The President’s New Freedom Commission on Mental Health: Achieving the Promise:Transforming Mental Health Care in America. Final Report, July 2003.
WESTERN PSYCHIATRIC TRADITIONAL ASIAN• Scientific epistemology • Spiritual orientation• Biochemical/Genetic etiology • Epistemologically based on of illness without considering faith and intergenerational soul or spiritual origins transmission of knowledge• Defines illness as physical • No discrete lines between or mental – discrete lines physical and mental illness between mental and physical – holistic view of health• Verbalization of problems • Verbalization of problems viewed as a necessary part is not viewed as productive of treatment or necessary. Silence is a virtue.
• Widely held stereotypes of Asian Americans as “problem free” may prompt clinicians to overlook their mental health problems (Takeuchi & Uehara, 1996).• Among all the major ethnic groups, Asian Americans confronted the most cultural and linguistic barriers in finding competent mental health care and received the lowest quality of care.
• Only 12 percent of Asians would mention their mental health problems to a friend or relative (versus 25 percent of whites).• A meager 4 percent of Asians would seek help from a psychiatrist or specialist (versus 26 percent of whites).• Only 3 percent of Asians would seek help from a physician (versus 13 percent of whites).• This study of Asian Americans in LA concluded that stigma was pervasive and pronounced (Zhang et al., 1998).
• Denise McNair – 11 years old• Carole Robertson – 14 years old• Cynthia Wesley – 14 years old• Addie Mae Collins – 14 years old
• Sept. 15, 1963 - instantly killed Denise, Carole, Cynthia, and Addie• Catalyzed the unified movement among civil rights leaders• July 2, 1964 - the passage of the most comprehensive body of civil rights laws in American history: U.S. Civil Rights Act of 1964
How Title VI affects healthand human service provisions for those with limited-English proficiency (LEP)?
"No person in the United States shall, on ground of race, color or nationalorigin, be excluded from participation in, be denied the benefits of, or besubjected to discrimination under anyprogram or activity receiving Federal financial assistance."
Birthplace, ancestry, culture, linguistic characteristics commonto a specific national minority group, or linguistic accent
LEP persons are those individuals with a primary or home language other than English who must, due to limited fluency in English, communicate in that primary or home language if they are to have an equal opportunity to participate in or benefit from any aids or servicesprovided by an agency that is receiving federal funding.
Nearly 30% of Asian andLatino Americans say they do not speak English “very well.”
• Verbal communication is critical to accurate diagnosis and effective treatment• Diagnoses are frequently made on the basis of symptoms verbally reported by the patient.• No objective medical tests, such as EKGs, blood tests, or x-rays to verify a psychiatric diagnosis or the effectiveness of psychotropic medications, other than the patient’s presentation and verbal reporting
• Minorities face greater disability burden not necessarily because the illnesses are more severe but because of the barriers they face in terms of access to care• Health disparities result
Established that language, by proxy, is national origin• The United States Supreme Court in Lau vs. Nichols (1974) stated that one type of national origin discrimination is discrimination based on a persons inability to speak, read, write, or understand English.• The government has to take affirmative steps, i.e., language interpretation, to rectify the lack of equal and comparable services based on limited-English language proficiency.
"Simple justice requires that public funds, to which all taxpayers of all races contribute, not be spent in any fashion which encourages, entrenches, subsidizes, or results in racial discrimination."
• There are 14 standards for culturally and linguistically appropriate services (CLAS), proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers.• Of these 14, Standards 4-7, which pertain to language assistance, are mandated by law for all programs and activities funded by Federal monies
Of these 14, Standards 4-7, which pertain to languageassistance, are mandated by law for all programs andactivities funded by Federal monies4. Language assistance services at no cost to each patient/consumer with LEP5. Notices to patients/consumers in their preferred language, informing them of their right to receive language assistance services.6. Competence of language assistance7. Patient-related materials and signage in the languages of the commonly encountered groups
Culturally and Linguistically Appropriate ServicesStandards (CLAS) are the collective set of culturally and linguistically appropriate services (CLAS) mandates, guidelines, and recommendations issued by the U.S. Department of Health andHuman Services Office of Minority Health intended to inform, guide, and facilitate required and recommended practices related to culturally and linguistically appropriate health services (National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, OMH, 2001).
STANDARD 4 Health care organizations must offerand provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
STANDARD 5Health care organizations must provide to patients/consumers in their preferredlanguage both verbal offers and written notices informing them of their right to receive language assistance services.
STANDARD 6 Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters andbilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).
STANDARD 7 Health care organizations must makeavailable easily understood patient-related materials and post signage in thelanguages of the commonly encountered groups and/or groups represented in the service area.
• Are supposed to be reported to the Office of Civil Rights (OCR), Federal Dept of Health and Human Services• Reports of violations are investigated by OCR• Can result in loss of funding for the organization in violation
More than 30 percent of direct medical costs facedby African Americans, Hispanics, and AsianAmericans were excess costs due to healthinequities – more than $230 billion over a threeyear period (2003-2006). And when you add theindirect costs of these inequities over the sameperiod, the tab comes to $1.24 trillion. — Ralph B. Everett, Esq. President and CEO Joint Center for Political and Economic Studies
Bruce Adelson, Esq.Former Senior Attorney of the Dept of Justice of Federal Compliance Consulting, LLC