SAMHSA’s New Office of Behavioral Health Equity
Written By: Larke Huang, Director Office of Behavioral Health Equity
In the past decade, key policy reports have documented disparities in behavioral health for diverse racial and ethnic populations in the United States. The Surgeon General’s report Mental Health: Culture, Race and Ethnicity (2001), the President’s New Freedom Commission on Mental Health (2003), and the IOM Reports, Unequal Treatment and Race, Ethnicity and Language Data: Standardization for Health Care Quality Improvement (2009) have called for a national approach to reducing disparities. While the prevalence rates of behavioral disorders are generally similar across populations groups and in comparison to the white majority population, the burden of disease is often greater for diverse populations due to the disparities in access, quality and outcomes of care.
Many racial, ethnic and sexual minority groups have called for improved behavioral health care that takes into consideration the cultures of these populations and their culturally-based help-seeking behavior. Some groups, particularly African American and Latino, are diverted to more restrictive, less treatment-oriented systems, such as the criminal and juvenile justice and child welfare systems instead of to the behavioral health specialty care system. Native Americans experience high rates of trauma in their families and communities yet this is rarely addressed in their treatment for mental or substance use disorders. Asian Americans and Latinos have among the highest rates of uninsurance, curbing their entry into care. And sexual minority populations experience high rates of victimization, depression associated with family rejection, and too few behavioral health services skilled in working with this population.
The Health and Human Services Department (HHS) has a new charge to address these behavioral health disparities. The Affordable Care Act of 2010 (health reform legislation) called for the development of Offices of Minority Health in six agencies within HHS. SAMHSA was one of the agencies named in this legislation and will address the nations behavioral health disparities.
In accord with this legislation, SAMHSA created the Office of Behavioral Health Equity (OBHE). SAMHSA is charged with reducing the impact of substance abuse and mental illness on America’s communities, with the knowledge that prevention works, treatment is effective and people recover from these disorders. The vision of OBHE is to ensure that populations experiencing behavioral health disparities are equally served by this vision. It is OBHE’s intent that diverse populations, i.e., culturally, racially and ethnically diverse individuals, and families, sexual minority populations and other groups vulnerable to behavioral health disparities, are provided the services and support to thrive, participate in, and contribute to healthy communities.
OBHE will coordinate SAMHSA policies and programs to promote cross-cultural partnerships, relevant data collection, culturally appropriate outreach and engagement, and ready access to quality services. Some of the key drivers for OBHE’s work include:
- The HHS Secretary’s plan to reduce health disparities.
- The HHS Office of Minority Health five core goal areas: awareness, leadership, health system and life experience, cultural and linguistic competency, and data, research and evaluation
- The Agency for Health Research and Quality’s National Healthcare Disparities Report which identifies improving, maintaining and worsening health indicators, including depression, illicit drug use and suicide.
- SAMHSA’s Eight Strategic Initiatives: Prevention of Substance Abuse and Mental Illness; Trauma and Justice; Military Families; Health Reform; Recovery Support; Health Information Technology; Data, Outcomes and Quality; and Public Awareness and Support. These eight initiatives are the drivers for SAMHSA’s program, policies and budgeting. The SAMHSA Administrator is committed to ensuring that the specific issues for minority and disparity populations are addressed in each strategic initiative.
As SAMHSA develops this new Office, SAMHSA will welcome input and guidance from ethnic/racial and LGBT stakeholder groups, national and local leadership, and researchers and providers with expertise in behavioral health disparities.
While I applaud most of your goals, I see a major one lacking. While almost all private insurance companies and medicaid all treat by Licensed Professional Counselors or Licensed Mental Health Professionals, wit Masters Degrees, trained and the aforementioned license, Medicare and Tricare make it either make it impossible for them to receive reimbursement, by rule or practice. One case in point both agencies say it is acceptable, but don’t even have the paperwork where one can apply and it has been approved fro over 2 years. How about an easy fix for this silly over-site, like a simple modification of the form for a psychologists application, it couldn’t take more than an hour of work even if the approval process takes 100 times longer!
The “Pathways Project”, a joint intiative of the Network of Behavioral Health Providers and the Greater Houston AHEC of Houston, Texas, is a funded project designed to increase awareness and interest in behavioral health professions. We are in our second year, and have expanded our work in local high schools from one to four: we have developed a curriculum which is being integrated into the regular high school curriculum, which is focused on increasing student understanding of mental health and mental illness as well as raise interest in behavioral health professions. We are also working with two nursing schools in Houston and have developed a new psychiatric nursing rotation model which is engaging students and raising their interest level in psychiatric nursing as a possible profession. As the Project Manager of “Pathways” I would be very interested in discussing my work and findings thus far with someone at SAMHSA; who should I contact?
No wonder why SAMHSA did not include reducing disparities among the strategic initiatives. This is an overarching initiative, institutionalized now in a new department. Go SAMHSA!
Very happy to see this development since “cultural competence” and reduction of disparities seemed to have been eliminated from the SAMHSA list of priorities.
This is a great initiative, institutionalized now in a new department. Thank you SAMHSA!
What a great thing to read about SAMHSA!! You are talking a more holistic approach to treating these substance abuse disorders. There is no “one size fits all” solution and it’s so refreshing and encouraging to see you address larger and more systemic cures.
ALL too often the various cultures can also influence the reasoning why and how substance abuse has been created in the individual and hopefully the results of SAMHSA will show that we can have higher rates of cure and SA reversal.
Well done.
Latinos Accessing Mental Health Services
As an immigrant to the U.S., I was able to experience the many challenges that faced my family while we attempted to access social services. The moment we walked into a social service office, we knew whether we were welcomed. The manner in which we were greeted, the tone of voice, the facial expressions, and the willingness to take extra time to work through some language barriers told us whether or not we would be able to receive assistance or find ourselves walking away. I worked as a mental health professional and was so disturbed by how people from minority groups were treated that I left the job. There are many barriers I saw that kept Latinos from seeking services for themselves and their children. Latinos not only have socioeconomic barriers to accessing mental health services, they also have perceptions about mental health that affects their utilization of mental health services. Many Latinos view physical symptoms more seriously than their problems associated with mental health. Research shows that Latinos are more likely to seek a physician’s help for psychological problems (e.g., Acosta, 1979; Wells, Hough, Golding, Burnam, & Karno, 1987).
The agency administrator had not provided any training for the therapists on offering culturally responsive services. I worked under the supervision of a Clinical Psychologist who had the best of intentions but did not possess strong cross-cultural communication skills. I interviewed psychologists who stated that the instruments they used for psychological evaluations were not designed to be used for ethnic populations, therefore, they were skewed. Psychological evaluations that were used within the judicial and educational systems that had some very negative impacts of these people’s lives.
I was assigned to work with Latino families since I am a Latina and bilingual. I worked with families providing Parent Child Interactive Therapy (PCIT). The model did not fit Latinos. The instruments for evaluating progress were not designed for Latino families and were not designed in a way to engage parents in play activities. Many parents were experiencing depression and anxiety which had developed as a result of the many changes they were experiencing. The stress they were experiencing was due to the process of acculturation. Acculturation refers to psychosocial changes that individuals or groups experience when they interact with another culture (Alvidrez, Azocar, & Miranda, 1996). The acculturation process brought forth stressors which were directly related to their identity. Coming to the U.S. is a dream for a better life, however, many Latinos have no idea of the stressors caused by leaving a culture they’ve known all their lives, and the demand for them to change their attitudes, behaviors, language, and cognition, all as a result of living in a host culture. Many of the immigrant families I was working with were experiencing depression, grief and loss.
http://ssrdqst.rfmh.org/cecc/.
Sue, S., Fujino, D. C., Hu, L. T., Takeuchi, D. T., & Zane, N. W. S. (1991). Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59, 533-540.