Health Equity and Civil Rights

The President’s New Freedom Commission

on Mental Health: Achieving the Promise:

Transforming Mental Health Care in America.

Final Report, July 2003.

WESTERN PSYCHIATRIC

• Scientific epistemology

• Biochemical/Genetic etiology

of illness without considering

soul or spiritual origins

• Defines illness as physical

or mental – discrete lines

between mental and physical

• Verbalization of problems

viewed as a necessary part

of treatment

TRADITIONAL ASIAN

• Spiritual orientation

• Epistemologically based on

faith and intergenerational

transmission of knowledge

• No discrete lines between

physical and mental illness

– holistic view of health

• Verbalization of problems

is not viewed as productive

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 health

and human service provisions for those

with limited-English proficiency (LEP)?

"No person in the United States shall,

on ground of race, color or national

origin, be excluded from participation

in, be denied the benefits of, or be

subjected to discrimination under any

program or activity receiving Federal

financial assistance."

Birthplace, ancestry, culture,

linguistic characteristics common

to 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 services

provided by an agency that

is receiving federal

funding.

Nearly 30% of Asian and

Latino 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 person's

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 language assistance, are mandated by law for all programs and activities funded by Federal monies

4. Language assistance services at no cost to each

patient/consumer with LEP

5. Notices to patients/consumers in their preferred language,

informing them of their right to receive language assistance

services.

6. Competence of language assistance

7. Patient-related materials and signage in the languages of

the commonly encountered groups

Culturally and Linguistically Appropriate Services

Standards (CLAS) are the collective set of culturally

and linguistically appropriate services (CLAS)

mandates, guidelines, and recommendations

issued by the U.S. Department of Health and

Human 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 offer

and 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 5

Health care organizations must provide

to patients/consumers in their preferred

language 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 and

bilingual 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 make

available easily understood patient-related

materials and post signage in the

languages 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 faced

by African Americans, Hispanics, and Asian

Americans were excess costs due to health

inequities – more than $230 billion over a three

year period (2003-2006). And when you add the

indirect costs of these inequities over the same

period, 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