Reducing mental health disparities and advancing health equity: Why culturally centered collaborative integrated care models matter

With growing diversity concerning various ethnicities and nationalities, and understanding the significant changes in risk factors that can influence physical and mental health outcomes, healthcare must advance strategic, clinic-based efforts that may improve individuals’ longevity and quality of life.

These issues have relevance for underserved, vulnerable and/or high-risk populations, such as racial and ethnic minorities, that have lower life expectancies compared to the white population in the United States.^1,2,3Moreover, individuals with severe mental illness die 10 to 20 years earlier from largely preventable comorbid medical conditions — such as heart disease, diabetes, cancer and pulmonary disease — that occur more frequently and have earlier onset in these vulnerable populations, and low rates of prevention, detection and treatment of comorbid conditions further compound such health disparities.^3,4

Addressing the multifaceted physical, mental, and behavioral health needs of ethnic minorities in the U.S. population is a complex issue that warrants attention from clinicians, researchers, scientists, public health professionals and policy makers.

When he was Surgeon General, David Satcher, MD, PhD, promulgated the idea that “There Is No Health Without Mental Health,” and released Mental Health: Culture, Race, and Ethnicity, a report that concluded that minority groups have less access to mental health care, are less likely to receive treatment, and when treated, often receive a poorer quality of care than nonminority populations. As a result, racial and ethnic minority populations often experience a greater burden of disability associated with behavioral disorders.⁵ In my clinical experience, I’ve found that many of the same deleterious and disjointed systemic issues remain relevant. I suggest that partnership with selected community-based organizations that includes collaboration with Community Health Workers and with primary healthcare facilities (e.g., Federally Qualified Health Care Centers) can help to implement strategies designed to improve health equity and reduce ethnic and racial disparities in mental health through culturally centered collaborative care.

For many individuals, making an appointment with a primary care doctor may be their first step, and in some cases the only way they can get access to a mental healthcare professional for screening for depression or anxiety. The primary care setting may be a critical link to aid in identifying and addressing mental health issues for ethnically and culturally diverse individuals.^6,7 There is a significant need to establish comprehensive methods on how to deliver quality and effective mental health services within the context of demonstrating respect for the cultural orientation of the patient.

Black adults in the United States who are seeking mental health care or living with serious mental illness disproportionately lack access to culturally responsive care.⁸ Only 2% of psychiatrists identify as Black. Integrated collaborative care is a multicomponent, healthcare system–level intervention that uses case managers to link primary care providers, patients and mental health specialists.9, Primary care providers receive consultation and decision-making support for diagnosis and treatment from mental health specialists, who form a supportive network of peers and professionals at the primary care level.⁹

Integrated collaborative care is designed to (1) improve routine screening and diagnosis of mental health disorders; (2) increase provider use of evidence-based protocols for proactive management of the disorder(s); and (3) improve clinical and community support for active client engagement in treatment goal setting and self-management.¹⁰ Collaborative care is effective for improving quality of life and a range of behavioral health conditions. It empowers patients by engaging them to manage their overall healthcare through community linkages and to establish a meaningful connection with their primary care doctor.¹⁰

As healthcare reform is implemented, there is an opportunity to improve behavioral health care and support individuals, families and communities with access to culturally centered integrated care.

About the author
Dr. Kisha Holden, PhD, MSCR, has dedicated her career to encouraging mental health and well-being among ethnically and culturally diverse families through research, programmatic initiatives and developing innovative strategies for informing health policies. Dr. Holden is a paid consultant to Janssen Pharmaceuticals, Inc., related to the Community Health Equity Alliance.

About the Community Health Equity Alliance
The Community Health Equity Alliance prioritizes community-informed solutions to meaningfully advance serious mental illness care. It brings together influential organizations, in collaboration with Janssen Neuroscience, in the areas of mental health advocacy, faith, civic, and healthcare professional services to help achieve more equitable mental health care for Black adults.

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