Majose Carrascot

Barriers to Mental Health Treatment for People of Color: 

Barriers to Mental Health Treatment for People of Color MaJosé Carrasco Director Multicultural Action Center

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Have less access to, and availability of, mental health services Are less likely to receive needed mental health services In treatment often receive a poorer quality care Are underrepresented in mental health research Mental Health: Culture, Race, and Ethnicity, a Supplement to the Surgeon General’s Report on Mental Health Members from Diverse Communities:

Barriers To Treatment: 

Barriers To Treatment Stigma Lack of Public Education Language Barriers Lack of bicultural and bilingual providers. Primary care providers as mental health providers Lack of Cultural Competence in service delivery Poverty Lack of Health Insurance

Stigma: 

Stigma High levels of stigma. Closely intertwined with stigma is the sense of shame that mental illness brings to a family. Specially in the Asian American communities. African Americans were most likely than whites to describe stigma as a reason for not seeking treatment (Cooper-Patrick et al., 1997). Believe that mental illness is the result, among others, of lack of character, a punishment from God, and/or the parent’s fault (Magaña, 2002).

Lack of Public Education: 

Lack of Public Education Lack of education about mental illness: Perpetuates discrimination and stigma. Prevents people from receiving treatment until the disease has progressed to an advanced stage requiring hospitalization. Magaña’s study found that the majority of people interviewed often referred to schizophrenia and other serious mental illness as “nervios” (nerves).

Language Barriers: 

Language Barriers In the 1990 census, about 40 percent of Latinos reported that they either didn't speak English or didn't speak English well. There are over 100 different language and dialects in the Asian American community. More than 200 indigenous languages spoken. Words such as “depressed” and “anxious” are absent from some indigenous languages.

Lack of Mental Health Professionals from Diverse Communities: 

Lack of Mental Health Professionals from Diverse Communities High levels of mistrust of white health care providers. Predominant use of primary care and/or traditional caregivers. Among clinically trained mental health professionals: 2% African American psychiatrics 2% African American psychologists Among Latinos with mental disorders, fewer than 1 in 11 contact mental health care specialists (Vega et al’1999). Fewer than 1 in 20 Latino immigrants use services from mental health specialists (Vega et al’1999).

Lack of Cultural Competence: 

Lack of Cultural Competence Mental Health provider are usually ill equipped to meet the needs of patients from different backgrounds and, in some cases, have displayed bias in the delivery of care (SG report 1999). 51% of white health care providers believe that their patients do not adhere to medical treatments as a result of cultural or linguistic barriers. 56% reported having no form of cultural competency training (Cho & Solis, 2001).

Lack of Cultural Competence:: 

Lack of Cultural Competence: Causes incorrect diagnosis of severe psychiatric disorders among Latinos. This is one of the most devastating results of lack of cultural competence. Does not see consumers as diverse individuals. Does not allow treatment approaches which address the range of socio-economic, educational, cultural, and other characteristics that may impact outcomes. Deters people of color from seeking treatment. Causes lack of commitment to treatment.

Lack of Research Based on Diverse Populations: 

Lack of Research Based on Diverse Populations Lack of minority participation in research projects related to mental illness and treatments. A 1998 study of the Office of Minority Health reported that states do not have appropriate health data for minority populations. The states that actually collect minority health data routinely break out black and white data only.

What Can We Do To Overcome These Barriers?: 

What Can We Do To Overcome These Barriers? Develop cultural competence in service delivery Establish culturally competent standards of care. E.g. CMHS standards Speak the language Train mental health providers. Increase participation in scientific research. Promote mental health education and awareness.

Cultural Competence : 

Cultural Competence Cultural competency refers to the practice of working effectively and sensitively within the cultural context of specific groups. Ability to adapt practices/programs to fit the cultural context of the target group. Entails: Cultural sensitivity: Attitudinal concept. Openness to the notion of diversity in people’s beliefs, values and behaviors. Cultural awareness: Understanding the assumptions and values upon which one’s behavior and worldview rest.

NAMI’s Strategic Plan: 

NAMI’s Strategic Plan NAMI must actively reach out to undeserved and priority populations. “To improve access to services, NAMI, must continue to build its grass-roots advocacy movement by involving increasingly diverse groups.”

NAMI’s Multicultural Action Center: 

NAMI’s Multicultural Action Center “Addressing America's Mental Health needs through cultural diversity planning, consulting, and leadership development.” NAMI Diverse Communities Symposia. Multicultural Partner Coalition. Cultural Competence across programs. Leadership Groups. Instituto de Liderazgo de NAMI. Technical assistance to NAMI state offices and affiliates.

Outreach Initiatives: 

Outreach Initiatives Programa Bienestar Mental- NAMI New Hampshire Mission: improve access, advocate for services, and empower Latinos Strong community coalition (churches, Latino community centers, information and referral services, mental health care providers, etc) Services: Group education: monthly mental health education and support groups conducted in Spanish. Home education: home based mental health educational sessions provided by peer educators.

Bienestar Mental: Services: 

Bienestar Mental: Services Referral Services: refer participants as needed to local mental health and other service providers. Interpretation services: Spanish/English available for all program participants on a limited basis. Advocacy services: Advocating for participants with other agencies and specially at schools. Support services: Accompanying participants to appointments, serving to translate forms, and as medical interpreters for treatment sessions. Assisting mental health providers to better understand how culture and language affect their provision of services.

Keys for Success : 

Keys for Success Do not re-invent the wheel. Look for what is already being done in the community. Build on existing programs. A good program adds value to existing programs instead of competing against them. Personal relations are the key. You cannot access a community without establishing personal relations with its members. Network. Bring community leaders together.

Keys for Success: 

Keys for Success Create a community based Advisory Committee. Do not expect them to come to you. Go to the places where the community meets. Acknowledge and embrace differences between your culture and the culture you are reaching out to. Do a community cultural assessment before you develop any outreach plans.

Contact Information: 

Contact Information Majose Carrasco majose@nami.org 703-312-7883