Tackling Disparities, Achieving Equity

vivianVivian H. Jackson, Ph.D.
National Center for Cultural Competence, National TA Center for Children’s Mental Health
Georgetown University Center for Child and Human Development

We are a nation of immigrants, but you wouldn’t know it by looking at our mental health care system. It’s hard enough to access quality mental health care services, but the challenge is even greater when cultural, racial, linguistic, or other demographic factors come into play. Today, Dr. Vivian Jackson blogs about what is being done to reduce the barriers to quality care and to promote culturally and linguistically appropriate services in mental health.

Tackling Disparities, Achieving Equity
How You Can Help Eliminate Disparities in Mental Health Care

What’s the problem?
As a society we claim to value fairness, yet every day there is evidence that we are a nation operating with significant disparities in mental health care. Is this fair? Are we offering services in a manner that meets the definition of fair: “not exhibiting any bias, and therefore reasonable and impartial”­?

In 2001, the Surgeon General concluded that there are disparities in:

  • Access to and availability of mental health services
  • Ability to receive needed mental health services
  • Quality of mental health services provided
  • Representation in mental health research

More than ten years later, government reports and published scientific studies document only limited progress—and  some regression—in these disparities. Attention to disparities in mental health lagged behind attention to disparities in maladies such as cancer and diabetes.

What is being done to reduce ethnic and racial disparities?
There is activity that generates hope.

Currently, Healthy People Goals for 2020 focuses on the elimination of disparities, including in mental health. But it is taking time to garner a systemic multilayered approach to address all of the factors that contribute to disparities in mental health status and mental health care. Here are some of the steps being taken:

What else needs to be done?
These steps represent only the tip of the iceberg in what it will take to eliminate disparities.

Take note of the Healthy People 2020 definition of disparities:

A health disparity is a particular type of health difference that is closely linked with social or economic disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion.

This definition points to issues of social justice, to fairness. It declares that the root of disparities is a society that has systematically discriminated, marginalized, and/or excluded certain populations over time.

We need to look at the role that housing, employment, educational, transportation, financial, recreational, criminal justice, and social service systems play in creating and/or maintaining inequities. We need to pay special attention to the fragmentation of the mental health system.

Further, we must tackle issues of racism, ageism, sexism, heterosexism, etc. The Institute of Medicine has documented the role of bias (conscious and unconscious) in health care as a contributing factor to disparities, even amongst providers who are well-intentioned. Indeed, the challenges to make a meaningful difference are numerous, but not insurmountable.

What can you do?
There are three first steps that can make a difference.

  • Raise awareness. Document disparities in both mental health status and mental health services in your community.
  • Engage in self-reflection. It is easy to try to get other people to change what they do, but what can we do to change ourselves? Examine first yourself and then your own organization for assumptions, biases, stereotypes, and evidence of inclusion and exclusion that reflect your own contribution to disparities. Follow up with a corrective action plan.
  • Advocate for change. Identify local, state, and national efforts that you can support that will heal the mental health system. Promote services and supports that are culturally and linguistically competent. Work to change those systems that promote and sustain inequities. Join and engage as partners with advocacy groups within the affected cultural groups to work on change.

There is a place for each of us to undo disparities, achieve health equity, and demonstrate that we are indeed a nation that can call itself “fair.” Visit both the National Center for Cultural Competence and National Technical Assistance Center for Children’s Mental Health websites for more information.

Your turn

  • Why don’t more people work on addressing disparities? What do you believe are barriers to taking steps to address disparities?
  • How can we engage more people in addressing the societal contributors to disparities?
  • What is one specific thing that you are willing to do to help address the unfairness of disparities?

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Why don't more people work on addressing disparities? The bases  for disparities are amoung the most regarded conversations at the table . But, when you ask why don't more people get involved with disparities is that they found the road endless in reality. A lot of talk is said, putting the talk into action is another and most is disfused State funding to ask for advocacy committeees to report on the conditions of this issue.

What do you believe are barriers to taking steps to address disparities? Barriers to eliminate disparity throughoiut the mental health area is a social issue not a mental health issue. Our culture and our origin of race is still a unequal battle. I personally have not seen in my visits to hospitals, doctors offices, schools, meetings trainings and community someone actually treated like a unlike human being except myself. Disparity is  only one step away from being used as topic to laggering on through the system if only people would except each other as a equal and not a target. Stigma is relavent everywhere except when someone has someone to guide them though the place they want to be. Barriers are setup by who, what, whewre, when, who, how. And breaks down the old unwanted attitudes on people with illness.

How can we engage more people in addressing the societal contributors to disparities? Changing the time of day on disparity in our society is reaching a new page in the book of history from the changing times that came along 50 years ago from two of the greatest advocates of our times JFK and MLK and today their dreams are turning the pages in the book. Voices are speaking up out of the crowds over the social disparities that should no longer exist  but they do. The most effective way to engage others in this interest is make meetings avialable for free at all mental health organizations , churches, colleges and other businesses with real people that believe the times are a changing and we are going to get it going that way.

What is one specific thing that you are willing to do to help address the unfairness of disparities? Personally, I will advocate everyday to everyone I know and beyond that to change there way issues after issues are being put under the rug or not addressed to get things moving. The other way would to be having local meetings and inviting community to get involved with life and people that have the time to deicate in changing unfairness and ignorant towards people with mental illness.



As an advocate for change, I rely on publications like the ones produced for SAMHSA's National Recovery Month. My favorite publication is "Recovery Benefits Everyone (see www.recoverymonth.gov). I received my first one in Sept of 2011 and I use it often. It proved to be an excellent resource when I was an Administrator of a treatment center and needed specific resources and information for any client we served who had culturally specific needs and we needed help and information. I also used it a Recovery Advocate when I had clients and families needing appropriate resources and culturally-sensitive care when they re-located to another part of the country. I also loaned my copy of the book to several licensed chemical dependency counselors in private practice when they needed culturally-specific information very quickly.  

Specifically, SAMSHA's publication entitled "Recovery Benefits Every - Prevention, Treatment and Recovery Resources", has a section entitled "Other Resources - Cultural Specific". This section includes lists of nonprofit groups, associations and a myriad of other organizations founded to provide culturally sensitive services and information, as well as help raise public awareness.

A few examples of organizations listed in the book include Black Administrators in Child Welfare, Inc - an association that provides help for African-American children and their families in the child welfare system; Asian Counseling and Referral Services, Inc, the National Alliance for Hispanic Health, the National Congress of American Indians and many more. 

I feel that these lists can help providers, educators, administrators, advocates etc.. quickly identify resources, information and appropriate care. 

Also, I am a big believer in SAMHSA's National Recovery Month, which "highlights that all individuals have the fundamental and inherent value to be treated with respect, dignity and worth." 


I wrote yesterday, and hope now to read Annabelle's post. Thank you.


I commented yesterday; want to get in to read Annabelle's. Stephen


From my experience as a professionally trained social work clinician, one needs to understand the various cultural/religious issues involved when patients needing and/or wanting mental health intervention won't seek treatment.  I have worked with a variety of folks from various cultural backgrounds wherein it is unacceptable as well as being "shameful" to become involved with a therapist, no matter what their professional status.  I have treated Native American families, black families; Latino families; Asian family members and/or individuals from all of these groups including families whose religious beliefs are Mormans.  It is a tough decision for these individuals to get into treatment knowing they are and/or may be "shunned" by their particular cultural/religious groups.  When working with Native Americans as a clinician with the Head Start Program and CPS, one needs to understand the "chain of command" and that before any intervention can be done, us therapist need to speak to the tribal chief.  Regarding folks who are Asian, korean and other related groups, these folks rarely accept outside help as it goes against their cultural beliefs and want to keep any needed mental health intervention within the family if they can do so.

As therapist who do so want to help these various cultural/religious families, I believe we must  tread lightly and most importantly be sensitive to their beliefs and feelings.  I believe for all folks no matter what their cultural/religious beliefs may be, who fall into the LGBA group, coming out of the closet is rarely accepted even in 2014 though more folks are feeling more comfortable about speaking out and hopefully continuing to maintain support from their families and church.

This is a tough issue, but I would suggest that the time has come to reach out to these various groups on an individual basis, listen to their concerns along with education about mental health and the stigma attached to being diagnosed with a mental illness and not be judgemental and accept the fact that they may never feel comfortable seeking help.   For me as a professionally trained licensed clinician and a patient,  I have just begun to talk about my mental illness, which hasn't been easy but now feel a bit more comfortable talking about my bipolar illness, perhaps because I am older, no longer in denial that I have a mental illness, aware that its not going to go away and treated for mental illness/bipolar is not the same way one treats a physical diagnosis.

We continue to have a ways to go, but hopefully in time, we will be able to reach out to various groups via education, understanding of their beliefs and concerns and give these patients time to say "I need help".  We can't save them all, but we can be sensitive, patient and understanding their concerns and fear about accepting treatment.


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