Mental illness is an equal opportunity disease, affecting whites and African-Americans about the same. What is different, especially for African-Americans in the Delta, are the barriers to mental health services, including perceptions that make them less willing to seek help.
Two years ago a first-of-its-kind study of the issue grew out of discussion with community advocates who have a history of partnership with UAMS and its Translational Research Institute.
“Mental disorders are prevalent and disabling, and we know that African-Americans are less likely to get help,” said Greer Sullivan, M.D., M.S.P.H., a UAMS professor of psychiatry and the study’s principal investigator. Mental disorders affect 1 out of 10 men and 4 out of 10 women, and depression is the second most disabling condition behind heart disease.
“We also know that these disorders are influenced by stress,” said Sullivan, a veteran community-based researcher who formerly directed the Translational Research Institute’s Community Engagement program and was the institute’s co-principal investigator. “So when you live in poverty and you live with racism and in sub-optimal environmental conditions, you are under a lot more stress than someone who doesn’t.”
Naomi Cottoms and Mary Olson, leaders of the Tri-County Rural Health Network, first discussed the mental health problem with Kate Stewart, M.D., M.P.H., a researcher at the UAMS Fay W. Boozman College of Public Health who has collaborated with the group on several research projects. Stewart then brought in Sullivan.
The group developed a plan that resulted in UAMS earning its first research grant from the national Patient Centered Outcomes Research Institute (PCORI), which requires researchers to make true partners of the communities they are studying.
There is both what we would call poor mental health literacy and a huge amount of stigma.Greer Sullivan, M.D., M.S.P.H.
Traditionally, researchers would use focus groups with key stakeholder groups defined by investigators to find out how the community thinks about a given issue. The Tri-County group, however, uses public forums, a structured but more inclusive approach of engaging citizens to participate in decision-making.
“We realized that Ms. Cottoms and Dr. Olson were doing something very innovative with community forums,” Sullivan said. “They’ve been doing them for a long time and they’ve done them primarily to get community input on a number of topics – not only topics related to health.”
Based in Jefferson County, Sullivan’s PCORI study has used both focus groups and forums and is comparing the outcomes. She and other researchers on the study, including Geoff Curran, Ph.D., Ann Cheney, Ph.D., Tiffany Haynes, Ph.D., and Keneshia Bryant, Ph.D., have talked to a cross-section of people, including mental health providers, people with mental illness, clergy and college students.
“We have literally talked to hundreds of people – real people in the real world,” Sullivan said. “That’s how we’ve come to understand these major issues from the point of view of the community.”
The early take-away is that mental illness is poorly understood in the Delta. “There is both what we would call poor mental health literacy and a huge amount of stigma,” Sullivan said.
Ultimately Sullivan hopes the pilot study data will lead to successful interventions.
“We are planning our next study to test effective ways to address mental health literacy and stigma.”