August 2001

Secretary of Health and Human Services

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.

To ensure that the messages outlined by the Surgeon General in this document reach the American people, the Department of Health and Human Services encourages its State and local partners to engage communities and listen to their needs. We must understand how local leaders and communities, including schools, families, and faith organizations, can become vital allies in the battle against disparities. Together, we can develop a shared vision of equal access to effective mental health services, identify the opportunities and incentives for collaborative problem solving, and then seize them. From a commitment to health and mental health for all Americans, communities will benefit. States will benefit. The Nation will benefit.

As was the case when Mental Health: A Report of the Surgeon General was released in 1999, Mental Health: Culture, Race, and Ethnicity provides cause for both celebration and concern for those of us at the Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS). We celebrate the Supplement's comprehensive coverage of issues relevant to the mental health of racial and ethnic minorities, its providing a historical and cultural context within which minority mental health may be better understood, and its appreciation of the hardships endured and the strength, energy, and optimism of racial and ethnic minorities in their quest for good mental health. The Supplement causes us concern because of its finding that very serious disparities do exist regarding the mental health services delivered to racial and ethnic minorities. We must eliminate these disparities.

SAMHSA and CMHS envision a Nation where all persons, regardless of their culture, race, or ethnicity, enjoy the benefits of effective mental health preventive and treatment services. To achieve this goal, cultural and historical context must be accounted for in designing, adapting, and implementing services and service delivery systems. Communities must ensure that prevention and treatment services are relevant, attractive, and effective for minority populations. As the field learns more about the meaning and effect of cultural competence, we will enrich our commitment to the delivery of evidence-based treatment, tailored to the cultural needs of consumers and families. This Supplement, and the activities it will inspire, represents both a Surgeon General and a Department striving to improve communication among stakeholders through a shared appreciation of science, culture, history, and social context.

Not only does this Supplement provide us with a framework for better understanding scientific evidence and its implications for eliminating disparities, it also reinforces a major finding of Mental Health: A Report of the Surgeon General. That is, it shows how stigma and shame deter many Americans, including racial and ethnic minorities, from seeking treatment. SAMHSA and CMHS have long been leaders in the fight to reduce the stigma of mental illness. We pledge to carry on our efforts in this fight.

SAMHSA and CMHS are proud to have developed this Supplement in consultation with the National Institute of Mental Health (NIMH) in the National Institutes of Health. NIMH has contributed to this Supplement in innumerable ways, and many of the future directions reflected herein, especially those related to the need for more research, can be addressed adequately only through NIMH's leadership. We are grateful that this leadership and the commitment to eliminating mental health disparities are well established at NIMH.

We again celebrate the publication of this Supplement, and we trust that you will see it as we do - as a platform upon which to build positive change in our mental health system for racial and ethnic minorities, and indeed, for our Nation as a whole.

Joseph H. Autry III, M.D

Acting Administrator

Substance Abuse and Mental Health Services Center for Mental Health Services Administration

Bernard S. Arons, M.D.

Director

Center for Mental Health Services

from the Surgeon General U.S. Public Health Service

Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General's report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders.

The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and availability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs.

A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.

Just as health disparities are a cause for public concern, so is our diversity a national asset. This Supplement carries with it a call to the people of the United States to understand and appreciate our many cultures and their impact on the mental health of all Americans. The main message of this Supplement - that culture counts - should echo through the corridors and communities of this Nation. In today's multi-cultural reality, distinct cultures and their relationship to the broader society are not just important for mental health and the mental health system, but for the broader health care system as well.

This Supplement encourages racial and ethnic minorities to seek help for mental health problems and mental illnesses. For this advice to be meaningful, it is essential that our Nation continues on the road toward eliminating racial and ethnic disparities in the accessibility, availability, and quality of mental health services. Researchers are working to fill gaps in the scientific literature regarding the exact roles of race, culture, and ethnicity in mental health, but much is already known. The mental health system must take advantage of the direction and insight offered by the research presented in this Supplement. Because State and local governments have primary oversight of public mental health spending, they have a clear and important role in assuring equal access to high quality mental health services for racial and ethnic minorities. Just as important, we need to redouble our efforts to support communities, especially consumers, families, and community leaders, in welcoming and demanding effective treatment for all. When it is easy for minorities to seek and use treatment, our vision of eliminating mental health disparities becomes a reality.

Finally, as noted in the previous report, it is inherently better to prevent an illness from occurring in the first place than to need to treat it once it develops. Just as other areas of medicine have promoted healthy lifestyles and thereby have reduced the incidence of conditions such as heart disease and some cancers, so now is the time for mental health providers, researchers, and policy makers to focus more on promoting mental health and preventing mental and behavioral disorders. Following this course will yield incalculable benefits, not only in terms of societal costs, but also in the significant decrease of human suffering.

David Satcher, M.D., Ph.D. Surgeon General

This report was prepared by the Department of Health and Human Services under the direction of the Office of the Surgeon General, in partnership with the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and in consultation with the National Institutes of Health, National Institute of Mental Health.

RADM Arthur Lawrence, Ph.D., R.Ph., Assistant Surgeon General, Acting Principal Deputy Assistant Secretary for Health, Office of Public Health and Science, Office of the Secretary, Washington, D.C.

RADM Kenneth Moritsugu, M.D., M.P.H., Deputy Surgeon General, Office of the Surgeon General, Office of the Secretary, Washington, D.C.

CAPT Allan Noonan, M.D., M.P.H., Senior Advisor, Office of the Surgeon General, Office of the Secretary, Washington, D.C.

Joseph H. Autry III, M.D., Acting Administrator, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Bernard S. Arons, M.D., Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Camille Barry, Ph.D., Deputy Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Michael English, J.D., Director, Division of Knowledge Development and Systems Change, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

RADM Brian Flynn, Ed.D., Director, Division of Program Development, Special Populations and Projects, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Anne Mathews-Younes, Ed.D., Chief, Special Programs Development Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Ruth L. Kirschstein, M.D., Acting Director, National Institutes of Health, Bethesda, Maryland.

Steven E. Hyman, M.D., Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Richard Nakamura, Ph.D., Deputy Director, National Institte of Mental Health, National Institutes of Health, Rockville, Maryland.

Jeanne Miranda, Ph.D., Senior Science Editor, Professor, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Neuropsychiatric Institute, Los Angeles, California.

Lonnie R. Snowden, Ph.D., Science Editor, Director, Center for Mental Health Services Research, Professor, School of Social Welfare, University of California, Berkeley, California.

Spero M. Manson, Ph.D., Science Editor, Professor and Head, American Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado Health Sciences Center, Denver, Colorado.

Stanley Sue, Ph.D., Science Editor, Professor, Departments of Psychiatry and Psychology, Director, Asian American Studies Program, University of California, Davis, California.

Steven R. Lopez, Ph.D., Science Editor, Professor, Department of Psychology, University of California, Los Angeles, California.

Nancy J. Davis, Ed.D., Managing Editor, Public Health Advisor, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Kana Enomoto, M.A., Associate Managing Editor, Public Health Advisor, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

CAPT Norma J. Hatot, Associate Managing Editor, Senior Nurse Consultant, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Miriam Davis, Ph.D., Senior Science Writer, Medical Writer and Consultant, Silver Spring, Maryland.

Sharon Hogan, M.A., Science Writer, Hingham, Massachusetts.

Donna Chen, M.D., Assistant Professor, University of Virginia, Charlottesville, Virginia.

Laura Kohn, Ph.D., Assistant Professor, Department of Psychology, University of Michigan.

David Takeuchi, Ph.D., Professor, Department of Sociology, Indiana University, Bloomington, Indiana.

Margarita Alegria, Ph.D., Associate Professor, Department of Administration, School of Public Health, Center for Evaluation and Socioeconomic Research, University of Puerto Rico, San Juan, Puerto Rico.

James P. Allen, Ph.D., Professor, Department of Geography, California State University Northridge, Northridge, California.

Naleen Andrade, M.D., Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii.

Thomas E. Arthur, M.Ed., M.A., Liaison for Consumer/Family, Core Service Agencies and Community Affairs, Maryland Health Partners, Columbia, Maryland.

Carl C. Bell, M.D., President and CEO, Community Mental Health Council, Chicago, Illinois.

Kinike Bermudez, Consumer Advocate, National Asian American Pacific Islander Mental Health Association, Richardson, Texas.

Theresa Chapa, Ph.D., Senior Social Science Analyst, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Daniel P. Chapman, Ph.D., Psychiatric Epidemiologist, Center for Disease Control and Prevention, Atlanta, Georgia.

Peggy Clark, M.S.W., M.P.A., Technical Director, Disabled and Elderly Health Program Group, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services, Baltimore, Maryland.

H. Westley Clark, M.D., J.D., M.P.H., Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Kim Crocker, R.N., Special Assistant to the Deputy Commissioner for International and Constituent Relations, Office of the Commissioner, Food and Drug Administration, Rockville, Maryland.

Terry L. Cross, A.C.S.W., Executive Director, National Indian Child Welfare Association, Portland, Oregon.

Marsha Davenport, M.D., M.P.H., Chief Medical Officer, Office of Strategic Planning, Centers for Medicare and Medicaid Services, Baltimore, Maryland.

King Davis, Ph.D., Robert Lee Sutherland Chair in Mental Health and Social Policy, University of Texas, Austin, Texas.

Deborah Duran, Ph.D., Former Public Health Analyst, Office of Policy and Program Coordination, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Tom Edwards, Chief, Clinical Interventions and Organizational Models Branch, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Lloyd C. Elam, M.D., Professor Emeritus, Department of Psychiatry, Meharry Medical College, Nashville, Tennessee

Kathryn Ellis, J.D., Principal Deputy Director, Office for Civil Rights, Office of the Secretary, Washington, D.C.

Jill Erickson, M.S.W., A.C.S.W., Public Health Advisor, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Javier Escobar, M.D. Professor and Chairman, Department of Psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey.

Loma K. Flowers, M.D., Clinical Professor of Psychiatry, University of California at San Francisco, San Francisco, California

Blanca Fuentes, M.P.A., Public Affairs Coordinator, Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland.

Rosa M. Gil, D.S.W., Special Advisor to the Mayor for Health Policy, New York City Mayor's Office of Health Services, New York, New York.

Sherry A. M. Glied, Ph.D., Associate Professor, Joseph

L. Mailman School of Public Health, Columbia University, New York, New York.

Howard Goldman, M.D., Ph.D., Professor of Psychiatry, University of Maryland School of Medicine, Potomac, Maryland.

Junius Gonzales, M.D., Chief, Services Research and Clinical Epidemiology Branch, Division of Services Intervention Research, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Eric Goplerud, Ph.D., Acting Associate Administrator, Office of Policy and Program Coordination, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Maria Guajardo-Lucero, Ph.D., Executive Director, Assets for Colorado Youth, Denver, Colorado.

Peggy Halpern, Ph.D., Program Specialist, Administration on Aging, National Institutes of Health, Bethesda, Maryland.

Kevin Hennessy, M.P.P., Ph.D., Health Policy Analyst, Office of the Assistant Secretary for Planning and Evaluation, Washington, D.C.

Pablo Hernandez, M.D., Administrator, Wyoming State Commission for Mental Health, Division of Behavioral Health, Evanston, Wyoming.

Angelia Hill, Office of Minority Health, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Tiffany Ho, M.D., Former Senior Medical Policy Advisor, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Michael F. Hogan, Ph.D., Director, Ohio Department of Mental Health, Columbus, Ohio.

Thomas Horvath, M.D., F.R.A.C.P., Chief of Staff, Houston VAMC, Houston, Texas.

Larke Nahme Huang, Ph.D., Director of Research, National Technical Assistance Center for Children's Mental Health, Georgetown University Medical Center, Washington, D.C.

DeLoris Hunter, Ph.D., Director, Office of Minority Health, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

D.J. Ida, Ph.D., Executive Director, National Asian American Pacific Islander Mental Health Association, Denver, Colorado.

Diane Justice, Principal Deputy Assistant Secretary, Office of the Assistant Secretary for Aging, Administration on Aging, Washington, D.C.

Mireille Kanda, M.D., M.P.H., Director, Health and Disabilities Services, Administration of Children, Youth and Families, Administration for Children and Families, Washington, D.C.

George Kanuck, Public Health Analyst, Office of Policy, Coordination and Planning, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Kelly J. Kelleher, M.D., Staunton Professor of Pediatrics, Psychiatry, and Health Services, Schools of Medicine and Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Teresa La Fromboise, Ph.D., Associate Professor, School of Education, Stanford University, Palo Alto, California.

Inez Larsen, Ph.D., Program Director, Youth Regional Treatment Center, Right Road Recovery Programs, Inc., Corning, California.

Keh-Ming Lin, M.D., M.P.H., Professor and Director of Research, Center on the Psycho-biology of Ethnicity, Harbor-UCLA Medical Center, Torrance, California.

Francis Lu, M.D., Professor of Clinical Psychiatry, Director, Cultural Competence and Diversity Program, Department of Psychiatry, University of California, San Francisco, California.

Gerrie Maccannon, M.P.H., Special Assistant to the Director, Office of Minority Health, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Delores Macey, Ph.D., Director, Cultural Action Program, South Carolina Department of Mental Health, Columbia, South Carolina.

Maria Mar, Director, Rehabilitation Support Team, Community Support Network, Santa Rosa, California.

Anthony Marsella, Ph.D., D.H.C., Professor, Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii.

Harriet G. McCombs, Ph.D., Senior Mental Health Advisor, Bureau of Primary Health Care, Health Resources and Services Administration, Bethesda, Maryland.

Jacki McKinney, M.S.W., Consultant, Philadelphia, Pennsylvania.

Denise Middlebrook, Ph.D., Public Health Advisor, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Charlotte Mullican, M.P.H., Health Scientist Administrator, Agency for Healthcare Research and Quality, Rockville, Maryland.

Hector Myers, Ph.D., Professor, Department of Psychology, University of California, Los Angeles, California.

Linda James Myers, Ph.D., Associate Professor, Department of African-American and African Studies, Ohio State University, Columbus, Ohio.

Harold W. Neighbors, Ph.D., Associate Professor, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.

James O'Brien, Program Specialist, Head Start Bureau, Administration for Children and Families, Washington, D.C.

Delores Parron, Ph.D., Deputy Assistant Secretary for Program Systems, Office of the Assistant Secretary for Planning and Evaluation, Washington, D.C.

Chester M. Pierce, M.D., Professor Emeritus, Psychiatry and Education, Harvard University School of Medicine, Harvard University Graduate School of Education, Boston, Massachusetts

Bernice Pescosolido, Ph.D., Professor, Department of Sociology, Indiana University, Bloomington, Indiana.

Aquila Powell, Special Assistant, Office of the Assistant Secretary for Legislation, Washington, D.C.

Andres J. Pumariega, M.D., Department of Psychiatry, East Tennessee State University, Johnson City, Tennessee.

Juan Ramos, Ph.D., Senior Advisor, Office of the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Rochelle Rollins, Ph.D., Special Assistant, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland.

Josie T. Romero, M.S.W., President, National Latino Behavioral Health Association, Gilroy, California.

Soledad Sambrano, Ph.D., Team Leader, Individual and Family Studies Unit, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Ruth Sanchez-Way, Ph.D., Acting Director, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Jean G. Spaulding, M.D., Vice Chancellor for Health Affairs, Duke University Medical Center, Durham, North Carolina

RADM Nathan Stinson, Jr., Ph.D., M.D., M.P.H., Deputy Assistant Secretary for Minority Health, Office of Public Health and Science, Office of the Secretary, Department of Health and Human Services, Rockville, Maryland.

Carolyn Strete, Ph.D., Associate Director for Health Disparities, Office of the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Gregg Taliaferro, Ph.D., Social Scientist, Agency for Healthcare Research and Quality, Rockville, Maryland.

Pamela Thurman, Ph.D., Research Associate, Tri-Ethnic Center for Prevention Research, Colorado State University, Fort Collins, Colorado.

RADM W. Craig Vanderwagen, M.D., Assistant Surgeon General, and Director, Office of Clinical and Preventive Services, Indian Health Service, Rockville, Maryland.

William Vega, Ph.D., Professor, Department of Psychiatry, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey.

Kenneth B. Wells, M.D., M.P.H., Professor, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Neuropsychiatric Institute, Los Angeles, California.

David R. Williams, Ph.D., Professor, Department of Sociology, University of Michigan, Ann Arbor, Michigan.

Roy C. Wilson, M.D., Director, Missouri Department of Mental Health, Jefferson City, Missouri.

Wilbur Woods, M.A., Management Analyst, Behavioral Health, Rockville, Maryland.

RADM Thomas Bornemann, Ed.D., Former Deputy Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Rhonda Baron-Hall, Ph.D., University of Pittsburgh at Bradford, Bradford, Pennsylvania.

Cheryl A. Boyce, Ph.D., Acting Chief, Sociocultural Processes and Health Disparities Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Shelly Burgess, Office of External Liaison, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Nelba Chavez, Ph.D., Former Administrator, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Jennifer Fiedelholtz, Ph.D., Office of Policy and Program Coordination, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Theodora Fine, M.A., Senior Public Affairs Specialist and Director of Communications Policy and Strategy, Office of Communications, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Charlotte Gordon, Writer/Editor, Office of the Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

LTJG Christine L. Guthrie, M.P.H., Public Health Advisor, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Sabrina Harrison, Secretary, Office of the Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Timothy C. Hays, Ph.D., Special Assistant to the Deputy Director, Office of the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Denyse Hicks, Ph.D., African American Women's Mental Health Authority, Philadelphia, Pennsylvania.

Ann A. Hohmann, Ph.D., M.P.H., Chief, Methodological , Sociocultural Services, and Quality of Care Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Jeannette Johnson, Ph.D., Associate Professor, Department of Psychiatry, University of Maryland, Baltimore, Maryland.

Mary Knipmeyer, Ph.D., Program Director, HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study. Office of the Associate Director for Medical Affairs, Center for Mental Health Services, Rockville, Maryland.

Kathy L. Kopniski, Ph.D., Special Assistant to the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Nicole Lurie, M.D., M.S.P.H., Former Principal Deputy Assistant Secretary for Health, Office of Public Health and Science, Office of the Secretary, Washington, D.C.

Michael Malden, Public Affairs Specialist, Office of External Liaison, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Beverly L. Malone, Ph.D., R.N., F.A.A.N., Former Deputy Assistant Secretary for Health, Office of Public Health and Science, Office of the Secretary, Washington, D.C.

Lynn Mandujano, Editor, Program Support Center, Department of Health and Human Services, Rockville, Maryland.

Anna Marsh, Ph.D., Director, Office of Program Services, Division of Administrative Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Leah McGee, Program Assistant, Office of the Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Carolyn O'Connor, Project Director, Program Support Center, Department of Health and Human Services, Rockville, Maryland.

Rajesh Rao, Office of the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

CAPT Patricia Rye, J.D., M.S.W., Former Managing Editor, Office of the Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Juned Siddique, M.S., Statistician, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Neuropsychiatric Institute, Los Angeles, California.

Anne Thomas, Editor, Program Support Center, Department of Health and Human Services, Rockville, Maryland.

Damon Thompson, Director of Communications, Office of Public Health and Science, Office of the Assistant Secretary, Washington, D.C.

Mark Weber, Associate Administrator, Office of Communications, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.

Parklawn Health Library Staff, Rockville, Maryland.

Numerous interns from various programs including the Hispanic Association of Colleges and Universities and the National Association for Equal Opportunity in Higher Education.