Written By:  Caroline S. Clauss-Ehlers

DCRE Executive Committee (at time of publication): Philip Wong, Grace Wong, Lourdes Rivera, Dinelia Rosa, Caroline Clauss-Ehlers, Melinda Finkel, Nancy Cope, Yoko Takebayashi

Liaison to NYSPA (at time of publication): Ruth Ochroch

In a recent executive committee meeting, the DCRE brainstormed various themes that could possibly anchor the work of the Division over the course of the next several years. Access and Utilization was agreed to best capture the work of the Division in 2007. The phrase Access and Utilization reflects the substantial work yet to be done to make mental health services available to diverse populations throughout the United States (US). Given the unique needs of diverse populations (i.e., the particular language spoken in treatment), access also includes the relevance of services provided so that they will be sought out and used. This latter point refers to the utilization component of the access and utilization equation. Both are described below.

The term access refers to individuals in society who have the option to seek out various mental health services that are available to them.  In the context of diverse populations, it is almost impossible to talk about access without discussing lack of access, or those individuals with less opportunity to choose and select from an array of mental health services. When the provision of mental health services to diverse populations is considered, suddenly we become faced with a plethora of diverse barriers. Writes the Surgeon General in his report Mental Health: Culture, Race, and Ethnicity, “The foremost barriers include the cost of care, societal stigma, and the fragmented organization of services. Additional barriers include clinicians’ lack of awareness of cultural issues, bias, or inability to speak the client’s language, and the client’s fear and mistrust of treatment. More broadly, disparities stem from minorities’ historical and present day struggles with racism and discrimination, which affect their mental health and contribute to the lower economic, social, and political status” (USDHHS, 2001, p. 4).

Given access and its associated barriers, utilization concerns the extent to which individuals in society use mental health services when desired or necessary. Utilization concerns what happens once the individual does engage in treatment. Questions presented by the utilization component of the equation include: What is the quality of the care received? How does quality of care influence continued utilization (one study, for instance, found that the modal number of therapy sessions across the country was one)? What is the ratio of disability burden among diverse populations to continued utilization of treatment?

The DCRE will address issues of access and utilization in upcoming efforts. Disparities in access and utilization have a tremendous significance for diverse populations in particular and society in general. The Surgeon General’s supplement concludes, “A major finding of this Supplement is that racial and ethnic minorities bear a greater burden for unmet mental health needs and thus suffer a greater loss to their overall health and productivity” (USDHHS, 2001, p. 3). The DCRE has four primary aims associated with the theme of access and utilization:

1. To create greater awareness about the problem of access and utilization among diverse communities.
2. To formulate new knowledge and understanding about how to decrease the burden of disparity.
3. To engage in the development of products that reflect the issue of access and utilization (i.e., workshops, conference presentations, publications).
4. To engage in ongoing dialogue within the Division and across NYSPA and other community organizations to facilitate understanding.
5. To encourage collaboration and partnership across divisions and other interested parties.

We invite you to join us.    


References

U.S. Department of Health and Human Services (2001).  Mental health:  Culture, race, and ethnicity--A supplement to mental health:  A report of the Surgeon General.  Rockville, MD:  U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General.