The authors document greater unmet need for alcoholism and drug abuse treatment and mental health care among African American and Hispanics relative to whites. New policies are needed to improve access to and quality of alcoholism, drug abuse, and mental health treatment across diverse populations.

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Depressed patients with comorbid medical disorders tend to have similar rates of treatment but worse depression outcomes than depressed patients without comorbid medical illness. Quality improvement programs for depression can improve treatment rates and outcomes for depressed primary care patients with comorbid medical illness. The authors discuss the implications of these findings for clinical practice.

Cross-cultural mental health services were assessed using qualitative interviews and focus groups of 43 mental health clinicians and program directors in one of the most ethnically integrated cities in the U.S. The commonly used strategy of ethnic matching between clinician and patient was found to be difficult to effectively apply to an ethnically diverse and highly integrated patient population. Information from cultural-competency training was also found to be difficult to apply, particularly due to time limitations and language barriers. Implementation of a cultural consultation service, which uses in-depth cultural evaluations and case-based learning, may help bridge these service gaps.

The current health care system in the United States is characterized by problems with access to timely and evidence-based care, particularly for mental disorders. Telemental health improves access to care, particularly for rural populations, which are underserved in terms of psychiatric services, culturally competent telepsychiatric consultation, and availability of interpreters. Providers and staff at 39 telemedicine sites rated patients' access to mental health care, need for culturally competent telepsychiatric consultation, and need for language interpreters. Compared to sites that did not respond, responder sites had greater telemedicine experience (e.g., obtained more telepsychiatric and telemedicine consultations). Actual respondents were approximately 50% primary care providers and 50% staff. Both access to and quality of telepsychiatric services with attention to cultural issues and language interpreting is very much needed, particularly for the large number of Hispanic and Vietnamese patients. Because untrained staff and family members are commonly used in clinical situations with limited English proficiency patients, solutions for managing language differences are also needed. More structured, qualitative and quantitative in-depth research is required to ascertain to what extent providers and staff are aware of these patients' needs, how cultural and language barriers can be reduced, and the pros and cons of different types of interpreters.