“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 Scientific epistemology Biochemical/Genetic etiology of illness without considering soul or spiritual origins Defines illness as physical or mental – discrete lines between mental and physical Verbalization of problems viewed as a necessary part of treatment WESTERN PSYCHIATRIC Scientific epistemology Biochemical/Genetic etiology of illness without considering soul or spiritual origins Defines illness as physical or mental – discrete lines between mental and physical Verbalization of problems viewed as a necessary part of 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.

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 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. 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 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 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. 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. 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). 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. 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 ( ). 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 ( ). 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