Mental Health Supplement of the 2001 Surgeon

General’s Report

Mental Health Supplement of the 2001 Surgeon

General’s ReportNational behavioral health disparityfor Asian Americans

• More likely than other ethnic groups to encounter cultural and linguistic barriers to finding competent mental health services

• Receive the lowest quality care out of all the major ethnic groups.

• Lower mental health service utilization rate than African-Americans, Latino-Americans and white Americans.

National behavioral health disparityfor Asian Americans

• More likely than other ethnic groups to encounter cultural and linguistic barriers to finding competent mental health services

• Receive the lowest quality care out of all the major ethnic groups.

• Lower mental health service utilization rate than African-Americans, Latino-Americans and white Americans.

Definition of Civil RightsDefinition of Civil Rights• May be comprehensively defined asthe rights to common or equal participation in civil society.  

• Protected classes under Federal civil rights laws: race, color, national origin, gender, religion, ethnicity, creed, age, disability (Americans with Disabilities Act), familial status (housing), etc.

• May be comprehensively defined asthe rights to common or equal participation in civil society.  

• Protected classes under Federal civil rights laws: race, color, national origin, gender, religion, ethnicity, creed, age, disability (Americans with Disabilities Act), familial status (housing), etc.

TITLE VIUS Civil Rights Act of 1964

TITLE VIUS Civil Rights Act of 1964

"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."

"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."

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)?

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

• Among people aged 5 and over, 47.0 million(18 percent) spoke a language other that Englishat home.

• The number of people who spoke a language other than English increased between 1990and 2000.

• Almost 11 million people , 4.2% of the U.S. population, speak English “not well” or“not at all.”

• 21 million, 8.1%, speak English less than very well.

• Among people aged 5 and over, 47.0 million(18 percent) spoke a language other that Englishat home.

• The number of people who spoke a language other than English increased between 1990and 2000.

• Almost 11 million people , 4.2% of the U.S. population, speak English “not well” or“not at all.”

• 21 million, 8.1%, speak English less than very well.

What is “Federal financial assistance” for purposes of civil rights complaints

handledby OCR?

What is “Federal financial assistance” for purposes of civil rights complaints

handledby OCR?

• Answer:  Title VI regulations define the term “Federal financial assistance” broadly to include:

• (1) grants and loans of Federal funds, (2) the grant or donation of Federal property and interests in property, (3) the detail of Federal personnel, (4) the sale and lease of, and permission to use Federal property or interest in such property without consideration or at a nominal consideration, and (5) any Federal agreement, arrangement, or other contract which has as one of its purposes the provision of assistance.  45 C.F.R. § 80.13(f)

• Answer:  Title VI regulations define the term “Federal financial assistance” broadly to include:

• (1) grants and loans of Federal funds, (2) the grant or donation of Federal property and interests in property, (3) the detail of Federal personnel, (4) the sale and lease of, and permission to use Federal property or interest in such property without consideration or at a nominal consideration, and (5) any Federal agreement, arrangement, or other contract which has as one of its purposes the provision of assistance.  45 C.F.R. § 80.13(f)

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. NicholsLanguage, 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.

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."

The Major Minority GroupsThe Major Minority Groups• African Americans – multi-cultural, but

linguistically unified English-speaking

• Latinos – multi-racial, but mostly Spanish-speaking

• Asian American/Native Hawaiian/Pacific Islander – speak more than 100 languages altogether and are comprised of more than 43 ethnic groups (2000 Census) and 50% are foreign-born• Top five groups in the U.S. are Chinese (many dialects of

Chinese with Mandarin and Cantonese the most common), Philippino (English and Tagalog), Vietnamese (Vietnamese and other Chinese dialects), Korean (Korean language), Japanese (English and Japanese)

• African Americans – multi-cultural, but linguistically unified English-speaking

• Latinos – multi-racial, but mostly Spanish-speaking

• Asian American/Native Hawaiian/Pacific Islander – speak more than 100 languages altogether and are comprised of more than 43 ethnic groups (2000 Census) and 50% are foreign-born• Top five groups in the U.S. are Chinese (many dialects of

Chinese with Mandarin and Cantonese the most common), Philippino (English and Tagalog), Vietnamese (Vietnamese and other Chinese dialects), Korean (Korean language), Japanese (English and Japanese)

Asian Americanswith Mental Disabilities

Asian Americanswith Mental Disabilities

Are often doubly marginalized

• Stigmatized for their disability within their culture of origin. Historically, many traditional Asian families hid the member of their family with a disability.

• Are often discriminated against for their national origin — by the lack of provision of culturally and linguistically appropriate services (CLAS) in health care settings and in broader society

Are often doubly marginalized

• Stigmatized for their disability within their culture of origin. Historically, many traditional Asian families hid the member of their family with a disability.

• Are often discriminated against for their national origin — by the lack of provision of culturally and linguistically appropriate services (CLAS) in health care settings and in broader society

Prevailing Attitudes Toward Health Care Providers Among Asian

Americans

Prevailing Attitudes Toward Health Care Providers Among Asian

Americans

“If you speak English well, then an American doctor will treat you better.If you speak Chinese and your Englishis not that good, they would also kindof look down on you. They would [be] kind of prejudiced.”

—Chinese focus group studyInstitute of Medicine, Unequal Treatment

“If you speak English well, then an American doctor will treat you better.If you speak Chinese and your Englishis not that good, they would also kindof look down on you. They would [be] kind of prejudiced.”

—Chinese focus group studyInstitute of Medicine, Unequal Treatment

Model Minority Myth:How It Affects Asian

Americans

Model Minority Myth:How It Affects Asian

Americans• Model Minority Myth – The public perception that Asian Americans, more than any other major minority, are upwardly mobile, industrious, and academically successful, reinforcing capitalistic notions of the American dream

• Does not take into account a myriad of underlying sociological issues which reveal a different set of facts

• The Model Minority Myth was unjustly used by right-wing to disparage other races for not “making it”

• Model Minority Myth – The public perception that Asian Americans, more than any other major minority, are upwardly mobile, industrious, and academically successful, reinforcing capitalistic notions of the American dream

• Does not take into account a myriad of underlying sociological issues which reveal a different set of facts

• The Model Minority Myth was unjustly used by right-wing to disparage other races for not “making it”

Deconstructing theModel Minority MythDeconstructing theModel Minority Myth

• More Asian Americans (1 out of 7) live in poverty than white Americans (1 out of 10) do

• Bi-modal distribution of education - Though Asian Americans overall have higher educational achievement than other minorities, there is even a larger number of Asian Americans without even an 8th grade level education.

• Asian Americans have the highest linguistic isolation compared to other groups, even Hispanics

• Historically, US immigration policy favored Asians with education and capital, which originally led to the creation of the Model Minority Myth

• More Asian Americans (1 out of 7) live in poverty than white Americans (1 out of 10) do

• Bi-modal distribution of education - Though Asian Americans overall have higher educational achievement than other minorities, there is even a larger number of Asian Americans without even an 8th grade level education.

• Asian Americans have the highest linguistic isolation compared to other groups, even Hispanics

• Historically, US immigration policy favored Asians with education and capital, which originally led to the creation of the Model Minority Myth

The Heteregeneous Nature of Asian Americans/Pacific

Islanders

The Heteregeneous Nature of Asian Americans/Pacific

Islanders• 43 ethnic groups and more than 100 languages

• Viewed by society as monolithic

• As a result of US immigration policy in the 50’s and 60’s, certain groups came with education and capital, which predestined them for professional success

• Others came as war refugees with only the clothes on their backs and agrarian skill sets, which made them less likely to succeed in an industrialized economy

• 43 ethnic groups and more than 100 languages

• Viewed by society as monolithic

• As a result of US immigration policy in the 50’s and 60’s, certain groups came with education and capital, which predestined them for professional success

• Others came as war refugees with only the clothes on their backs and agrarian skill sets, which made them less likely to succeed in an industrialized economy

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

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 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 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 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 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 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 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