cultural competence principles in achieving equity in mental … · 2015-03-18 · • 70% of...

© 2015 American Psychiatric Association. All Rights Reserved.

Cultural Competence Principles in Achieving Equity in Mental Health

Care March 21, 2015

Ranna Parekh, MD, MPH Director, Division of Diversity and Health Equity American Psychiatric Association

© 2015 American Psychiatric Association. All Rights Reserved. 2

Cultural Competence It is the ability of mental health professionals and services to provide pa5ent-‐centered care by taking into account the mul5ple, changing and individualized cultural iden55es of each person receiving care.


Culture and Mental Health

•  Culture includes place of origin, race, ethnicity and others iden6fiers such as gender, age, educa6onal level, income, sexual orienta6on, religious beliefs

•  Culture is dynamic and evolving

•  Cultural iden6ty varies from person to person


DSM 5 Definition of Culture •  Values, orienta6ons, knowledge and prac6ces that

individuals derive from membership in diverse social groups (ie, ethnic groups, faith communi6es, occupa6onal groups, veterans groups, etc.)

•  Aspects of individual’s background, developmental experinces, current social contexts that affect his/her perspec6ve(ie, geographical origin, migra6on, language, religion, sexual orienta6on, race/ethnicity)

•  The influence of family, friends and other community members (social network) on the individual’s illness experience.

© 2015 American Psychiatric Association. All Rights Reserved.

U.S. Population Changes

Majority minority by 2043 Minority births exceeded white births as of 2011


Population Diversity Kentucky and US

Kentucky US

White 86% 63% Black/African American 8% 13% Hispanic/La6no 3% 17% Two or more races 2% 2% Asian 1% 5%

Source: US Census 2014


Kentucky and US

Kentucky US

Foreign born 3% 13% With disability (under age 65) 13% 8%

Median income $43,000 $53,000

Source: US Census, 2014


Uninsured Rates for the Nonelderly by Race/Ethnicity, 2013

Kentucky US

White 13% 12% African American 11% 17% Hispanic N/A 26% Other N/A 15%% Total 14% 15%

Sources:Kaiser Family Founda6on


Appalachia •  Higher prevalence of mental health disorders in

Appalachia than US (more report psychological distress and MDD)

•  Higher rates of serious psychological stress and MDD in central Appalachia (vs northern and southern)

•  Alcohol is predominant substance of abuse in US and Appalachia

•  Methamphetamine use is rising, but rates lower in Appalachia than US Source: ARC, 2008


Reasons People Do Not Seek Help for Mental Health Concerns

•  S6gma

•  Low Perceived Need

•  Cost/Insurance

•  Structural Barriers

•  Do Not Believe Services Would Help •  NSHUD 2011


Stigma and Mental Health

The s6gma associated with mental illness prevents many individuals and families from seeking help and/or ge`ng treatment. Mental health providers need to be cognizant and sensi6ve to the shame associated with mental illness and respect individuals, families and communi6es concerns (oben related to saving face). Utmost assurance and acen6on must be paid to maintain confiden6ality.


Access Challenges for Underserved Populations

•  Shortage of behavioral health providers in some areas

•  Major cutbacks in public mental health services

•  Severe lack of mental health workforce diversity

•  Transportation (physical access)


Mediators Outcomes

Barriers and Mediators to Access to Equitable Health Care for Diverse Racial and Ethnic Groups

Quality of providers n Cultural competence n Communication skills n Medical knowledge n Technical skills n Racial bias/

stereotyping n Appropriateness of

care n Efficacy of treatment n Adherence to

treatment

Health Status n Mortality n Morbidity n Well-being n Functioning

Equity of Services Consumer Views of Care

n Experiences n Satisfaction n Effective

partnership

Modified from Institute of Medicine. Access to Health Care in America: A Model for Monitoring Access. Washington, DC: National Academy Press; 1993. Cooper LA, Hill MN, Powe NR. J Gen Internal Med. 2002;477-486.

Barriers Use of Services Personal/Family

n Language/literacy n Attitudes, beliefs n Preferences n  Involvement in care n Health behavior n Education/income

Structural n Availability n Appointments n How organized n Transportation

Financial n  Insurance coverage n Reimbursement

levels n Public support

Visits n Primary care n Specialty n Emergency

Procedures n Preventive n Diagnostic n Therapeutic


Mental Health Parity

Parity Law (Mental Health Parity and Addictions Equity Act, 2008) mandates that employer-based health plans must provide benefits similar to those provided for medical/surgical conditions.

Final Rule issued in November 2013

Affordable Care Act builds on this and requires all new plans to offer coverage for mental health and substance use disorders at parity as a core benefit.


ACA and Mental Health: Expanding Access to Treatment Provide coverage for mental health and substance use disorder services for all plans sold through state exchanges

Patients can’t be denied coverage because they have had a psychiatric illness

Eliminate the lifetime limits on services or coverages

Closing Medicare’s drug benefit “doughnut hole”


Health Care Reform Contributions to Eliminating Disparities Integrated care between primary care and mental health

•  People with severe mental illness die 25 years sooner than those in the general population

•  70% of individuals with significant MH/SUD had at least 1 chronic health condition, 45% have 2, and almost 30% have 3 or more

•  Ethnically and racially diverse populations have high rates of chronic disease and premature death


Health Care Reform Contribution to Eliminating Disparities

•  Mental health parity

•  Expanding health coverage

Employer mandate, health exchanges, Medicaid expansion

•  Improving access to care

Community health centers, Indian Health Care Improvement Act, HRSA NHSC, workforce development, behavioral health services reimbursable in primary care

•  Culturally and linguistically appropriate information to Medicaid and health exchange enrollees

Kaiser Family Foundation, 2010


Future Trends Increasing Access

•  Peer Support Specialists •  Community Health Workers •  Promotoras •  Mental Health Navigators •  Cultural Brokers


What is the APA Doing to Eliminate

Mental Health Disparities in the context of

Health Care Reform?


APA and Diversity Working to

•  Eliminate mental health dispari6es among minority and vulnerable popula6ons

•  Advance professional interests of psychiatrists from minority and underrepresented (MUR) groups

•  Educate public about mental health and s6gma affec6ng assessment and 6mely treatment

•  Train culturally competent psychiatrists


APA Approach •  Components/Governance •  Professional Educa6on/ Career Development

•  Recruitment •  Public Educa6on Accomplished through

•  Division of Diversity & Health Equity •  Alliance building & collabora6ons


Career Development

Fellowships

•  APA SAMHSA Minority •  Diversity Leadership •  Public Psychiatry •  Jeanne Spurlock Congressional


•  Council on Minority Mental Health and Health Dispari6es

•  MUR Trustee on the Board of Trustees (began 2013)

•  MUR Caucuses (7)

•  Assembly Commicee of MUR Reps

Components/ Governance Support


Books


Mental Health and Faith Community Partnership •  American Psychiatric

Founda6on •  American Associa6on for

People with Disabili6es/ Interfaith Disability Advocacy Coali6on

•  American Psychiatric Founda6on


Public Education APA On Tour Community Meetings

Regional forums in areas with high propor6ons of underserved popula6ons hosted by APA’s Division of Diversity and Health Equity

Discussions about mental health dispari6es and the impact on overall health, economic produc6vity and societal well-‐being


APA Diversity Mental Health Month

Bringing attention to mental illness needs and services in culturally diverse communities

APA will celebrate in July 2014 for the 1st time

www.psychiatry.org/diversity-‐month


Public Education


American Psychiatric Associa6on www.psychiatry.org Ranna Parekh, MD, MPH [email protected]

cultural competence principles in achieving equity in mental … · 2015-03-18 · • 70% of...

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