Healthcare Disparities Among Racial and Ethnic Minority Populations

Mental Health America believes that it is essential that all aspects of mental health systems be reflective of the diversity of the communities that they serve and that mental health agencies strive to become and remain culturally and linguistically competent. A culturally and linguistically competent mental health system incorporates skills, attitudes, and policies to ensure that it is effectively addressing the needs of consumers and families with diverse values, beliefs, and sexual orientations, in addition to backgrounds that vary by race, ethnicity, religion, and language.

The unique geographical and cultural challenges to service delivery in rural America hamper the effectiveness of current delivery models. Rural behavioral health needs remain constant with the lack of available professional staff, a lack of cultural and linguistically competent providers, social stigma, fear of lack of confidentiality, financing and reimbursement issues (i.e. lack of funding and uninsured), lack of integration of behavioral (mental and substance use) with physical health, little prevention efforts, transportation difficulties (i.e. long distances and/or lack thereof), and low numbers of providers. 

Mental Health America Policies and Resources

• Position Statement: Cultural and Linguistic Competency
• Position Statement: Access to Healthcare
• Mental Health America Multi-State Initiative pdf

Additional Resources

Organizations

Search Institute
The Search Institute identifies and provides essential elements of development tools to help young people to become healthy adults who are interested in the common welfare of their communities and to be responsible individuals through external and internal support.
40 Elementos Fundamentales del Desarrollo.  
http://www.search-institute.org/  

Funding

The Foundation Center
The Foundation Center's mission is to strengthen the nonprofit sector by advancing knowledge about U.S. philanthropy.  The Center maintains the most comprehensive database on U.S. grantmakers and their grants — a robust, accessible knowledge bank for the sector. It also operates research, education, and training programs designed to advance philanthropy at every level. The Center's web site receives more than 47,000 visits each day, and thousands of people gain access to free resources in its five regional library/learning centers and its national network of more than 340 Cooperating Collections
http://foundationcenter.org/

The National Institutes of Health
The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research. Helping to lead the way toward important medical discoveries that improve people's health and save lives, NIH scientists investigate ways to prevent disease as well as the causes, treatments, and even cures for common and rare diseases. Composed of 27 Institutes and Centers, the NIH provides leadership and financial support to researchers in every state and throughout the world.

With the support of the American people, the NIH annually invests over $28 billion in medical research. More than 83% of the NIH's funding is awarded through almost 50,000 competitive grants to more than 325,000 researchers at over 3,000 universities, medical schools, and other research institutions in every state and around the world. About 10% of the NIH's budget supports projects conducted by nearly 6,000 scientists in its own laboratories, most of which are on the NIH campus in Bethesda, Maryland.  The following links are grant opportunities from the National Institutes of Mental Health (a part of NIMH) that are relevant to eliminating disparities.

http://grants.nih.gov/grants/guide/pa-files/PAR-07-004.html
http://grants.nih.gov/grants/guide/pa-files/PAR-07-018.html
http://grants.nih.gov/grants/guide/pa-files/PA-07-076.html
http://grants1.nih.gov/grants/guide/pa-files/PA-07-103.html
http://grants.nih.gov/grants/guide/pa-files/PA-08-074.html
http://grants.nih.gov/grants/guide/pa-files/PAR-08-075.html
http://grants.nih.gov/grants/oer.htm  

Articles

Methodological Issues in Measuring Health Disparities. (2005). CDC.  S(2), V(141).
Provides guidelines for making choices and creating health policy frameworks to combat health disparities.
http://www.cdc.gov/nchs/data/series/sr_02/sr02_141.pdf.

Toward Evidence-Based Interventions for Diverse Populations: The San Francisco General Hospital Prevention and Treatment Manuals. Munoz, R.F. & Mendelson, T. (2005). Journal of Consulting and Clinical Psychology, 73(5), 790-799.
“This article summarizes the development and empirical evaluation of prevention and treatment manuals designed for low-income ethnic minority populations at San Francisco General Hospital” p.2.
http://repositories.cdlib.org/cgi/viewcontent.cgi?article=3842&context=postprints.

Critical Disparities in Latino Mental Health: Transforming Research into Action. NCLR. (2008).
Addresses mental health issues facing Latinos in the United States through the development of research.

Achieving Health Equity: From Root Causes to Fair Outcomes. Commission on Social Determinants of Health Interim Statement.
Article on social and global health disparities.
http://whqlibdoc.who.int/publications/2007/interim_statement_eng.pdf.

The Impact of An Enhanced Interpreter Service Intervention on Hospital Costs and Patient Satisfaction. Jacobs, E.A., Sadowski, L.S., & Rathouz, P.J. (2007). J Gen Intern Med, 22(2), 306–11.
Adequate language access is adding to the language barriers to health care in Hispanic communities. Sadowski et al., (2007) provides recommendations to enhance interpreter services to this population.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2078550.

Revisiting the Latino Health Paradox. Taningco, M. V (2007).
Paradox in healthcare outcomes in Latinos group(s) and the general population.

Reconceptualizing Native Women’s Health: An “Indigenist” Stress-Coping Model. Walters, K.L.,  and Simoni, J.M. (2002). American Journal of Public Health, 92(4), 520-524.
This commentary presents an “in-digenist” model of Native women’s health, a stress-coping paradigm that situates Native women’s health within the larger context of their status as a colonized people. The model is grounded in empirical evidence that traumas such as the “soul wound” of historical and contemporary discrimination among Native women influence health and mental health outcomes. The preliminary model also incorporates cultural resilience, including as moderators identity, enculturation, spiritual coping, and traditional healing practices.
http://www.ajph.org/cgi/reprint/92/4/520

Breaking Down Barriers to Mental Health Care. Michelle Chen. (2008). Gotham Gazette.
Addresses cultural and communication barriers in the community related to mental health issues.

Poverty is Poison. Paul Krugman. (2/18/2008). New York Times.
This article from the Opinion section, discusses how America is failing to reduce poverty, while disparities between classes grow.
http://www.nytimes.com/2008/02/18/opinion/18krugman.html

Regions of Refuge in the United States: Issues, Problems, and Concerns for the Future of Mexican-Origin Populations in the United States. Vélez-Ibáñez, C.B. (2004), Human Organization, 63(1), 1-20
“This address provides a conceptual heuristic of ‘regions of refuge’ as a means of understanding the complex and dynamic processes responsible for the great growth and emergence of Mexican-origin populations in the United States.”
http://egarc.ucr.edu/VelezIbanez.pdf

Mental Health, Wellness, and the Quest for an Authentic American Indian Identity. Gone, J.P. (2006) from Mental Health Care for Urban Indians, Witko, T.M., Washington, D.C.: American Psychological Association.
This chapter of a book provides “a conceptual overview of Native identity that will enable mental health professionals, practitioners, and researchers to more effectively address the mental health needs of American Indians in urban settings.”

Mental Health Services for Native Americans in the 21st Century. Gone, J.P. (2004). Professional Psychology: Research and Practice, 35(1), 10-18.
“This article provides a general overview of contemporary tribal America before describing the legal, political, and institutional contexts for mental health service delivery administered through the federally sponsored Indian Health Service. Recommendations for mental health professionals who desire to avoid a subtle but profound Western cultural proselytization in their therapeutic service to Native clients and their communities are presented.”

Practice Makes Perfect? Identifying Effective Psychological Treatments for Mental Health Problems in Indian Country. Gone, J.P. & Alcantara, C. (2005). from Best Practices in Behavioral Health Services for American Indians and Alaska Natives, edited by Hawkins, E.H. & Walker, R.D., Portland, OR: One Sky National Resource Center for American Indian and Alaska Native Substance Abuse Prevention and Treatment Services.
This chapter will canvas the scientific literature related to the identification of “best practices” in the treatment of mental health problems for Native Americans while simultaneously reviewing concepts and approaches that frame (and complicate) the worthy pursuit of evidence-based practice in American Indian mental health service delivery.
http://sitemaker.umich.edu/joseph.p.gone/files/ebp_mono.pdf  

Facts and Statistics

American Indian and Alaska Native Heritage Month: November 2007. Facts for Features.
Mental health facts and statistics on several Native American tribes.
This Facts for Features presents data for American Indians and Alaska Natives, as this is one of the six major race categories.

Projected Population of the United States, by Race and Hispanic Origin 2000 to 2050.
Statistical Table.
http://www.census.gov/ipc/www/usinterimproj/natprojtab01a.pdf.

Census: More Diversity, Slower Growth in U.S.A. 2050. (2008) IMDiversity.com
Census Bureau projects tripling of Hispanic and Asian populations in 50 Years; Non-Hispanic Whites may drop to half of total population.
http://www.imdiversity.com/Villages/Asian/reference/census_2050_asian_projections.asp

SAMHSA’s Online Multi-Language Resources
The Multi-Language Initiative (MLI) of the Center for Substance Abuse Treatment (CSAT) has released  publications for members of non–English-speaking groups or those with limited English-language abilities. MLI products available in Spanish, Russian, and Navajo can be downloaded from the KAP website.  New to the site are Navajo-language products about inhalant abuse for both children and parents.

Rural Minority Health Resources. (2008).
Provides information, links, and tools on rural minority health education.

Organizing to Address Minority Health Disparities: A Directory of State and Local Initiatives.
State resources.
http://www.prrac.org/pdf/HealthDirectory.pdf.  

Key Health Disparities-Focused Legislation Introduction in the 110th Congress

Health legislation addressing the issues of social class, race, and rural communities.
http://kff.org/minorityhealth/upload/7724.pdf.

Pfizer’s Patient Health Questionnaires—Multi-Lingual Options
Multi-lingual options available for various mental health self-screening tools. Spanish is emphasized.
http://www.phqscreeners.com/overview.aspx

Assuring Cultural Competence in Health Care: Developing National Standards and an Outcomes-Focused research Agenda. (2003).
Cultural competence training and education resources.
mhtml:http://googlemail.com/attachment?ui=2&ik=30543cf7bb&attid=0.11&disp=safe&view=att&th=1189946cdbd2ae1....

Increases in Age Group: Specific Injury Mortality in the United States, 1999-2004. Paulozzi, L. (2007). MMWR Weekly Report, 56(49); 1281-1284.
From 1999 to 2004, there was an increase in injury mortality rates—the first in 25 years. To assess this increase, CDC analyzed the most recent data from the National Vital Statistics System (NVSS). This report summarizes the results of that analysis.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5649a1.htm  

Studies

Walking a Mile: A First Step Toward Mutual Understanding: A Qualitative Study Exploring How Indians and Non-Indians Think About Each Other, Public Agenda
http://publicagenda.org/research/pdfs/walkingamile.pdf

Demographics and Health Care Access and Utilization of Limited-English-Proficient and English-Proficient Hispanics. Research Findings # 28.
Evidence suggests that Hispanics that can not speak the English language are less likely to utilize health care services than any other subgroup within the Hispanic population.
http://www.meps.ahrq.gov/mepsweb/data_files/publications/rf28/rf28.pdf.

Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation. May, P.A., Serna, P., Hurt, L., & DeBruyn, L.M. (2005). Research and Practice. 95(7), 1-7.
An outcome evaluation of a suicide prevention program among the Western Athabaskan Tribal Nation (a pseudonym used to protect the identity of this tribe—one of several Athabaskan tribes in the southwestern United States—and its reservation) of New Mexico is described. This program is part of an ongoing effort to evaluate AIAN
suicide trends, potential causes of these trends, and the efficacy of prevention programs in New Mexico.
http://www.ajph.org/cgi/reprint/95/7/1238.pdf

Prevalence of Mental Disorders and Utilization of Mental Health Services in Two American Indian Reservation Populations: Mental Health Disparities in a National Context, (2005). Beals, J., Novins, D.K., Whitesell, N.R., Spicer, P., Mitchell, C.M.,  & Manson, S.M. American Psychiatry, 162, 1723-1732.
Estimates of the prevalence of DSM-III-R disorders and utilization of services for help with those disorders in American Indian populations are compared with the results of the
baseline National Comorbidity Survey (NCS), conducted in 1990–1992, which reflected
the general United States population.

Reports

Mental Health, Culture, Race, Ethnicity. (2008). Surgeon General’s Report.
Fact sheets on Latino/Hispanic Americans.

The Surgeon General’s Workshop on Women’s Mental Health, Nov. 30-Dec. 1, 2005
Addresses critical mental health issues affecting girls and women. The goal of this workshop was for participants to develop practical and actionable recommendations for materials and toolkits that could be produced by the Surgeon General to advance knowledge, understanding, and behaviors regarding women’s mental health issues – and ultimately to improve the mental health of our Nation’s girls and women.
http://www.surgeongeneral.gov/topics/womensmentalhealth/mentalhlth_rpt.pdf

Mental Health, United States. (2004). SAMHSA.
This report provides recommendations of framework and health tools  so that high quality of care can be provided.

We the People: American Indians and Alaska Natives in the United States. Stella Ogunwole. (2006). Census 2000 Special Reports.
This report provides a portrait of the American Indian and Alaska Native population in the United States that presents demographic, social and economic characteristics collected from Census 2000.
http://www.census.gov/prod/2006pubs/censr-28.pdf.

Overcoming Obstacles to Health. Robert Wood Johnson Foundation to the Commission to Build a Healthier America, (2008).
This report describes in detail the scope of health disparities in this nation—how the poor and middle class are so much less healthy than those above them on the economic ladder, the factors in our society and communities that contribute to such disparities, and the areas that hold promise for improving the health of this country.
http://www.rwjf.org/files/research/obstaclestohealth.pdf

Turning Racial and Ethnic Data into a Quality Improvement Strategy. Center for Health Care Strategies, Inc.
Tool for states to more effectively use data analysis and quality improvement strategies through questions and suggestions.
http://www.chcs.org/usr_doc/QI_TOOL.pdf

Abstracts

Mental Illness in Hispanics: A Review of The Literature. Marin, H., Escobar, J.I., & Vega, W.A. (2006). Focus. 4(1), 1-15.
Findings on the state of mental illness and other resulting problems of Hispanic people in the United States.

Barriers to Serving the Vulnerable: Thoughts of a Former Public Official. (2007). Ferguson, C.C. Health Affairs, 26(5), 1358-1366.
This article addresses the fact that policymakers’ capacity to measure the impact of programs beyond their direct effect on the budget is inadequate.
http://content.healthaffairs.org/cgi/content/abstract/26/5/1358

Considering a Theory of Cultural Trauma and Loss. (2004). Hundall Stamm, B., Stamm, H.E. IV, Hundall, A.C., & Hidgon-Smith, C. Journal of Trauma and Loss. 9, 89-111.
The authors propose a model of cultural trauma and revitalization.
http://www.informaworld.com/smpp/content~content=a714111073~db=all~order=page

Identity Crisis: Indian Identity in a Changing World. (2005). Talahongva, P. Native Peoples, Sept/Oct, 2005, 58-62.
Perhaps no issue is of greater importance and divisiveness than the question of who is—and isn’t—an Indian. Who determines this, and what happens in cases of tribal disenrollment, missing records and “mixed bloods.”

A Theory of Reservation-Dwelling American Indian Alcohol Use Risk. (2007). Spillane, N.S. & Smith, G.T. Psychological Bulletin, 133(3), 395-418.
The authors present a theory for understanding risk for problem drinking among reservation-dwelling American Indians. The theory offers an overall framework for understanding the risk process for this group.
http://content.apa.org/journals/bul/133/3/395

Conceptualizing and Measuring Historical Trauma Among American Indian People. (2004). Whitbeck L.B., Adams G.W., Hoyt D.R., Chen X.  American Journal of Community Psychology, 33(3-4), 119-130.
This article reports on the development of two measures relating to historical trauma among American Indian people: The Historical Loss Scale and The Historical Loss Associated Symptoms Scale.
http://www.ingentaconnect.com/content/klu/ajcp/2004/00000033/F0020003/00485687;jsessionid=b6fs1o21qmd94.alexandra

Fact Sheets

African American Communities and Mental Health (.DOC)

Asian American and Pacific Islander Communities and Mental Health (.DOC)

GLBT Communities and Mental Health (.DOC)

Latino Communities and Mental Health (.DOC)

Native American Communities and Mental Health (.DOC)

For More Information

Mental Health America continues to expand resources to assist advocates across the country.  Please direct inquiries to Mental Health America's Advocacy Resource Center or by phone (1-800-969-6642, option 6).