In the context of health care reform, governmental, organizational and individual health care providers are discussing key issues relevant to improving access to and quality of health care in the United States. One key issue is the availability and quality of mental health care for all Americans. Though the ideal is equal access to high quality mental health care, researchers have found disturbing disparities among our population in access to and quality of mental health care. According to the Center for American Progress, racial/ethnic minorities, the elderly, the less educated, the uninsured/underinsured and rural residents tend to suffer considerable disparities in both access to mental health care and in the quality of mental health care received (Russell, 2010, p. 3); (Proser & Cox, 2004, pp. 9-11).

Regarding racial/ethnic minorities, specific data reveals that psychiatric services are underutilized, engagement and retention in treatment is problematic; schizophrenia is over-diagnosed in the African-American population; depression is over-diagnosed among Latinos; antipsychotic medications are over-dosed for African-Americans and under-dosed for Latinos; very high rates of substance abuse and suicide occur in Native American populations (Russell, 2010, p. 29). In addition, there are longstanding barriers to treatment in the form of inadequate insurance, inadequate health care workforce, inadequate diagnoses by primary care physicians, under-referral of patients to mental health care, high dropout rates from treatment and a high percentage of missed appointments (Russell, 2010, p. 29), all creating significant impacts on the mental health of racial/ethnic minorities. Experts have suggested reforms to reduce the disparities in access and quality. These include: improving access by expanding health insurance coverage; counteracting providers' biases and stereotypes of minorities by educating providers and enhancing communication between patients and providers; and enhancing more diversity among mental health providers by encouraging and creating greater opportunities for minority members to join the mental health care profession (Russell, 2010, p. 30). In a comprehensive effort to deal with disparities affecting racial/ethnic minorities, §10334 of the ACA establishes the Office of Minority Health, several minority-focused departments and transforms the National Center on Minority Health and Health Disparities from a mere center to an institute. In addition, in a specific effort to reach youth who suffer mental health care disparities due to their race/ethnicity and/or lack of education, the Comprehensive Community Health Services Program for Children and their Families was established in 1992 and has since funded 92 grant communities, 61 of which are still in existence (Russell, 2010, p. 25).

Regarding all underserved groups, including racial/ethnic minorities but also including the elderly, uninsured/underinsured, poorly educated and rural individuals, among others, researchers have suggested reforms such as better long-term planning of the mental health care workforce by acknowledging the high level of unmet needs, appropriately training