“The current mental health system
has neglected to incorporate, respect
or understand the histories, traditions, beliefs, languages and
value systemsof culturally diverse groups.”
“The current mental health system
has neglected to incorporate, respect
or understand the histories, traditions, beliefs, languages and
value systemsof culturally diverse groups.”
The President’s New Freedom Commissionon Mental Health: Achieving the Promise:
Transforming Mental Health Care in America.Final Report, July 2003.
The President’s New Freedom Commissionon Mental Health: Achieving the Promise:
Transforming Mental Health Care in America.Final Report, July 2003.
EXPLANATORY MODELS OF HEALTHWestern vs. Eastern
Paradigms
EXPLANATORY MODELS OF HEALTHWestern vs. Eastern
ParadigmsWESTERN 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
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
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.
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.
TITLE VI ofUS Civil Rights Act of 1964
“Discrimination Based on National Origin”
TITLE VI ofUS Civil Rights Act of 1964
“Discrimination Based on National Origin”
How Title VI affects healthand human service provisions
for those with limited-English proficiency
(LEP)?
How Title VI affects healthand human service provisions
for those with limited-English proficiency
(LEP)?
National Origin IncludesNational Origin Includes
Birthplace, ancestry, culture,
linguistic characteristics common to
a specific ethnic group, or accent
Birthplace, ancestry, culture,
linguistic characteristics common to
a specific ethnic group, or accent
Definition ofLimited-English Proficient
(LEP)
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.
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-EnglishProficient Americans
Limited-EnglishProficient Americans
Nearly 30% of Asian andLatino Americans say they
do notspeak English “very well.”
Nearly 30% of Asian andLatino Americans say they
do notspeak English “very well.”
Civil Rights andLanguage Access to
Healthcare
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
•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
US Supreme Court Case Law:
Lau Vs. NicholsEstablished 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.
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. NicholsLogic 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."
"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)
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
• 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)
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
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 LinguisticallyAppropriate Services Standards
(CLAS)
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).
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).
National Standards for Culturallyand Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human Services)
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.
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.
National Standards for Culturallyand Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human Services)
National Standards for Culturallyand 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.
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 Culturallyand Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human Services)
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).
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).
National Standards for Culturallyand Linguistically Appropriate Care
(Office of Minority Health, Dept. of Health and Human Services)
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.
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 Burdenof Health Inequities
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
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