Silence and invisibility go hand-in-hand with powerlessness

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The current mental health systemhas neglected
to incorporate, respector understand the
histories, traditions, beliefs, languages and
value systemsof culturally diverse groups.

• The Presidents New Freedom Commissionon Mental
  Health Achieving the Promise Transforming
  Mental Health Care in America.Final Report, July
  2003.

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EXPLANATORY MODELS OF HEALTHWestern vs. Eastern
Paradigms

• TRADITIONAL ASIAN
• Spiritual orientation
• Epistemologically based on faith and
  intergenerational transmission of knowledge
• No discrete lines between physical and mental
  illness holistic view of health
• Verbalization of problems is not viewed as
  productive or necessary. Silence is a virtue.

• WESTERN PSYCHIATRIC
• Scientific epistemology
• Biochemical/Genetic etiologyof illness without
  consideringsoul or spiritual origins
• Defines illness as physicalor mental discrete
  linesbetween mental and physical
• Verbalization of problemsviewed as a necessary
  partof treatment

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TITLE VI ofUS Civil Rights Act of
1964Discrimination Based on National Origin

• How Title VI affects healthand human service
  provisions for those with limited-English
  proficiency (LEP)?

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National Origin Includes

• Birthplace, ancestry, culture,linguistic
  characteristics common toa specific ethnic
  group, or accent

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Definition ofLimited-English Proficient (LEP)

• LEP persons are those individuals with a primary
  or home language other than English who must, due
  to limited fluency in English, communicate in
  that primary or home language if they are to have
  an equal opportunity to participate in or benefit
  from any aids or services provided by an agency
  that is receiving federal funding.

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Limited-EnglishProficient Americans

• Nearly 30 of Asian andLatino Americans say they
  do notspeak English very well.

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Civil Rights andLanguage Access to Healthcare

• Minorities face greater disability burden not
  necessarily because the illnesses are more severe
  but because of the barriers they face in terms of
  access to care
• Health disparities result

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US Supreme Court Case LawLau Vs. Nichols

• Established that language, by proxy, is national
  origin
• The United States Supreme Court in Lau vs.
  Nichols (1974) stated that one type of national
  origin discrimination is discrimination based on
  a person's inability to speak, read, write, or
  understand English.
• The government has to take affirmative steps,
  i.e., language interpretation, to rectify the
  lack of equal and comparable services based on
  limited-English language proficiency.

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Logic of Lau Vs. Nichols

• "Simple justice requires that public funds, to
  which all taxpayers of all races contribute, not
  be spent in any fashion which encourages,
  entrenches, subsidizes, or results in racial
  discrimination."

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Health Care - National Standards for Culturally
and Linguistically Appropriate Services (CLAS)

• There are 14 standards for culturally and
  linguistically appropriate services (CLAS),
  proposed as a means to correct inequities that
  currently exist in the provision of health
  services and to make these services more
  responsive to the individual needs of all
  patients/consumers.
• Of these 14, Standards 4-7, which pertain to
  language assistance, are mandated by law for all
  programs and activities funded by Federal monies

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14 National Standards for Culturally and
Linguistically Appropriate Services (CLAS)

• Of these 14, Standards 4-7, which pertain to
  language
• assistance, are mandated by law for all programs
  and
• activities funded by Federal monies
• Language assistance services at no cost to each
  patient/consumer with LEP
• Notices to patients/consumers in their preferred
  language, informing them of their right to
  receive language assistance services.
• Competence of language assistance
• Patient-related materials and signage in the
  languages of the commonly encountered groups

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Culturally and LinguisticallyAppropriate
Services Standards (CLAS)

• Culturally and Linguistically Appropriate
  Services Standards (CLAS) are the collective set
  of culturally and linguistically appropriate
  services (CLAS) mandates, guidelines, and
  recommendations issued by the U.S. Department of
  Health and Human Services Office of Minority
  Health intendedto inform, guide, and facilitate
  required and recommended practices related to
  culturally and linguistically appropriate health
  services(National Standards for Culturally and
  Linguistically Appropriate Services in Health
  Care Final Report, OMH, 2001).

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National Standards for Culturallyand
Linguistically Appropriate Care(Office of
Minority Health, Dept. of Health and Human
Services)

• STANDARD 4
• Health care organizations must offerand provide
  language assistance services, including bilingual
  staff and interpreter services, at no cost to
  each patient/consumer with limited English
  proficiencyat all points of contact, in a timely
  manner during all hours of operation.

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National Standards for Culturallyand
Linguistically Appropriate Care(Office of
Minority Health, Dept. of Health and Human
Services)

• STANDARD 5
• Health care organizations must provideto
  patients/consumers in their preferred language
  both verbal offers and written notices informing
  them of their right to receive language
  assistance services.

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National Standards for Culturallyand
Linguistically Appropriate Care(Office of
Minority Health, Dept. of Health and Human
Services)

• STANDARD 6
• Health care organizations must assurethe
  competence of language assistance provided to
  limited English proficient patients/consumers by
  interpreters and bilingual staff. Family and
  friends should not be used to provide
  interpretation services (except on request by the
  patient/consumer).

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National Standards for Culturallyand
Linguistically Appropriate Care(Office of
Minority Health, Dept. of Health and Human
Services)

• STANDARD 7
• Health care organizations must make available
  easily understood patient-related materials and
  post signage in the languages of the commonly
  encountered groups and/or groups represented in
  the service area.

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The Economic Burdenof Health Inequities

• More than 30 percent of direct medical costs
  faced by African Americans, Hispanics, and Asian
  Americans were excess costs due to health
  inequities more than 230 billion over a three
  year period (2003-2006). And when you add the
  indirect costs of these inequities over the same
  period, the tab comes to 1.24 trillion.
• Ralph B. Everett, Esq.President and CEO Joint
  Center for Political and Economic Studies

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