of the stigma of being an African-American in this society and culture on top of having a mental illness, which is also stigmatized. We've made some gains in that area, raising awareness and so forth. But I think we still have a ways to go.

MARTIN: I can imagine that there are family members who are listening to this conversation who know what happened in Washington last week who are just wondering whether their family member could be next. Because here's a situation where this young woman did seem to have support in her life. I mean, she seemed to have family members who were savvy. There seemed to be awareness of what was needed to help her, but it somehow did not seem to be enough.

And I just wondered if you could offer some thought here about what people should do if they feel like they see a family member who's struggling and aren't sure what to do. Particularly when someone is an adult and someone's opportunity to intervene is more limited.

PRIMM: I think that family members, neighbors, coworkers, anyone who is in someone's kind of social sphere should educate themselves about mental illness, what some of the signs and symptoms are, and be aware of some of the resources and supports in one's community, so that when a loved one or friend or neighbor is in need, that we can encourage them to get help. Even go with them. Even if initially those suggestions are rebuffed, that people should keep trying and not give up. Because it's so important that people with a mental health need get connected to services.

MARTIN: I just have to ask you a very blunt question, though, Dr. Primm. Do those services actually exist? People talk about this all the time, they say get help, get help. Do those services actually exist for people who are in those circumstances?

PRIMM: Maybe in one's community there might not be actual psychiatric services available, but you can get services from a psychiatrist, from other mental health professionals as well, and even in the primary care community, which is a place where many Americans, if they seek mental health services at all, are most likely to receive them. And this is particularly true for African-Americans and other people of color. So, even one's general practitioner, internist, primary care provider could do screening for mental illness and provide treatment. And so, we need to get to the point where there's really no wrong door for people to enter into to get help. It may be the primary care setting.

And it could be the faith community, 'cause I didn't get to mention earlier that people of faith often turn to their religious institutions for help, and I think more and more people in the religious community are collaborating with mental health professionals. And they're even having mental health ministries in their religious institutions to help people who are going through mental health challenges. So there are many different resources out there.

MARTIN: Dr. Annelle Primm is director of Minority and National Affairs at the American Psychiatric Association. She was kind enough to join us here in our Washington, D.C. studios. Dr. Primm, thank you so much for speaking with us.

PRIMM: Thank you. Transcript provided by NPR, Copyright NPR.

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