Reducing Mental Health Disparities King Davis, Ph.D.

1. Reducing Mental Health Disparities King Davis, Ph.D.

2. What is the relationship between the mental health services system and help seeking behavior patterns of people of color?

4. What is Help – Seeking? Help-seeking involves a number of pro-active steps that take a person, family, or community from the point of recognizing a problem exists to using [entrusting] an external resource to solve, lessen, or cure the problem.

5. The Help Seeking Paradox Although there are reportedly minimal differences in rates, there are marked differences in help seeking by race, ethnicity, language, gender, residence, and other identifiable characteristics.

7. Status of Cultural Knowledge: The Clinical Application of Cultural Competency is Relative

8. Working Definition of Disparity Measurable, not assumed, differences between two or more objects, groups, people, or an absence of parity or equality between them. Unlike health disparities, mental health disparities are mainly in service patterns rather than rates of morbidity.

9. Mental Health Disparity Principally, a measurable difference in services [clinical choices and decisions], risk, help seeking, outcome, prevalence/incidence, and/or mortality by race, culture, ethnicity, language, gender, or any other identifiable characteristic.

11. Disparity “…should be viewed as a train of events leading to a difference in: Access to, utilization of, or quality of care Health status, or Health outcome ….that deserves scrutiny.”

12. Train of Events Family/Community Help Seeking Stigma Religious Based Family Burden(?) Vol. Participation Myth & Fear Cultural Beliefs Discrimination MH Literacy History/Memory Provider System Workforce Diversity Fragmentation Ethics/IRB Issues Commitment Resources/Costs Availability/Access Location/Hours Service Design EBPs/PBEs Courts/Police Knowledge Base Conceptualization Problem Formulation Theory/Hypotheses Research Methods Sampling Bias Community Involvement Public Policy Impact University Education Media Portrayals/Stigma Cultural Competence Comparative Outcomes

13. FRAGMENTATION The U.S. health, mental health and substance abuse treatment systems have developed independent of each other and of primary care. They typically are operated separately, without regard for the reality that physical and behavioral health are linked if not the same. Training programs reflect the same fragmentation.

14. Historical Research Hypotheses byAuthor and Chronological Period

15. Examples of Disparities Admissions Involuntary Commitments Length of Stay Access to Service Recidivism Rates Diagnosis of SMI Use of Police Quality of Care Homelessness Use of Medication - EBPs Mortality Rates Accuracy of Diagnosis

16. Mental Health, Health, Mortality and Race Individuals with a diagnosis of severe mental illness die an average of 25-32 years earlier than individuals without mental illness. What are the implications for people of color with severe mental illness? What solutions can be offered to prevent or reduce the rate of deaths?

17. Mortality Associated with Mental Disorders: Mean Years of Potential Life Lost

18. Access and Quality of Care SMI may be a health risk factor because of: Patient factors, e.g.: amotivation, fearfulness, homelessness, victimization/trauma, resources, advocacy, unemployment, incarceration, social instability, IV drug use, etc Provider factors: Comfort level and attitude of healthcare providers, coordination between mental health and general health care, stigma, System factors: Funding, fragmentation

19. Table 19. Death rates for diseases of heart, by race and Hispanic origin 1990 and 2004

20. Table 2. Changes in Ranking of mortality by race, Hispanic origin, and year

21. Neighbors, Baser & Martin (2007). unpublished data from the National Survey of American Life

23. Why be Concerned: Multiple Costs Excess Preventable Deaths Untreated Illness & Lower Achievement Excess Hospital Admissions & Readmissions Misdiagnosis & Poor Application of EBPs Community Suspicion and Mistrust Staff Division and Conflict Absence of Scientific Knowledge & Theory Ethical Conflict: Professional & Personal Increased Direct and Indirect Costs: Tremendous Waste Loss of Input from Special Markets: Volunteers/Policy Clinical Dropouts Cultural Malpractice Public Customers are Disproportionately Persons of Color!

25. Research Foci: Train of Events Family/Community Help Seeking Stigma Religious Based Family Burden(?) Vol. Participation Myth & Fear Cultural Beliefs Discrimination MH Literacy History/Memory Provider System Workforce Diversity Fragmentation Ethics/IRB Issues Commitment Resources/Costs Availability/Access Location/Hours Service Design EBPs/PBEs Courts/Police Knowledge Base Conceptualization Problem Formulation Theory/Hypotheses Research Methods Sampling Bias Community Involvement Public Policy Impact University Education Media Portrayals/Stigma Cultural Competence Comparative Outcomes