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Asian American Mental Health and Civil Rights
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The President’s New Freedom Commission
on Mental Health: Achieving the Promise:
Transforming Mental Health Care in America.
Final Report, July 2003.
WESTERN PSYCHIATRIC
• Scientific epistemology
• Biochemical/Genetic etiology
of illness without considering
soul or spiritual origins
• Defines illness as physical
or mental – discrete lines
between mental and physical
• Verbalization of problems
viewed as a necessary part
of treatment
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.
• Widely held stereotypes of Asian Americans
as “problem free” may prompt clinicians
to overlook their mental health problems
(Takeuchi & Uehara, 1996).
• Among all the major ethnic groups, Asian
Americans confronted the most cultural and
linguistic barriers in finding competent
mental health care and received the lowest
quality of care.
• Only 12 percent of Asians would mention their
mental health problems to a friend or relative
(versus 25 percent of whites).
• A meager 4 percent of Asians would seek help
from a psychiatrist or specialist (versus 26 percent
of whites).
• Only 3 percent of Asians would seek help from
a physician (versus 13 percent of whites).
• This study of Asian Americans in LA concluded that
stigma was pervasive and pronounced (Zhang et
al., 1998).
•Denise McNair – 11 years old
•Carole Robertson – 14 years old
•Cynthia Wesley – 14 years old
•Addie Mae Collins – 14 years old
• Sept. 15, 1963 - instantly killed Denise,
Carole, Cynthia, and Addie
•Catalyzed the unified movement among
civil rights leaders
• July 2, 1964 - the passage of the most
comprehensive body of civil rights laws
in American history: U.S. Civil Rights
Act of 1964
How Title VI affects health
and human service provisions for those
with limited-English proficiency (LEP)?
"No person in the United States shall,
on ground of race, color or national
origin, be excluded from participation
in, be denied the benefits of, or be
subjected to discrimination under any
program or activity receiving Federal
financial assistance."
Birthplace, ancestry, culture,
linguistic characteristics common
to a specific national minority group,
or linguistic accent
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.
Nearly 30% of Asian and
Latino Americans say they do not
speak English “very well.”
• Verbal communication is critical to accurate
diagnosis and effective treatment
• Diagnoses are frequently made on the basis
of symptoms verbally reported by the patient.
• No objective medical tests, such as EKGs,
blood tests, or x-rays to verify a psychiatric
diagnosis or the effectiveness of psychotropic
medications, other than the patient’s
presentation and verbal reporting
•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
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.
"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."
• 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
Of these 14, Standards 4-7, which pertain to language assistance, are mandated by law for all programs and activities funded by Federal monies
4. Language assistance services at no cost to each
patient/consumer with LEP
5. Notices to patients/consumers in their preferred language,
informing them of their right to receive language assistance
services.
6. Competence of language assistance
7. Patient-related materials and signage in the languages of
the commonly encountered groups
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 intended
to 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).
STANDARD 4
Health care organizations must offer
and provide language assistance services,
including bilingual staff and interpreter
services, at no cost to each patient/
consumer with limited English proficiency
at all points of contact, in a timely manner
during all hours of operation.
STANDARD 5
Health care organizations must provide
to patients/consumers in their preferred
language both verbal offers and written
notices informing them of their right to
receive language assistance services.
STANDARD 6
Health care organizations must assure
the 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).
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.
•Are supposed to be reported to the
Office of Civil Rights (OCR), Federal
Dept of Health and Human Services
•Reports of violations are investigated by
OCR
•Can result in loss of funding for the
organization in violation
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
Bruce Adelson, Esq. Former Senior Attorney of the Dept of Justice
of Federal Compliance Consulting, LLC