Vivian 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:
- The 2003 President’s New Freedom Commission on Mental Health listed Elimination of Disparities as a goal for a transformed mental health system
- The Affordable Care Act includes provisions that promote growth in capacity, establish structures for implementation of necessary tasks, and set forth mechanisms for accountability for outcomes in relationship to disparities
- In April of 2011, the Department of Health and Human Services developed An Action Plan to Reduce Racial and Ethnic Disparities
- The Substance Abuse and Mental Health Services Administration created an Office on Behavioral Health Equity
- Grant programs are being required to describe the impact of their program on disparities
- This spring the HHS Office of Minority Health released the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care, revised to promote application in health settings, broadly defined to include mental health.
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.
- 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?