Mental Health Advocacy with
Diverse Communities
Sita Diehl
Director of State Policy and Advocacy
Objectives
• Consider mental illness in multicultural
communities
• Increase awareness of cultural competence
• Learn strategies for multicultural advocacy
partnership
• Take advantage of National Minority Mental
Health Awareness Month to move your
advocacy agenda forward
• Culture: Common heritage and set of beliefs, norms, and
values
• By 2042 “minorities” will be the majority.
• Racial/ethnic minorities represented between 81 percent and
89 percent of the U.S. population growth since 2000.
• Latinos increased from 13 percent of the U.S. population a
decade ago to 16 percent.
• Blacks represent about 12 percent and Asians roughly 5
percent of the total U.S. population.
Source: MaJose Carasco NAMI Multicultural Action Center, 2011
• Have less access to mental
health services.
• Are less likely to receive needed
mental health services.
• Often receive a poorer quality
treatment and care
• Are underrepresented in mental
health research
–
Surgeon General David Satcher, 2000
Source: MaJose Carasco, NAMI Multicultural Action Center, 2011
• Less likely to rely on professional
services.
– Seen as part of dominant culture
– Historical:
• Misdiagnosis
• Inadequate treatment
• Cultural insensitivity
• Mental health treatment = oppression
• Help sought through:
– Faith leaders
– Traditional healers
Source: MaJose Carasco, NAMI Multicultural Action Center, 2011
Source: Sue Wintz and Earl Cooper 2000-2003, A Quick Guide to Cultures and Spiritual Traditions, Association of Professional Chaplains.
• Cultural competence: embrace and act on different
cultural viewpoints
• Cultural competence is based on a willingness to use
“beginner’s mind”
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Focus on a culture or population
Come listening and learning
Rather than telling and selling
Be patient! Take the time to build trust
Individual advocacy partners
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Choose someone from a diverse
background
Never go alone - small commitments
Advocacy events, meetings, conference
calls
Reporting to the affiliate at monthly
meetings
Writing or forwarding email alerts
Activating the telephone tree
When you are both confident,

Choose new partners and pass it on…
• Be thoughtful when selecting
members for the group.
• Do not make the mistake of
only including “diverse people” on your committee.
• This group needs to be an important part of your
leadership and connected to your overall efforts.
• Assign roles according to interests, talents, skill sets and
experience.
Source: MaJose Carasco NAMI Multicultural Action Center, 2011
• Learn as much as you can about characteristics and
history of that group in your area
• Understand core values
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–
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Role of family
Level of trust in institutions and outsiders
Role of faith, traditions, celebrations
Cultural icons
Respect for youth/ elderly
Humor and body language
• Identify community agencies and leaders
• Phase in target groups over several years
Source: MaJose Carasco NAMI Multicultural Action Center, 2011
• Supports your organizational mission
– Affected by mental health conditions directly
or as a family member
– Knows your goals and programs
– Strong self-identity with target population and
culture
– Yet comfortable in the dominant culture
• Be patient - Take time to find the right
people
– Build relationships and trust
– Move beyond tokenism to integration of
cultural perspectives
– Boundary spanner keeps your group informed
- but others must engage
•
Identify Key Community Leaders
– Approach to partner with them
– Listen to priorities of cultural leaders
• Identify intersection of priorities
• Identify how each ally will benefit
– Ask for representative to interact with NAMI
and vice versa
– Build the relationship over time
– When issues arise that are important to
allies, invite them to advocate with you
– Respond to their invitations to advocate
– BE PATIENT, DON’T GIVE UP
• Tips for Partnering
– Who has a strong interest in your issue?
– Who is working on your issue or issue
area?
– Who has significant influence?
– Who has the capacity to act?
– Will cooperating enhance effectiveness?
Source: Angela Kimball, Game On! Winning at the New Advocacy Game, 2010
• Plan now to take action in July
– Involve individuals from diverse cultures as
advocacy partners
– Establish/refocus multicultural advisory group
• Identify a target population as a focus for the next year
• Conduct multi-cultural advocacy training – Telling Your
Story
– Identify and involve boundary spanners
– Partner with diverse organizations as allies
Questions?
Embedding Multicultural
Issues into Our Existing Policy
Priorities
Majose Carrasco
Director, NAMI Multicultural Action Center
NAMI State Action Agenda
• Increase access to effective mental health care
• Promote integration of mental health, addictions and
primary care
• Strengthen the mental health workforce
• Eliminate disparities in mental health care
• Ensure transparency and accountability
• Ensure the mental health care of children and youth
• Provide homes and jobs for people with mental
illness
• End the inappropriate jailing of people with mental
illness
Increase access to effective
mental health care
• State Medicaid Programs should provide an
array of mental health services.
– Minorities more likely to relay on Medicaid (50%+
of all Medicaid recipients are minorities)
• Access to medications
– Differences in how minorities metabolize
psychiatric medications. e.g. African Americans
and Asian American may be slow metabolizers.
– African Americans are not often prescribed SSRIs
and often times receive older medications.
Promote integration of mental health,
addictions and primary care
• Minorities with mental illness are more likely
to seek help from their primary care physician.
Almost 2.5 Times as Many Hispanics
as Whites Report Having No Doctor.
Percentage of adults ages 18 to 64 reporting no regular doctor,
2006
100
80
*
60
40
51 *
27
21
28
23
20
0
Total
White
Black
Hispanic
Asian
* Compared with whites, differences remain statistically significant after adjusting for age, income, and insurance.
Source: The Commonwealth Fund. Health Care Quality Survey. 2006.
Strengthen the
mental health workforce
• Among clinically trained mental health
professionals:
– 2% African American psychiatrics
– 2% African American psychologists
Percentage of Spanish Speaking
Health Care and Mental Health
Providers in the U.S.
100%
90%
MDs
PhDs
MSWs
RNs
80%
70%
60%
50%
40%
30%
20%
10%
4%
0%
MDs
1%
PhDs
4%
MSWs
1%
RNs
Culture, Race, and Ethnicity: A Supplement to the
Surgeon General’s Report on Mental Health, 2001
• Culture Counts!
• Striking disparities in access, quality and
availability of mental health services exist for
racial and ethnic minority Americans
• Racial and ethnic minority communities bear a
disproportionately high burden of disability from
untreated or inadequately treated mental health
problems and mental illnesses
http://www.surgeongeneral.gov/library/mentalhealth/cre/
Culture, Race & Ethnicity:
Major Findings
Ethnic/Racial communities:
– Have less access to, and availability of, mental
health services
– Are less likely to receive needed mental health
services
– Often receive a poorer quality treatment and care
– Are underrepresented in mental health research
Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care
Institute of Medicine Report 2003
• Racial and ethnic disparities in healthcare
exist, and because they are associated with
worse outcomes in many cases, are
unacceptable
• Racial and ethnic disparities in healthcare
occur in the context of broader social and
economic inequality
Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care
Institute of Medicine Report 2003
• Many sources may contribute to racial and
ethnic disparities
• Bias, stereotyping, prejudice, and clinical
uncertainty on the part of healthcare
providers may contribute to racial and
ethnic disparities in health care
• Minority patient refusal rates do not fully
explain health care disparities
2010 National Healthcare
Disparities Report
Disparities in quality of care are common:
• Blacks and American Indians and Alaska Natives
received worse care than Whites for about 40% of
core measures.
• Asians received worse care than Whites for about
20% of core measures.
• Hispanics received worse care than non-Hispanic
Whites for about 60% of core measures.
http://www.ahrq.gov/qual/qrdr10.htm
Treatment: Depression
• In 2008, the percentage of
adults who received treatment
for depression in the last 12
months was significantly lower
for Blacks than for Whites
(56.0% compared with 70.4%;
and lower for Hispanics than
for non-Hispanic Whites
(57.4% compared with 71.8%).
Figure: Adults with a major depressive episode in the last 12 months
who received treatment for depression in the last 12 months,
by race, ethnicity, and gender, 2008
Outcome: Suicide Deaths
For community specific facts visit:
www.nami.org/multicultural
For National Minority Mental Health
Awareness Month resources visit:
www.nami.org/minoritymentalhealthmonth