Tune into a television medical drama and most often you will get a glimpse into the emergency department of a hospital. Nighttime TV portrays the fast-paced environment of the ER as an exciting, even s*xy, place for nurses to work.
But one area of nursing that doesn't receive nearly as much media attention, yet is just as rewarding a career opportunity, is psychiatric-mental health (PMH) nursing—a specialty that is in urgent need of more minority nurses from all racial and ethnic backgrounds.
"If [people who are interested in pursuing careers in nursing] only see what's on television and the glamorous parts of the ER or some other very acute care setting, they don't get to see much about what working with patients who have mental disorders is all about.
We have to do a better job in our nursing programs to get [students interested in the specialty]," says Ann K. Beckett, PhD, RN, assistant professor in the Division of Mental Health Nursing at Oregon Health & Science University School of Nursing in Portland.
While PMH education is now incorporated into most nursing school curricula, it's not a specialty that many nurses choose to pursue. Beckett believes that students need to have positive exposure to mental health nursing early on in their studies, including exposure to faculty members who have a strong interest in mental health.
"A lot of curricula are changing and [schools are teaching] mental health nursing in all of the [programs] so that [students] at least know enough about it to make a decision if that's where they want to work," she says.
One reason why more nurses in general do not go into PMH nursing is because of fear and misperceptions about mentally ill patients, who are often stereotyped as dangerous and untreatable.
But PMH nurses who are passionate about their field believe it provides an exceptional opportunity to make a real difference in improving the quality of people's lives. Untreated mental illness can have a devastating impact on individuals, families and entire communities.
"Poor mental health is the thief of all health," says Faye Gary, EdD, RN, FAAN, Medical Mutual of Ohio Kent W. Clapp chair and professor of nursing at Case Western Reserve University's Frances Payne Bolton School of Nursing in Cleveland, Ohio.
"Without good mental health people can't function in their families, they can't function on the job as a valuable and productive employee and they cannot contribute to their communities and neighborhoods. So they fail in three of the basic domains where it's important for people to be productive."
Well-documented racial and ethnic disparities in mental health outcomes and access to treatment point to a huge need for more minority nurses in the specialty. According to the Centers for Disease Control and Prevention (CDC)'s Office of Minority Health & Health Disparities:
African Americans are more likely to experience mental disorders than whites, but are less likely to seek treatment.
Asian Americans and Pacific Islanders are only 25% as likely as whites and 50% as likely as African Americans and Hispanics to seek outpatient mental health care, and they are less likely than whites to receive inpatient care. When they do seek care, they are more likely to be misdiagnosed as "problem-free."
American Indians and Alaska Natives suffer from disproportionately high rates of depression and substance abuse and are overrepresented in inpatient mental health care compared to whites.
"There's a definite stigma attached to mental illness, and yet African Americans are more apt to be diagnosed with schizophrenia than any other ethnic group.
Latino women are more apt to be diagnosed with anxiety and depression than any other group," says Norma Martinez Rogers, PhD, RN, FAAN, clinical professor at the University of Texas Health Science Center at San Antonio School of Nursing and president of the National Association of Hispanic Nurses (NAHN).
Social and Cultural Complexities Minority health disparities are often a tangled web of inequities that can be traced back to a variety of socioeconomic and cultural issues.
When it comes to treating mental illness in communities of color, health care professionals are not only dealing with troubled minds but with complex social problems, such as racism, poverty, crime, violence and historical trauma, all of which can take a toll on mental health.
According to the 2001 Surgeon General's report Mental Health: Culture, Race and Ethnicity:
African Americans, Hispanics and American Indians/Alaska Natives have higher incarceration rates than whites.
In a 1993 study, over one-fourth of African American youth who had been exposed to violence had symptoms severe enough to meet the diagnostic criteria for post-traumatic stress disorder (PTSD).
Many Central American immigrants in the U.S. are not recognized as political refugees, despite the fact that the war-related trauma that preceded their immigration may place them at high risk for PTSD.
Many American Indian/Alaska Native people live in stressful environments with potentially negative mental health consequences.
Add in factors like cultural differences and language barriers and it's clear why more minority mental health nurses are needed.
In many cases, minority nurses who share the same cultural background as their patients can bring to the table a first-hand understanding of the patient's life and societal experiences, which enables them to build trust and rapport.
Patients of color who are suffering from depression or other types of psychological distress may feel more comfortable when they are treated by a nurse who looks like them and/or speaks their language.
The linguistic piece is especially important in mental health nursing because so much of the treatment is based on verbal communication.
Nurses need to know the language, but they also need to know the cultural nuances."
Culturally competent nurses can also help break through barriers of cultural stigma about mental illness that can prevent patients of color from receiving the care they need.
For example, Beckett notes that African Americans tend to keep their mental health problems a secret.
They do not talk about it openly or try to seek care, because of the shame and embarrassment they feel. Instead, they are more likely to turn to their church community for help, which may do more harm than good if the pastor or minister doesn't have a good grasp of mental health principles.
"And even if they do seek care," she says, "if they have a therapist or [other mental health professional] whom they don't feel they can relate to based on their cultural background, it limits how much they can build a trusting relationship with that health care provider
It's a different relationship, because [patients are] very vulnerable in those situations. It's important for them to have someone they feel they can relate to and [who will] understand what [they're] experiencing at that time."
"Minorities [already] have limited access to mental health care," adds Rogers. "Being treated by someone who lacks cultural sensitivity or who doesn't understand your culture leads to disparities in the quality of care as well."
