CHAPTER 7

A Vision for the Future

Improve Quality of Care

This Supplement identified racial and ethnic disparities in the quality of mental health services people receive. Therefore, the provision of high-quality services in settings where there is an appreciation for diversity and its impact on mental health is a priority for meeting current and future needs of diverse racial and ethnic populations.

Ensure Evidence-Based Treatment

As noted earlier, the recommended treatments available for all patients are those based on a strong and consistent evidence base and tailored to the age, race, gender, and culture of the individual. It is clear that the Nation’s mental health service system needs to ensure that all Americans receive the highest standard of care. This Supplement finds that racial and ethnic minorities are less likely than whites to receive effective, state-of-the-art treatments. Therefore, frontline providers need incentives and opportunities to participate in quality improvement activities that will help them better manage medications and provide effective psychosocial treatments to racial and ethnic minority consumers, children, and families in ways that are both culturally and linguistically appropriate and consistent with practice standards.

Develop and Evaluate Culturally Responsive Services

Culture and language affect the perception, utilization, and, potentially, the outcomes of mental health services. Therefore, the provision of culturally and linguistically appropriate mental health services is a key ingredient for any programming designed to meet the needs of diverse racial and ethnic populations. This programming should include:

(1) language access for persons with limited English proficiency;

(2) services provided in a manner that is congruent, rather than conflicting, with cultural norms; and

(3) the capacity of the provider to convey under-standing and respect for the client’s worldview and experiences.

The refinement and study of cultural competence may reveal a mechanism for helping mental health organizations and providers deliver culturally appropriate services. This approach underscores the recognition of cultural differences in consumers and families and then develops a set of skills, knowledge, and policies in an effort to deliver services more effectively. There have been, however, few direct empirical studies of cultural competence. Research is needed to determine its key ingredients and what influence, if any, they have on improving service delivery, utilization, treatment response, adherence, outcomes, or quality for racial and ethnic minorities.

Engage Consumers, Families, and Communities in Developing Services

One way to ensure that mental health services meet the needs of racial and ethnic minority populations is to involve representatives from the community being served in the design, planning, and implementation of services. Modeled on primary health care programs that successfully target recent immigrants and refugees, some minority-oriented mental health programs appear to succeed by maintaining active relationships with community institutions and leaders. These programs do aggressive outreach, furnish a familiar and welcoming atmosphere, and identify and encourage styles of practice tailored to racial and ethnic minority groups.

State, county, and local communities carry the primary responsibility for developing, organizing, and operating their own mental health services. Their leaders are frequently in the position to determine the investment of Federal, State, and local mental health resources. It is incumbent upon those who control the organizational structure of local programs to engage consumers, families, and other community members in the process of reducing mental health service disparities.

One organization that is successfully reaching out is the Feather River Tribe of California. With Federal seed-grant funds, this tribe has developed a plan for serving tribal children with serious emotional problems that is based on community members’ assessment of needs and expectations from mental health treatment. Their effort has engaged tribal members so successfully that, through their own fundraising efforts, they have netted sufficient tribal, State, foundation, and Federal resources to implement a comprehensive, community-based children’s services program. As a result, this community feels ownership and commitment to its mental health service delivery system, and Feather River children are receiving more and better quality services.