Mental health is a vital part of every person’s overall health and well-being. Every adult, child, youth and family should receive essential services and support regardless of how they enter the healthcare system. According to the Social Equity Report (Yale Global Health Leadership, 2015), there is strong evidence that increased investment in social services – as well as various models of partnership between health care and social services – can result in substantial health benefits and reduce health care costs for targeted populations.
We know that achieving optimum health requires much more than just controlling disease. It requires ensuring conditions in which people can be healthy. Good health results from having choices – that is sound reasonable options. Conditions in the social and physical environments determine the range of options that are available and their ease or difficulty of use. Healthful social and physical conditions can ensure that all members of society benefit from the same basic rights, security, and opportunities.
By addressing inequalities in social and physical environmental factors, we can increase health equity and decrease health disparities. Doing so involves recognizing the substantial, often cumulative effects of socioeconomic status and related factors on health, functioning, and well-being from even before birth throughout the entire life course. Reducing inequalities in the social environment and physical environment, as well as addressing behavioral health disparities can help people meet their health objectives (Healthy People 2020). Strategies aimed at eliminating behavioral health disparities include (SAMHSA-HRSA, 2012):
- Increasing knowledge and implementation of integrated primary and behavioral healthcare models that serve communities of Color and those with limited English proficiency.
- Promoting best, promising and evidence-based practices that are racially/culturally/linguistically appropriate.
- Supporting efforts to build a multidisciplinary, racially and culturally diverse, knowledgeable, bilingual and racially and culturally attuned workforce and leadership for integrated care.
- Improving health and behavioral healthcare by first understanding then addressing the role of social determinants of health.
- Improving information dissemination strategies through learning collaboratives.
Service Integration
Service integration as an example of a quality health care delivery design that facilitates communication and coordination based on consumer and family preferences and sound economics (Position Statement 13, Mental Health America-MIA), 2016.
- Communication: Each clinician caring for the patient (consumer) shares needed clinical information about the patient (consumer) to other clinicians also treating the patient (consumer)
- Collaboration: A multidimensional, shared understanding of goals and roles, effective communication, and shared decision-making.
- Care Coordination: The outcome of effective collaboration and corresponds to clinical integration.
- Service integration: The extent to which patient (consumer) care services are coordinated across people, functions, activities, and sites over time so as to maximize the value of services delivered to patients.
The main responsibility for providing mental health care continues to fall on primary care, with 42% of patients with clinical depression and 47% with generalized anxiety disorder first diagnosed in primary care (The American Academy of Family Physicians, 2015). Although primary professionals provide the majority of mental health care, they may lack the knowledge or the time to adequately diagnose and treat mental health conditions. Many individuals prefer to receive their mental health care within primary care since it is perceived as less stigmatizing. As such, the role of primary care identification and treatment of mental health conditions is especially important for special populations who often go undiagnosed due to lack of access.
Communities of Color and persons with limited English proficiency often seek behavioral health assistance through their primary care providers. The Office of Minority Health (OMH) first examined the role of integrated care in 2004 to find solutions for improving access, engagement and utilization of mental health services. Since then, the field has gained significant momentum. OMH highlighted and promoted models that provided efficient and seamless coordination of access, quality and delivery of care. The goals were centered on promoting health equity, building on innovation and leadership, working collaboratively with other federal and non-federal partners, leveraging dollars, and bridging gaps. Below are some models of integrated care aimed at improving the overall quality of care for underserved communities (SAMHSA-HRSA, 2012):
- Integrated Care for Asian American, Native Hawaiian & Pacific Islander Communities: A Blueprint for Action Summit (August 2011) and A Blueprint for Action. Consensus Statements and Recommendations (2012).
- Eliminating Behavioral Health Disparities through the Integration of Behavioral Health and Primary Care Services for Racial and Ethnic Minority populations: Establishing Models for Improving Clinical Outcomes. Hogg Foundation for Mental Health. Consensus meeting: Nov. 2011. Consensus paper: Jan. 2012. Final rollout: February 7, 2012. Review of the literature due May 2012.
- Mobilizing Social Work as a Resource for Eliminating Behavioral Health Disparities: a Disparities Curriculum Infusion Project, National Association of Deans and Directors of Schools of Social Work. Literature Review. Due April 2012.
- Dialogue and Strategies for Effective Holistic Health for African Americans-Blacks: Addressing the Integration of Mental Health, Substance Abuse and Primary Care (2010) and Pathways to Integrated Health Care, Strategies for African American Communities and Organizations: consensus statements and recommendations (2011).
For clinicians working in integrated care settings, racial and cultural understanding and sensitivity are vital to engaging and caring for communities of Color in the care they need to achieve recovery and improved health. The goal is to empower the community and their families to enjoy healthier and more fulfilling lives by providing culturally affirming and affordable behavioral health and prevention services. Below are 10 tips that can help build stronger, more culturally competent relationships with clients (SAMHSA-HRSA, 2012).
- Recognize that culture is a defining characteristic for some clients, and that their cultural identity may be at the root of their presenting health problem.
- Do not assume that culture is a defining characteristic of all clients.
- Do not assure any client that you understand.” Rather than try to prove how much you know about a client’s culture, demonstrate your willingness to learn from the client.
- Treat each client as an individual, not as a member of a group.
- Do not assume you have an advantage with clients of the same culture as you.
- Remember that human beings are more alike than different – do not overlook obvious interpretations of behavioral health and health symptoms by only interpreting a client’s actions in context of their culture.
- Accept that we all relate to others within the context of our own set of values, knowledge and experiences.
- Assume that you have biases and beliefs that may hinder optimal provider-client relationships.
- Draw upon your own expertise at the same time you honor and acknowledge each client’s expertise.
- Realize that as an integrated healthcare provider, you are the expert on strategies of health behavior change and treatment and services (and each of your clients is the expert on his or her own culture and the place it holds in his or her life and healthcare).
