Ethnic Disparities in Behavioral Healthcare

1 Analyze Ethnic Disparities in Behavioral Healthcare Chow, J. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792-797. https://dx.doi.org/10.2105%2Fajph.93.5.792 The article by Chow, Jaffee, and Snowden (2003) describes a study investigating the influence of racial/ethnic disparities on the utilization of mental health services in socioeconomically disadvantaged regions. The researchers used a systematic review of the literature to gather data on the research topic. Chow et al. (2003) noted that gaps in mental health reflect underlying differences in access to care. Research in mental health shows distinct differences in patterns and rates of mental health care for Asian Americans, African Americans, and Latinos.

2 Chow et al. (2003) pointed out that these differences are related to socioeconomic factors inherent to the target groups. The authors also noted that the mental health needs of people residing in poor regions remain largely unmet. Even among poor people, who have received mental health care, premature termination rates are incredibly high. It is undeniable that residential patterns and geographical differences are potential contributors to disparities in mental health. The researchers pointed out that culturally sanctioned belief systems and a lack of health insurance coverage contribute to mental health disparities in the target groups. Chow et al. (2003) also identified religious beliefs and limited access to culturally compatible healthcare professionals as notable contributors to mental health inequalities. The researchers noted that poor people do not receive timely treatment for their mental illnesses. Subsequently, these individuals experience high hospitalization rates and prolonged hospital stays.

Kirmayer, L. J., & Jarvis, G. E. (2019). Culturally responsive services as a path to equity in mental healthcare. HealthcarePapers, 18(2), 11-23. https://doi.org/10.12927/hcpap.2019.25925 The article by Kirmayer and Jarvis (2019) describes a systematic review of literature highlighting the inequalities that hinder ethnic minority populations’ access to mental health services. The researchers reviewed models to address mental healthcare diversity in this study and identify critical areas needing urgent policy innovation. These areas include cultural competence, clinical communication, national regulations, quality assurance standards, and integrating attention into clinical practice and mental health services. The theme for this study was that cultural values, knowledge, and practice play an invaluable role in creating and maintaining health inequalities. Kirmayer and Jarvis

3 (2019) noted that systematic attention to culture in systems, research, training, and policy could help address inequalities. The researchers noted that ethnic minority populations, including indigenous people, radicalized groups, and refugees, experience significant inequalities in mental health. These inequalities are attributable to social structural health determinants embedded in the target group's cultural values, attitude, knowledge, and the larger society. The social structural factors include racism, violence, discrimination, and poverty. Kirmayer and Jarvis (2019) pointed out that culture influences the experience and expression of mental health and mental health illnesses. It also influences the coping mechanisms, pathways to care, and the processes of resilience and recovery (Kirmayer & Jarvis, 2019). The researchers, thus, argued that systematic attention to culture in providing mental health services could enhance access, help-seeking, utilization, and health outcomes.

Sentell, T., Shumway, M., & Snowden, L. (2007). Access to mental health treatment by English language proficiency and race/ethnicity. Journal of General Internal Medicine, 22 Suppl 2(Suppl 2), 289–293. https://doi.org/10.1007/s11606-007-0345-7 The article by Sentell, Shumway, and Snowden (2007) describes a study in which the researchers aimed to evaluate the extent to which language barriers affect access to mental health care by race/ethnicity. The researchers argued that despite limited English proficiency is associated with racial and ethnic health inequalities. These relationships have not been previously extensively investigated through empirical research. The current study was based on the view that mental health disparities are attributable to limited English proficiency. The researchers employed a cross-sectional design to analyze the 2001 California Health Interview Survey. The survey participants included

4 adults between 18 and 60 years of age. The researchers allocated the participants to three groups: English-speaking only, non-English speaking, and bilingual participants. The researchers used self-reported data to assess the participants' mental health and access to mental health services. The study revealed that non-English speaking participants were less likely to receive mental health services than their English-speaking counterparts. The study revealed an even more dramatic relationship within racial groups. For instance, non-English speaking Asians had lower odds of accessing mental health services than non-English speaking Latinos (Sentell et al., 2007). The researchers thus concluded that limited English proficiency influence the use of mental health services. This argument is valid since diagnosis and treatment of mental illnesses depend on direct communication rather than medication and objective assessments. Therefore, the language barrier would prove problematic to mental health care.

Valentine, A., DeAngelo, D., Alegría, M., & Cook, B. L. (2014). Translating disparities research to policy: a qualitative study of state mental health policymakers' perceptions of mental health care disparities report cards. Psychological Services, 11(4), 377–387. https://doi.org/10.1037/a0037978 The article by Valentine, DeAngelo, Alegría, and Cook (2014) focuses on translating evidence of disparities gathered through research to policy. 1the researchers employed a qualitative approach to determine the state mental health policymakers’ view of mental health care disparities’ report cards. The researchers noted that health care professionals commonly use report cards to enhance accountability and quality of mental care in hospitals. These cards also provide the base for improving state infrastructure to provide quality mental health services. Unfortunately, as denoted by Valentine et al. (2014),

5 leaders and researchers have not utilized report cards as tools for comparing states on racial disparities in mental health care. The current study focuses on examining the responses of mental health policymakers to mental health disparities reports. The feedback obtained from the policymakers addresses the content, the salience, and the format of the report cards. The researchers conducted interviews with nine state policymaker’s senior advisors and one national nongovernmental organization policy director. The study findings were grouped into four major themes: the divide between policymakers' and researchers' goals and language, fairness in state-by-state comparisons, data quality concerns, and targeted policymakers’ suggestions. The researchers concluded that stakeholders’ responses provide crucial information that avails evidence-based research to policymakers. Valentine et al. (2014) also noted that stakeholders need to engage in activities that facilitate understanding research methodologies, standards for interpreting research-based evidence, and its application to evaluating policies that ameliorate disparities.

Yasui, M., Pottick, K. J., & Chen, Y. (2017). Conceptualizing culturally infused engagement and its measurement for ethnic minority and immigrant children and families. Clinical Child and Family Psychology Review, 20(3), 250–332. https://doi.org/10.1007/s10567-0170229-2 Yasui, Pottick, and Chen's (2017) article describes a systematic review of the literature to conceptualize culturally infused engagement and measure it for immigrant and ethnic minority families and children. The researchers clarified that racial disparities influence mental health care and treatment outcomes. They acknowledged that members of ethnic minority communities have limited access to mental health services than mainstream

6 populations. They noted that despite culture play a vital role in racial and ethnic disparities in mental healthcare for the target population, existing measures of engagement do not integrate culturally specific factors that influence the target population’s engagement with mental health services. The researchers systematically reviewed existing instruments that assess developmental and multidimensional processes for the target population. The review is pegged on the culturally infused engagement model, a new integrated conceptualization of engagement. The researchers assessed culturally relevant behavioral, attitudinal and cognitive mechanisms of engagement problem acknowledgment and help-seeking to treatment. The study revealed that existing engagement evaluated four critical domains relevant to engagement processes for the target groups. The explored domains include the expression of mental illnesses, casual explanation of mental disorders, help-seeking beliefs and experiences, and views on mental health. The findings reflect the instruments applied to assess attitudinal and behavioral scopes of engagement. Findings also highlight the limitations of applying the instruments to measure critical engagement dimensions in ethnic minority and immigrant families.

7 References Chow, J. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792-797. https://dx.doi.org/10.2105%2Fajph.93.5.792 Kirmayer, L. J., & Jarvis, G. E. (2019). Culturally responsive services as a path to equity in mental healthcare. HealthcarePapers, 18(2), 11-23. https://doi.org/10.12927/hcpap.2019.25925 Sentell, T., Shumway, M., & Snowden, L. (2007). Access to mental health treatment by English language proficiency and race/ethnicity. Journal of General Internal Medicine, 22 Suppl 2(Suppl 2), 289–293. https://doi.org/10.1007/s11606-007-0345-7 Valentine, A., DeAngelo, D., Alegría, M., & Cook, B. L. (2014). Translating disparities research to policy: a qualitative study of state mental health policymakers' perceptions of mental health care disparities report cards. Psychological Services, 11(4), 377–387. https://doi.org/10.1037/a0037978 Yasui, M., Pottick, K. J., & Chen, Y. (2017). Conceptualizing culturally infused engagement and its measurement for ethnic minority and immigrant children and families. Clinical Child and Family Psychology Review, 20(3), 250–332. https://doi.org/10.1007/s10567-0170229-2