Policy: Challenges for Mental Healthcare Purchasers and Providers

1
PolicyChallenges for Mental Healthcare
Purchasers and Providers

• Annelle B. Primm, MD, MPH
• Director, Office of Minority and National Affairs
  (OMNA)
• American Psychiatric Association

2
Surgeon Generals Report on Mental Health Race,
Culture, and Ethnicity

• Mental Illness affects all
• Striking disparities in MH Care for Minorities
• Less likely to receive services
• Poorer quality of care
• Underrepresented in MH research
• Culture Counts
• Disparities impose great disability burden on
  minorities
• Lopez, 2002

3
Vicious Cycle
Violence and Incarceration
Substance Abuse
Socioeconomic Problems
Unmet Mental Health Needs
Poor Physical Health
4
Barriers and Mediators to Equitable Health Care
for Racial and Ethnic Groups
Use of Services
Mediators
Outcomes
Barriers

• Personal/Family
• acceptability
• cultural
• language/literacy
• attitudes, beliefs
• preferences
• involvement in care
• health behavior
• education/income
• Structural
• availability
• appointments
• how organized
• transportation
• Financial
• insurance coverage
• reimbursement levels
• public support

• Visits
• primary care
• specialty
• emergency
• Procedures
• preventive
• diagnostic
• therapeutic

• Quality of providers
• cultural competence
• communication skills
• medical knowledge
• technical skills
• bias/stereotyping
• Appropriateness of care
• Efficacy of treatment
• Patient adherence

• Health Status
• mortality
• morbidity
• well-being
• functioning
• Equity of Services
• Patient Views of Care
• experiences
• satisfaction
• effective partnership

Modified From Access to Health Care in America 10
, From Cooper LA, Hill MN, and Powe NR. JGIM
2002 477-486
5
APA OMNA Priority Areas

• Expand the Science Base
• Support Education, Training, and Career
  Development
• Enhance Access and Reduce Barriers
• Promote Mental Health through Collaboration and
  Advocacy

6
Expand the Science Base

• Importance of data collection to uncover
  disparities in outcomes including patient
  satisfaction (State of Maryland Mental Hygiene)
• Report cards for employer and consumer use
• Requirements and incentives to include minorities
  in research as investigators and subjects
• Prevention research to optimize health by
  buffering the effects of toxic environments and
  predisposition to disease

7
Support Education Training and Career Development

• Cultural competence training requirements for
  clinicians-NJ and MD legislation
• Development of health professional curricula to
  ensure confidence in clinical knowledge, good
  communications skills, and respectful attitudes
• Stoking the pipeline early to increase diversity
  in the mental health professions
• Leadership training to ensure diverse
  representation at all levels of mental health
  care agencies and organizations

8
Enhance Access and Reduce Barriers to Quality Care

• Stop discrimination in coverage for mental health
  and substance abuse treatment
• Support primary care clinicians in providing
  mental health services (co-location,
  consultation, reimbursement, mental health
  screening)
• Forge partnerships with gatekeepers schools,
  faith community, substance abuse treatment (no
  wrong door)
• Drug courts and jail diversion programs

9
Promote Collaboration and Advocacy

• Provide opportunities for partnerships across
  disciplines and stakeholder groups that intersect
  with mental health and substance abuse concerns
  (OMNA on Tour)
• Convince legislators that spent to eliminate
  disparities will save and lives in the long run
  
• Convince employers that investment in eliminating
  disparities among employees will enhance
  productivity the bottom line as underserved
  ethnic and racial groups will be 40 of the
  workforce in 2008