You Can't Eliminate Disparities Without Cultural Sensitivity

An impassioned group of addiction specialists, mental health advocates, clergy, consumers, and family members gathered in Los Angeles in July to tackle a problem complex in nature and broad in scope: co-occurring disorders in diverse populations.

The daylong meeting, held at the California Endowment in downtown Los Angeles, was the fifth and largest of APA's OMNA on Tour series, launched in 2005 by APA's Office of Minority and National Affairs (OMNA) to engage communities to eliminate racial and ethnic disparities in mental health care.

More than 200 people representing a multitude of racial and ethnic backgrounds and professional disciplines attended the Los Angeles meeting.

Presenters and attendees shared insights on the impact of co-occurring mental illness and substance abuse in underserved populations and shared strategies for treatment, prevention, and recovery.

“Through OMNA on Tour, we visit areas with highly diverse populations and engage communities in discussions about mental health disparities and their manifestations,” said OMNA director Annelle Primm, M.D., M.P.H., at the meeting. “Our aim is to foster collaborations and showcase local and national models designed to eliminate mental health disparities.”

OMNA on Tour meetings have been held in Philadelphia, New Orleans, Washington, D.C., and Arlington Heights, Ill.

Representatives from local chapters of the National Alliance on Mental Illness are present at each meeting, and July's was no exception—the morning program was moderated in part by Nancy Carter, executive director of NAMI Urban Los Angeles.

Primm emphasized that concentrating on particular regions of the country affords the opportunity to respond to each community's unique needs and develop tailored programs that take into account specific strengths and limitations.

Los Angeles, she noted, has a higher proportion of foreign-born residents than the rest of California or the United States as a whole.

In developing a strategy to eliminate mental health disparities, it is crucial to consider cultural environments in which co-occurring disorders exist and to include people from outside of the mental health arena in the discussion, Primm said. In many communities of color, alcohol and illicit drugs are readily available, which complicates life for minorities with unmet mental health needs and often “leads to a cascade of negative events, including homelessness, incarceration, and death,” she said.

The meeting began with a dose of reality offered by one of the keynote speakers. “We're never going to be rid of mental health disparities,” said Carl Bell, M.D., adding that prevention is the fastest way to reduce mental health disparities among underserved populations.

Bell is president and CEO of the Community Mental Health Council and Foundation in Chicago and director of public and community psychiatry and a clinical professor of psychiatry and public health at the University of Illinois at Chicago.

Bell emphasized the importance of identifying children who are at risk for developing mental illness or becoming addicted to drugs and providing them with what have become known as protective factors—mentorship, social support, a sense of safety and security, and social skills. “Risk factors are not predictive factors due to protective factors,” he told attendees—a phrase that became a mantra of sorts for the meeting.

Addiction researcher and public health expert Donald Vereen Jr., M.D., M.P.H., also stressed the importance of prevention. Vereen is director of community-based public health in the Dean's Office of Public Health Practice at the University of Michigan School of Public Health.

After explaining some of the events and changes in the brain that occur during and after addiction to drugs, Vereen concluded that “we should be protecting our kids' brains. We need to protect our children from making bad choices by providing them with positive experiences.”

Part of the meeting showcased innovative mental health and addiction programs that are fostering recovery in minority populations. One such program is Family Oasis, a counseling project for Asian and Pacific-Islander youth and their families in San Francisco.

The program, which receives federal funding from the Center for Substance Abuse Treatment (CSAT), was established in 1985 and serves more than 2,700 clients a year, according to David Mineta, deputy director of Asian American Recovery Services Inc., also in the San Francisco area.

Mineta explained that denial and unwillingness to recognize substance abuse problems is a major barrier to treatment in Asian-American and Pacific-Islander families, so clinicians working in the program are careful to respect family values and validate family members' experiences and emotional pain. Another strategy is to “reduce shame around seeking help through reflective listening and validation,” Mineta noted.

Joe Powell, a chemical-dependency counselor who once struggled with addiction to drugs and alcohol and has been sober for more than 20 years, touted the value of peer counseling and involving the community—including schools, churches, and social programs—in recovery for minorities with mental illness and substance abuse. Add evidence-based and culturally competent care, he noted, and recovery is even more likely.

Powell is executive director for the Association of Persons Affected by Addiction, a Dallas-based organization that has also received CSAT funding for its work with survivors of Hurricane Katrina who were relocated to Dallas.

“The quality of recovery is related to the quality of relationships” between people with co-occurring disorders and the community, he stressed.

Ray Daw, a member of the Navajo Nation, noted that programs designed to treat Native-American populations with co-occurring disorders often incorporate traditional healing practices with psychoeducation and a focus on understanding trauma that has occurred on different levels. Daw is on the board of directors of the Takini Network, a nonprofit organization developed in 1992 by Maria Yellow Horse Brave Heart, Ph.D., to promote healing among Native-American clients with histories of trauma. He is also a member of the Substance Abuse and Mental Health Services Administration's Co-Occurring Disorders Center for Excellence and co-chair of the National Institute on Drug Abuse's Native-American Workgroup.

Daw also embraced the concept of prevention as embodied by the Edventures Group, in which clinicians and teachers work with at-risk Native-American youth to improve school attendance, academic performance and reduce behavioral problems. Daw is regional director of the program, which serves youth in six Arizona middle and high schools. Siamak Khadjenoury launched the Edventures program in 2003.

At the end of the day, presenters and attendees exchanged contact information and vowed to stay in touch to continue to share knowledge about ways to reduce mental health disparities in underserved populations.

“It is my hope that we will be empowered by the information presented today and that together, we can change lives of people with co-occurring disorders for the better,” said Primm. ▪