1. Mental Health Advocacy with Diverse Communities Sita Diehl Director of State Policy and Advocacy

3. Objectives Consider mental illness in multicultural communities Increase awareness of cultural competence Learn strategies for multicultural advocacy partnership Take advantage of National Minority Mental Health Awareness Month to move your advocacy agenda forward

4. Culture: Common heritage and set of beliefs, norms, and values By 2042 “minorities” will be the majority. Racial/ethnic minorities represented between 81 percent and 89 percent of the U.S. population growth since 2000. Latinos increased from 13 percent of the U.S. population a decade ago to 16 percent. Blacks represent about 12 percent and Asians roughly 5 percent of the total U.S. population. Source: MaJose Carasco NAMI Multicultural Action Center, 2011

5. Have less access to mental health services. Are less likely to receive needed mental health services. Often receive a poorer quality treatment and care Are underrepresented in mental health research –Surgeon General David Satcher, 2000 Source: MaJose Carasco, NAMI Multicultural Action Center, 2011

6. Less likely to rely on professional services. –Seen as part of dominant culture –Historical: Misdiagnosis Inadequate treatment Cultural insensitivity Mental health treatment = oppression Help sought through: –Faith leaders –Traditional healers Source: MaJose Carasco, NAMI Multicultural Action Center, 2011

7. Source: Sue Wintz and Earl Cooper 2000-2003, A Quick Guide to Cultures and Spiritual Traditions, Association of Professional Chaplains.

8. Cultural competence: embrace and act on different cultural viewpoints Cultural competence is based on a willingness to use “beginner’s mind” –Focus on a culture or population –Come listening and learning –Rather than telling and selling –Be patient! Take the time to build trust

9. Individual advocacy partners Choose someone from a diverse background Never go alone - small commitments Advocacy events, meetings, conference calls Reporting to the affiliate at monthly meetings Writing or forwarding email alerts Activating the telephone tree When you are both confident, Choose new partners and pass it on…

10. Be thoughtful when selecting members for the group. Do not make the mistake of only including “diverse people” on your committee. This group needs to be an important part of your leadership and connected to your overall efforts. Assign roles according to interests, talents, skill sets and experience. Source: MaJose Carasco NAMI Multicultural Action Center, 2011

11. Learn as much as you can about characteristics and history of that group in your area Understand core values –Role of family –Level of trust in institutions and outsiders –Role of faith, traditions, celebrations –Cultural icons –Respect for youth/ elderly –Humor and body language Identify community agencies and leaders Phase in target groups over several years Source: MaJose Carasco NAMI Multicultural Action Center, 2011

12. Supports your organizational mission –Affected by mental health conditions directly or as a family member –Knows your goals and programs –Strong self-identity with target population and culture –Yet comfortable in the dominant culture

13. Be patient - Take time to find the right people –Build relationships and trust –Move beyond tokenism to integration of cultural perspectives –Boundary spanner keeps your group informed - but others must engage

14. Identify Key Community Leaders –Approach to partner with them –Listen to priorities of cultural leaders Identify intersection of priorities Identify how each ally will benefit –Ask for representative to interact with NAMI and vice versa

15. –Build the relationship over time –When issues arise that are important to allies, invite them to advocate with you –Respond to their invitations to advocate –BE PATIENT, DON’T GIVE UP

16. Tips for Partnering –Who has a strong interest in your issue? –Who is working on your issue or issue area? –Who has significant influence? –Who has the capacity to act? –Will cooperating enhance effectiveness? Source: Angela Kimball, Game On! Winning at the New Advocacy Game, 2010

17. Plan now to take action in July – Involve individuals from diverse cultures as advocacy partners – Establish/refocus multicultural advisory group Identify a target population as a focus for the next year Conduct multi-cultural advocacy training – Telling Your Story – Identify and involve boundary spanners – Partner with diverse organizations as allies

18. Questions?

19. Embedding Multicultural Issues into Our Existing Policy Priorities Majose Carrasco Director, NAMI Multicultural Action Center

20. NAMI State Action Agenda Increase access to effective mental health care Promote integration of mental health, addictions and primary care Strengthen the mental health workforce Eliminate disparities in mental health care Ensure transparency and accountability Ensure the mental health care of children and youth Provide homes and jobs for people with mental illness End the inappropriate jailing of people with mental illness

21. Increase access to effective mental health care State Medicaid Programs should provide an array of mental health services. – Minorities more likely to relay on Medicaid (50%+ of all Medicaid recipients are minorities) Access to medications – Differences in how minorities metabolize psychiatric medications. e.g. African Americans and Asian American may be slow metabolizers. – African Americans are not often prescribed SSRIs and often times receive older medications.

22. Promote integration of mental health, addictions and primary care Minorities with mental illness are more likely to seek help from their primary care physician.

23. * Compared with whites, differences remain statistically significant after adjusting for age, income, and insurance. Source: The Commonwealth Fund. Health Care Quality Survey. 2006. Almost 2.5 Times as Many Hispanics as Whites Report Having No Doctor. Percentage of adults ages 18 to 64 reporting no regular doctor, 2006 *

24. Strengthen the mental health workforce Among clinically trained mental health professionals: – 2% African American psychiatrics – 2% African American psychologists

25. Percentage of Spanish Speaking Health Care and Mental Health Providers in the U.S.

26. Culture, Race, and Ethnicity: A Supplement to the Surgeon General’s Report on Mental Health, 2001 Culture Counts! Striking disparities in access, quality and availability of mental health services exist for racial and ethnic minority Americans Racial and ethnic minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental health problems and mental illnesses http://www.surgeongeneral.gov/library/mentalhealth/cre/

27. Culture, Race & Ethnicity: Major Findings Ethnic/Racial communities: – Have less access to, and availability of, mental health services – Are less likely to receive needed mental health services – Often receive a poorer quality treatment and care – Are underrepresented in mental health research

28. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care Institute of Medicine Report 2003 Racial and ethnic disparities in healthcare exist, and because they are associated with worse outcomes in many cases, are unacceptable Racial and ethnic disparities in healthcare occur in the context of broader social and economic inequality

29. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care Institute of Medicine Report 2003 Many sources may contribute to racial and ethnic disparities Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in health care Minority patient refusal rates do not fully explain health care disparities

30. Disparities in quality of care are common: Blacks and American Indians and Alaska Natives received worse care than Whites for about 40% of core measures. Asians received worse care than Whites for about 20% of core measures. Hispanics received worse care than non-Hispanic Whites for about 60% of core measures. http://www.ahrq.gov/qual/qrdr10.htm 2010 National Healthcare Disparities Report

31. Treatment: Depression In 2008, the percentage of adults who received treatment for depression in the last 12 months was significantly lower for Blacks than for Whites (56.0% compared with 70.4%; and lower for Hispanics than for non-Hispanic Whites (57.4% compared with 71.8%). Figure: Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 months, by race, ethnicity, and gender, 2008

32. Outcome: Suicide Deaths

33. For community specific facts visit: www.nami.org/multicultural For National Minority Mental Health Awareness Month resources visit: www.nami.org/minoritymentalhealthmonth www.nami.org/multicultural www.nami.org/minoritymentalhealthmonth