I was working the evening shift at a Crisis Unit in a Community Mental Health Center in California. A young adult female was brought in by her family. She was severely ill with psychosis and was nine months pregnant – and her Chinese-speaking parents had no awareness of either condition. Later that evening, an elderly African American man with a lengthy history of institutionalization for mental and substance use disorders was brought in – in handcuffs – by the police for disorderly conduct. He was homeless and disoriented. He was cleaned up, given a meal and some meds and then discharged. Early the next morning a Latino couple could be seen rejoicing in the hall, having found their 21 year old son who was removed from their home by the police when summoned by a neighbor for hallucinations and disruptive behavior. With limited English proficiency, the couple searched for three days but because of privacy regulations, hospitals were not allowed to tell them if he had been admitted.
These are routine stories of ordinary people and families from different cultures trying to understand mental and substance use disorders and navigate a confusing behavioral health care system. These are stories from the early 1980’s. Now, three decades later, some things are the same, but much has changed. The Report of the Secretary’s Task Force on Black and Minority Health (also known as the Heckler Report) highlighted the inequities in access and quality of care for individuals and families from diverse and underserved racial and ethnic minority populations.
For behavioral health, especially mental health care, there was much misunderstanding, misdiagnosis and miscommunication between providers and recipients of care. Pathways to care became divided into two branches with young people and adults of color more likely to be referred to child welfare and criminal justice rather than to specialty behavioral health care. As a result, more ethnic/race-specific community-based organizations were developed to address the cultural and class-specific behavioral health needs of these communities, and the federal government took steps toward ensuring better behavioral health services for racial and ethnic minorities.
In 2001, then US Surgeon General Dr. David Satcher issued the report Mental Health: Culture, Race and Ethnicity which underscored the poor access, treatment and outcomes for people of color with mental health disorders. Research continued to show similar prevalence of these disorders across populations, but very uneven access to appropriate care, thus creating a substantial burden in these communities. In 2003, the President’s New Freedom Commission on Mental Health reiterated the imperative to reduce disparities in behavioral health care and the Substance Abuse and Mental Health Services Administration (SAMHSA) was charged with addressing these disparities and the recommendations of the report. And in 2010, the SAMHSA Office of Behavioral Health Equity was created by the Patient Protection and Affordable Care Act. SAMHSA also provides critical funding for minority and vulnerable populations, an outcome of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities. And, through its National Network to Eliminate Disparities in Behavioral Health consisting of over 750 community-based organizations addressing the mental and substance use disorders in communities of color around the country, SAMHSA works to build capacity in these organizations and provide a platform to promote collective impact to reduce disparities.
Looking back, we can see how these advances in behavioral health grew out of the Heckler Report, started us on a path to understanding health and health care as a civil right and laid the basis for the new approach to social determinants of health and achieving health equity for all.
Larke N. Huang, PhD is the Director of the Substance Abuse and Mental Health Services Administration Office of Behavioral Health Equity.
Last Edited: 04/30/2015