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Addressing Healthcare Disparities

  • Diane Eckert
  • Deborah Goebert
Chapter

Abstract

Mental health needs of minorities receive minimal attention, resulting in inadequate provision of culturally appropriate mental health care in racial and ethnic minority communities. Advancing our understanding of cultural issues is essential for reducing disparities. Culture is embedded in many social components, including identity, gender ideologies, generational experience, racial discrimination, and socioeconomic status. Through ongoing efforts to improve our understanding of the ways culture influences mental illness, health, and wellbeing, we enhance our ability to reduce stigma, optimize screening, enhance formulation, and design more effective interventions for all groups. Using case vignettes, this chapter illustrates key cultural considerations for psychosomatic practitioners to provide quality care and reduce mental health disparities in children and adolescents.

Keywords

Child and adolescent Cultural competency Cultural formulation Help-seeking Identity Mental health disparity Treatment barriers Vignette 

References

  1. Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97(1), 68–75.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Alegría, M., Vallas, M., & Pumariega, A. J. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent PsychiatricClinics of North America, 19, 759–774.  https://doi.org/10.1016/j.chc.2010.07.001.CrossRefGoogle Scholar
  3. Alegría, M., Green, J. G., McLaughlin, K. A., & Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the U. S. New York: William T Grant Foundation.Google Scholar
  4. American Psychiatric Association. (2013). Cultural formulation. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 749–759). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  5. Barnett, M. L., Gonzalez, A., Miranda, J., Chavira, D. A., & Lau, A. S. (2017). Mobilizing community health workers to address mental health disparities for underserved populations: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 45, 1–17.Google Scholar
  6. Barry, C. L., & Huskamp, H. A. (2011). Moving beyond parity—Mental health and addiction care under the ACA. New England Journal of Medicine, 365(11), 973–975.CrossRefPubMedGoogle Scholar
  7. Becker, A. E., & Kleinman, A. (2013). Mental health and the global agenda. New England Journal of Medicine, 369(1), 66–73.CrossRefPubMedGoogle Scholar
  8. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.CrossRefGoogle Scholar
  9. Breslau, J., Kendler, K. S., Su, M., Gaxiola-Aguilar, S., & Kessler, R. C. (2005). Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine, 35(03), 317–327.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Breslau, J., Aguilar-Gaxiola, S., Kendler, K. S., Su, M., Williams, D., & Kessler, R. C. (2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36(01), 57–68.CrossRefPubMedGoogle Scholar
  11. Chow, J. C. 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, 792–797.  https://doi.org/10.2105/AJPH.93.5.792.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Dua, T., Barbui, C., Clark, N., Fleischmann, A., Poznyak, V., van Ommeren, M., et al. (2011). Evidence-based guidelines for mental, neurological, and substance use disorders in low-and middle-income countries: Summary of WHO recommendations. PLoS Medicine, 8(11), e1001122.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Flannery, W. P., Reise, S. P., & Yu, J. (2001). An empirical comparison of acculturation models. Personality and Social Psychology Bulletin, 27(8), 1035–1045.CrossRefGoogle Scholar
  14. Gee, G. C., & Payne-Sturges, D. C. (2004). Environmental health disparities: A framework integrating psychosocial and environmental concepts. Environmental Health Perspectives, 112, 1645–1653.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Holden, K., McGregor, B., Thandi, P., Fresh, E., Sheats, K., Belton, A., et al. (2014). Toward culturally centered integrative care for addressing mental health disparities among ethnic minorities. Psychological Services, 11(4), 357.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.Google Scholar
  17. Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006). Advancing health disparities research within the health care system: A conceptual framework. American Journal of Public Health, 96, 2113–2121.  https://doi.org/10.2105/AJPH.2005.07762821.CrossRefPubMedPubMedCentralGoogle Scholar
  18. McGuire, T. G., & Miranda, J. (2008). Racial and ethnic disparities in mental health care: Evidence and policy implications. Health Affairs (Project Hope), 27(2), 393–403.  https://doi.org/10.1377/hlthaff.27.2.393.CrossRefGoogle Scholar
  19. Mistry, K. B., Minkovitz, C. S., Riley, A. W., Johnson, S. B., Grason, H. A., Dubay, L. C., & Guyer, B. (2012). A new framework for childhood health promotion: The role of policies and programs in building capacity and foundations of early childhood health. American Journal of Public Health, 102(9), 1688–1696.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Oetting, E. R., & Beauvais, F. (1990). Orthogonal cultural identification theory: The cultural identification of minority adolescents. International Journal of the Addictions, 25, 655–685.CrossRefPubMedGoogle Scholar
  21. Raguram, R., Venkateswaran, A., Ramakrishna, J., & Weiss, M. G. (2002). Traditional community resources for mental health: A report of temple healing from India. BMJ: British Medical Journal, 325, 38–40.CrossRefPubMedGoogle Scholar
  22. Ryder, A. G., Alden, L. E., & Paulhus, D. L. (2000). Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment. Journal of Personality and Social Psychology, 79(1), 49.CrossRefPubMedGoogle Scholar
  23. Sam, D. L., & Berry, J. W. (2010). Acculturation when individuals and groups of different cultural backgrounds meet. Perspectives on Psychological Science, 5(4), 472–481.CrossRefPubMedGoogle Scholar
  24. Saravanan, B., Jacob, K. S., Johnson, S., Prince, M., Bhugra, D., & David, A. S. (2007). Belief models in first episode schizophrenia in South India. Social Psychiatry and Psychiatric Epidemiology, 42, 446–451.  https://doi.org/10.1007/s00127-007-0186-z.CrossRefPubMedGoogle Scholar
  25. Schwartz, S. J., Zamboanga, B. L., Rodriguez, L., & Wang, S. C. (2007). The structure of cultural identity in an ethnically diverse sample of emerging adults. Basic and Applied Social Psychology, 29(2), 159–173.CrossRefGoogle Scholar
  26. Smedley, B., Stith, A. Y., & Nelson, A. R. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine of the National Academie.Google Scholar
  27. Tadmor, C. T., & Tetlock, P. E. (2006). Biculturalism: A model of the effects of second-culture exposure on acculturation and integrative complexity. Journal of Cross-Cultural Psychology, 37(2), 173–190.CrossRefGoogle Scholar
  28. Triandis, H. C., Brislin, R., & Hui, C. H. (1988). Cross-cultural training across the individualism-collectivism divide. International Journal of Intercultural Relations, 12(3), 269–289.CrossRefGoogle Scholar
  29. U.S. Department of Health and Human Services. (2001). Mental Health: Culture, race, and ethinicity-A supplement to mental health: A report of the surgeon general. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.Google Scholar
  30. Williams, D. R., & Earl, T. R. (2007). Commentary: Race and mental health—More questions than answers. International Journal of Epidemiology, 36(4), 758–760.CrossRefPubMedGoogle Scholar
  31. World Health Organization. (2014). Social determinants of mental health. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department Psychiatry, John A Burns School of MedicineUniversity of Hawaii at ManoaHonoluluUSA

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