Transcript Silence and invisibility go hand-in

“The current mental health system
has neglected to incorporate, respect
or understand the histories, traditions,
beliefs, languages and value systems
of culturally diverse groups.”
The President’s New Freedom Commission
on Mental Health: Achieving the Promise:
Transforming Mental Health Care in America.
Final Report, July 2003.
EXPLANATORY MODELS OF HEALTH
Western vs. Eastern Paradigms
WESTERN PSYCHIATRIC
TRADITIONAL ASIAN
• Scientific epistemology
• Spiritual orientation
• Biochemical/Genetic etiology
of illness without considering
soul or spiritual origins
• Epistemologically based on
faith and intergenerational
transmission of knowledge
• Defines illness as physical
or mental – discrete lines
between mental and physical
• No discrete lines between
physical and mental illness
– holistic view of health
• Verbalization of problems
viewed as a necessary part
of treatment
• Verbalization of problems
is not viewed as productive
or necessary. Silence is a
virtue.
TITLE VI of
US Civil Rights Act of 1964
“Discrimination Based
on National Origin”
How Title VI affects health
and human service provisions for those
with limited-English proficiency (LEP)?
National Origin Includes
Birthplace, ancestry, culture,
linguistic characteristics common to
a specific ethnic group, or accent
Definition of
Limited-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.
Limited-English
Proficient Americans
Nearly 30% of Asian and
Latino Americans say they do not
speak English “very well.”
Civil Rights and
Language 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
US Supreme Court Case Law:
Lau 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.
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."
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
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
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)
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).
National Standards for Culturally
and Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human Services)
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.
National Standards for Culturally
and Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human Services)
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.
National Standards for Culturally
and Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human 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).
National Standards for Culturally
and 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.
The Economic Burden
of 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