221454 Sociocultural Elements in Health Care for People with Serious Mental Illness

Monday, November 8, 2010 : 10:30 AM - 10:45 AM

Elizabeth Siantz, MSW , School of Social Work, University of Southern California, Los Angeles, CA
Leopoldo J. Cabassa, PhD , New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute/Columbia University, New York, NY
Roberto Lewis-Fernández, MD , Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY
Andel Nicasio, MsED , Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, NY
Ron Turner, BA , Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, NY
Denise Reed, MBA, MPH , Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, NY
Angela Parcesepe, MPH, MSW , Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Jerel Ezell, MPH , Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, NY
Madeline Tavarez, BA , Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City, NY
     
Objectives: Racial and ethnic minorities with serious mental illness (SMI) experience disparities in health and healthcare resulting from high medical need, inadequate access to primary care, and poor quality of care compared to their white counterparts. The aims of this qualitative study are to (1) examine sociocultural elements in the provision and coordination of healthcare services in mental health organizations serving Latino and African American consumers with SMI; and (2) develop a culturally competent model of service integration. Methods: A purposive sample of five community based organizations that serve a large number of African American and Latino consumers with SMI participated in this study. Individual interviews, focus groups, and participant observations were analyzed using constant comparative methods informed by grounded theory. Results: Forty interviews with clinic staff along with sixty consumers and friend/family members participated in this study. At the consumer level, cultural norms that link heaviness to good health combined with internalized self-blame for leading “unhealthy lives” presented barriers to improving health habits. At the provider level, ambivalence regarding professional boundaries combined with the perceived socioeconomics that influence consumers' options for healthy living contributed to providers' reluctance to take full responsibility for consumers' health needs. Conclusion: Providing culturally tailored health promotion approaches in mental health settings could empower consumers to make healthier choices within their environment. Such a model of service integration could result in (a) consumer health promotion and treatment engagement; and (b) increased organizational and provider support to improve information exchange through care management and treatment collaboration.

Learning Areas:
Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Program planning

Learning Objectives:
1) Discuss the public health significance of reducing barriers to physical health care for African American and Latino consumers with SMI. 2) Present findings from a qualitative study examining the sociocultural elements that impact the provision of and access to physical health services to consumers with SMI and are of African American and Latino descent. 3) Discuss public health research and practice recommendations for developing culturally appropriate models of integrating physical and mental health services.

Keywords: Cultural Competency, Health Service

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Community Project Associate for this study. In this capacity I collected much of the presented data, and had a lead role in its analysis having been closely mentored by the study's principal investigator.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3137.0: Race, stigma and mental health needs