Racial/Ehtnic Diversity In Mental Health Research Careers

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An Investment in America’s FutureRacial /Ethnic Diversity inMental Health Research CareersReport of the National Advisory Mental Health Council’s Workgroup onRacial/Ethnic Diversity in Research Training and Health Disparities ResearchDEPARTMENT OF HEALTH AND HUMAN SERVICESPUBLIC HEALTH SERVICENATIONALINSTITUTES OF HEALTHIINationalInstituteof MentalHealth

The National Advisory Mental Health Council Workgroup on Racial/Ethnic Diversity in Research Training andHealth Disparities Research conducted these deliberations and prepared this report.Recommended Citation:The National Advisory Mental Health Council Workgroup on Racial/Ethnic Diversity inResearch Training and Health Disparities Research, “An Investment in America’s Future:Racial/Ethnic Diversity in Mental Health Research Careers.”Washington, D.C.: 2001.Single copies of this report are available through:The National Institute of Mental HealthOffice of Communications and Public Liaison6001 Executive Boulevard, Room 8184Rockville, MD 20892-9663Telephone: 301-443-4513and are available online at www.nimh.nih.gov/council/diversity/pdf

An Investment in America’s FutureRacial/Ethnic Diversity inMental Health Research CareersReport of the National Advisory Mental Health Council’s Workgroup onRacial/Ethnic Diversity in Research Training and Health Disparities ResearchDEPARTMENT OF HEALTH AND HUMAN SERVICESPUBLIC HEALTH SERVICENATIONAL INSTITUTES OF HEALTHIINational Instituteof Mental Health

ContentsPreface . iExecutive Summary . 1Chapter I.Prologue . 9Workgroup Charges and Focus Areas . 11Strategic Plan for Reducing Health Disparities . 11Guiding Principles . 12Workgroup Composition . 12Workgroup Procedures and Process . 12Report Organization . 13Acknowledgment . 13Chapter II.The Importance of Racial/Ethnic Diversity in Mental Research andResearch Training Programs . 15The Importance of a Diversified Racial/Ethnic Mental HealthResearch Community . 15Ethnic Minorities and Disparities in Mental Health . 18Expanding the Scientific Knowledge Base by IncreasingRacial/Ethnic Minority Participation in Research Protocols . 19Conclusion . 20Chapter III.The Educational Context of Racial/Ethnic Minorities . 21Faculty . 21Students at Graduate/Professional Schools and Colleges/Universities . 22High School and Earlier . 25Barriers to Positive Educational Outcomes: Qualitative Data . 25Conclusion . 25Chapter IV.Progress in NIMH Support of Racial/Ethnic Minority Researchers and Trainees . 27NIMH Investigator-Initiated Applications and Awards by Race/Ethnicity . 27Research Training and Career Development Funding Mechanisms . 30Conclusion . 38

Chapter V.Mentoring and Model Programs . 39Mentoring and Tracking . 39Model Programs . 40Conclusion . 40Chapter V.Action Plan . 43Recommendation No. 1 . 43Recommendation No. 2 . 44Recommendation No. 3 . 45Recommendation No. 4 . 46Recommendation No. 5 . 46Recommendation No. 6 . 47Concluding Comment . 47References and Further Reading . 49AppendicesAppendix A. 1999 National Advisory Mental Health Council . 53Appendix B. National Advisory Mental Health Council Workgroup . 55Appendix C. National Advisory Mental Health Council . 58Appendix D. October 1999 NIMH Workshop . 60Appendix E. Special Consultants . 64Appendix F. Research Training and Development Timetable (Funding Mechanisms) . 65Appendix G. Native American Colleges . 66Appendix H. America’s Predominantly African-American Colleges and Universities . 68Appendix I. Hispanic-Serving Colleges and Universities . 73Figure, Table, and Box References . 78

PrefaceEliminating disparities in mental health treatment outcomes among various population groups andtraining a scientific workforce for research on mental disorders that reflects the full racial and ethnicdiversity of the Nation are separate but related challenges, and the National Institute of Mental Health(NIMH) is committed to addressing each. This report on Racial/Ethnic Diversity in Mental HealthResearch Careers, prepared by the National Advisory Mental Health Council’s Workgroup onRacial/Ethnic Diversity in Research Training and Health Disparities Research will be a useful tool towardboth of these ends.The NIMH has a long history of supporting minority research training. In light of this history, twoparticularly significant contributions of this report are found in its analysis of where we have investedtraining funds over the past several years and in the glimpse it affords us of the yield of this investmentin the form of active minority researchers. As enlightening as they are, the available data make it clearthat we must find more effective strategies for following the progress of our trainees if we are to monitortrends in the increasing diversity of mental health researchers. The data also make clear the need todevelop new strategies for overcoming the barriers that impede career progress of minorities at various,identifiable points along the career continuum. Removing these barriers will require the collective effortof many agencies, organizations, and the private sector, all of which stand to gain from having wellprepared minority citizens as members of research, research education, and health practice teams,working in the best interest of all Americans.We thank the Council and its Workgroup for developing this report. NIMH will review it carefully andwill make every effort to respond productively to the recommendations.Steven E. Hyman, M.D.Director, NIMHv

Executive Summaryhowever, focuses on only one aspect of diversity,race/ethnicity.Mental disorders adversely affect individuals,family systems, our national infrastructure, andthe global economy. In the United States, mentaldisorders account for more than 15% of theburden of disease from all causes (Murray &Lopez, 1996), and their respective direct costs andindirect costs are estimated to be 69.0 billion(Mark et al., 1998) and 78.6 billion (Rice &Miller, 1996). These data (as noted in USDHHSMental Health: A Report of the Surgeon General,1999) indicate the social effects of mentaldisorders and reflect their staggering economicimpact on our Nation in its entirety. There exist,however, a paucity of empirical data that describethe impact and effects of mental disorders on ourNation’s racial/ethnic minority groups, defined inthis report as African Americans, AmericanIndians/Alaska Natives, Asian/Pacific Islanders,and Hispanics. Members of these groups remainunderrepresented or unreported in most studies ofmental illness, although they are overrepresentedamong the conditions thought to generatesusceptibility to, or prolong the effects of, mentalillness, such as poverty, racism, homelessness,incarceration, substance abuse, and poor access tohealth care. Thus the burden of mental illnessfalls disproportionately on minority groups. TheWorkgroup believes that an important componentin reducing that burden will be to bring a diversepopulation of research investigators to the task.Since its creation in 1946, the National Instituteof Mental Health (NIMH) has introduced a varietyof innovative funding mechanisms designed tofacilitate career development for mental healthresearchers in general, and racial/ethnic minorityinvestigators, specifically. Today, NIMH remains aleader at the National Institutes of Health inproviding funds for research training and researchfor racial/ethnic minority scientists. Despite theInstitute’s efforts, however, the number ofracial/ethnic minority investigators in mentalhealth related fields is considered insufficient tomeet current or projected demands.In 1999, the National Institute of Mental Health(NIMH) Director, Steven E. Hyman, M.D., calledfor an assessment of the Institute’s progress indeveloping racial/ethnic minority investigators. Heinitially asked staff to convene a workshop thatwould include interested members of the NationalAdvisory Mental Health Council (NAMHC), juniorand senior minority investigators, consultantswith expertise in diversity training, NIMH-fundedtraining program directors, NIMH trainingprogram administrators, and others concernedwith these issues. Upon issuance of a staff reporton the workshop findings, the NAMHC establisheda Council Workgroup to continue the assessment.This group, whose membership mirrored theworkshop participants, identified eight focus areasfor follow-up study. The foci were clustered intothree general domains: (a) the educational contextof the racial/ethnic minorities who constitute theWomen and other groups, including persons withdisabilities, are underrepresented amongresearchers receiving independent investigatorsupport from the NIMH, and targeted efforts areneeded to increase their numbers. This report,1

research, or other fields traditionally associatedwith clinical research, in light of projections thatthe current inventory of scientists is sufficient tomeet demands until the year 2005. At the sametime, however, the NRC recommended that NIHa) increase efforts to identify and supportprograms that encourage and prepare“underrepresented” minorities for careers in basicbiomedical research (p. 30); b) continue efforts toidentify and support programs that prepare andencourage underrepresented minorities for careersin behavioral and social science research (p. 41);c) intensify efforts to train and retain physiciansin clinical research (p. 52); and d) increase effortsto identify, support, encourage, and prepareunderrepresented minorities for careers in clinicalresearch (p. 52). The Workgroup also took note ofa National Science and Technology Council report(NSTC, 2000) that projects a shortfall in thescientific workforce by the year 2050 if correctiveactions—including an increase in the Nation’ssupply of racial/ethnic minority scientists—arenot implemented.trainee, faculty, mentor, and investigator“pipeline” in the United States; (b) the progressand status of racial/ethnic minority trainees andinvestigators supported by the NIMH; and (c)recommended actions the NIMH can take toimprove racial/ethnic minority representationamong trainees and investigators.The Workgroup analyzed qualitative andquantitative data relevant to each of thesedomains. To interpret the quantitative data, theWorkgroup used several reference points. In allcases, the representation of minorities amongNIMH support mechanisms was compared to theirrepresentation within the Nation’s population.Given that racial/ethnic minorities are frequentlyunderrepresented within latter stages of theeducational pipeline, it is important to apply asecond reference point, specifically the ethnicgroup’s representation in the pool from which thenext career stage draws. The former represents anaspirational goal, whereas the latter reflects theavailable pool from which institutions currentlydraw to promote minority representation.The second rationale for this report is grounded ina consensus that more racial/ethnic minoritymental health researchers are needed to addressthe disparities in access to and quality of healthcare experienced by the majority as well asminority populations in the United States.The Workgroup met periodically to reviewfindings, consult with subject matter experts, andgenerate recommendations.Rationale for Increasing DiversityThe third rationale for an increase, closely relatedto the second, reflects the need to enrich thescientific knowledge base through increasedparticipation, in every research arena, of bothracial/ethnic minority investigators and researchparticipants. The presence of more minority groupinvestigators would encourage more racial/ethnicminority individuals to participate in research.Moreover, both empirical and anecdotal evidencereveals that racial/ethnic minority investigatorsoften have a particular commitment to researchdesigned to address health care disparities.The Workgroup developed a three-prongedrationale for increasing the number of racial/ethnicminority scientists. Because these rationales areinterrelated, the order of presentation is not meantto suggest their relative merit.The first rationale derives from information andrecommendations developed by the NationalResearch Council (NRC Report, 2000), whichrecently recommended that there be no aggregateincrease, in the United States, of Ph.D.’s in basicbiomedical research, behavioral and social science2

and a quarter of African American adults did notcomplete high school. The exception, again, wereAsian/Pacific Islanders, whose graduation rate(85%) exceeded the national average.Major FindingsRacial/ethnic minority groups areunderrepresented among the mental healthresearch workforce. Although the efforts of NIMH(particularly in comparison to those of otherNational Institutes of Health [NIH] components)to increase their representation are noteworthy,the limited data that are available indicate thatprogress has been and remains slow. Preciseinformation about the effectiveness orshortcomings of initiatives designed to increasediversity in the mental health research career fieldis lacking for several reasons, including a) severalkey initiatives have not been in effect long enoughto allow for a full transition from the level ofresearch trainee to that of independentinvestigator/grantee; and b) an effective traineetracking system is not in place to determineoutcomes.Available evidence indicates that the career pathfor racial/ethnic minority mental healthresearchers, particularly American Indians,African Americans, and Hispanics, has numerouspoints of attrition that extend from high schoolthrough post-doctoral training and into careers inacademia/research.The increase in numbers of American Indians,African Americans, and Hispanics enrolled incommunity colleges, which now approximates theproportion of these groups in the Nation’spopulation, is encouraging. This trend suggeststhat, with proper encouragement and support,programs that remove impediments to higherlevels of education can help improve graduationrates and lead, in turn, to a larger pool ofpotential investigators.The Educational ContextRelative to their representation in the U.S. census,American Indians, African Americans andHispanics are underrepresented among facultyand graduate/professional students. In contrast,the number of Asian/Pacific Islander faculty andpost-baccalaureate students is proportionallygreater than in the population at large. At thefour-year college level, American Indians, AfricanAmericans, and Hispanics are stillunderrepresented, albeit to a lesser extent than inthe post-graduate environment. Only amongcommunity college students isunderrepresentation either eliminated or nearlyeliminated for these three groups. Analyses ofhigh school data reveal that the greatest attritionin the educational development of racial/ethnicminorities occurs prior to high school graduation.According to 1999 census data, nearly half ofLatino adults, a third of American Indian adults,Progress at NIMHAt present the representation of minority groupmembers among NIH/NIMH-funded researchersand trainees parallels minority representationwithin U.S. educational institutions. Few minorityinvestigators submitted research applications in1999 and even fewer were funded. AmericanIndians, African Americans, and Hispanics, whoaccount collectively for some 24% of the U.S.population, submitted only 5.2% of allapplications to NIMH that year and, ultimately,accounted for only 3.9% of funded applicants.Asian/Pacific Islanders again are an exception;they made up 3.7% of the 1999 U.S. populationand 5.5% of NIMH grant recipients in the sameyear. When compared to an estimate of thepotential pool of applicants, that is, minorityrepresentation among faculty members (8.4% for3

proportion of baccalaureate recipients. However,minority groups’ representation in trainingprograms continues to fall short of most minoritygroups’ national representation.American Indians, African Americans, and Latinoscombined, and 5.8% for Asian/Pacific Islanders),under-representation of minority grantappl

racial/ethnic minority investigators and research participants. The presence of more minority group investigators would encourage more racial/ethnic minority individuals to participate in research. Moreover, both empirical and anecdotal evidence reveals that racial/ethnic minority investigators often have a particular commitment to research

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