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Special Programs and Initiatives

National Congress for Hispanic Mental Health

V. Action Plan for Hispanic Mental Health

Introduction

The National Congress on Hispanic Mental Health was held on March 20-21, 2000, to develop an Agenda for Hispanic Mental Health and an Action Plan for achieving the agenda. This document contains the preliminary action items developed and ratified by the National Congress on March 21st. The Action Plan is envisioned by the Congress as a living document that will undergo continuous revision as the Hispanic mental health community grows and coalesces around its Agenda for Mental Health.

The Action Plan was developed by the National Congress participants who addressed five activity areas: community mobilization, marketing, policy, accountability, and research. The groups gave priority to those goals and recommendations in the Agenda that were most likely to benefit from the activity under consideration by the groups. In many cases, current and potential partners with Hispanic mental health leaders were at the table during the Action Planning process. Many action items reflect commitments made by partners during the deliberations. These commitments are identified by using the term "will" in the action language. Other partnerships and corresponding commitments have yet to be forged. Action items envisioned for future partnerships are identified using the term "should" in the action language. Forging new partnerships and corresponding commitments is a critical next step for the National Congress.

Many action items refer to various Federal agencies. Many of the actions proposed for Federal agencies require Congressional authorization and appropriations.

Individual commitments will ultimately make or break the Agenda. During the second day of the Congress, participants and partners were asked to make individual commitments to achieving the Agenda. These have been submitted to the Steering Committee and will become an integral part of the Action Plan as it evolves. The Congress appreciates the willingness of many people to make personal commitments to help improve Hispanic mental health in America. This willingness alone provides strong evidence of the viability and potential for success of this ambitious enterprise.

Time constraints prevented action items from being developed for each recommendation or each possible contributor to achieving the Agenda. It was understood that further work would be needed before a fully comprehensive Action Plan could be completed. This task is a critical next step for the Steering Committee as it continues the work of the National Congress.

Cross-Cutting Actions

Discussion: All of the workgroups identified the need for a permanent entity to champion the national Agenda and promote accomplishment of the Action Plan. In addition, increased Hispanic representation on the widest possible variety of mental health organization governing boards and advisory groups was determined to be critical by all. Concrete action items that cross-cut all of the goals and recommendations contained in the Agenda follow:

Discussion: Consumer and family representation at all levels was the dominant theme for this topic. Viewing knowledge as power, many workgroups emphasized the need to provide a wide array of training and educational opportunities to consumers and families that would help them become more effective in exercising their representative functions.

Recommendation 1.1: Include Hispanic representation on national, State, and local mental health advocacy group boards in order to address Hispanic issues and concerns in all programs and policy recommendations.

Recommendation 1.2: Ensure funding for Hispanics in proportion to the demographics and need to achieve the goal.

Discussion: This fundamental recommendation was viewed as critical to the Agenda despite its breadth and scope. While a number of concrete action items were developed, the workgroups also determined that several broad approaches should be emphasized, including: (1) requiring proportional allocations to Hispanics eligible for Federal programs, (2) identifying specific examples of disparities to be remedied, rather than dealing in generalities, and (3) using population demographics as criteria for funding allocations. Specific action items follow:

Recommendation 1.3: Educate government and elected officials on Hispanic-specific needs and issues.

Recommendation 1.4: Promote consumers and families as equal partners with decision makers in policy development, funding allocation, program design, and service delivery models.

Discussion: In general, the workgroup reasoned that publicly funded programs should be required to demonstrate the inclusion and incorporation of consumers and families in all mental health program designs and implementation decisions, particularly funding decisions. Consumers should be actively engaged and recruited to participate in decision-making at all levels of the mental health delivery system. Specific action items follow:

Recommendation 1.5: Train and educate Hispanic consumers and families to become advocates, to impact legislation, and to create bureaucratic changes.

Recommendation 1.6: Educate funding sources to support relevant Hispanic-community issues for consumer/family-driven community-based research which will result in an increase in Hispanic-funded initiatives.

Discussion: The workgroups envisioned establishing a council/coalition which serves as a contact point to identify and advocate for Hispanic community-based mental health research issues. This recommendation overlaps with the recommendations addressed in Hispanic Research. Action items are addressed under Hispanic Research.

ACCREDITATION, STANDARDS, REGULATIONS AND HUMAN RESOURCES

Recommendation 2.1: Attract Hispanic leadership and professional involvement in mental health, and increase awareness of Hispanic mental health needs and opportunities in our own community and mainstream institutions and policy forums.

Recommendation 2.2: Actively recruit and retain an Hispanic mental health workforce at all educational and skill levels, including traditional and non-traditional service providers.

Recommendation 2.3: In partnership with academia, public and private sectors, consumers, and families reform education and training at all levels by incorporating Hispanic mental health and culturally competent curriculum to meet Hispanic mental health needs.

Recommendation 2.4: Implement the national Hispanic mental health cultural competence standards and the national performance measures within the Centers for Medicare and Medicaid Services (CMS) regulations and clinical and professional accreditation. (e.g. Joint Commission on Accreditation of Healthcare Organizations, National Committee for Quality Assurance, and Commission on Accreditation of Rehabilitation Facilities, etc.)

Recommendation 2.5: Implement and enforce clinical access, outcome standards at national, State, and local levels.

Recommendation 2.6: Promote integration of the cultural competence standards and accountability measures across systems that interface with mental health (e.g. justice, welfare, education, housing, primary care, etc.).

Recommendation 3.1: Enforce and make accountable an information and referral system that is comprehensive and that reaches the Latino population effectively and with FUERSA (focus on cultural competence, utilizing the community, every-domain specific, reinforce cultural values, strength-based, across ages).

Recommendation 3.2: Train primary care providers with FUERSA to screen mental health disorders.

Recommendation 3.3: Develop a user- and child-friendly mental health community education system for prevention that is responsive to the needs of the Hispanic population.

Recommendation 3.4: Provide community-based services in early childhood care and education for children 0 to 5 years (e.g. expand Head Start beyond 40 percent children eligible in Hispanic community) with a family and community focus, from a strength-based perspective, by expanding Head Start.

Recommendation 3.5: Provide school-based services, including before and after school services, and community-based services with a family and community focus and a strength-based perspective for children and youth 5 to 20 years of age.

Recommendation 3.6: Provide community- and home-based mental health services with a family and community focus and a strength-based perspective for elder care and development.

Discussion: The workgroup recognized that creation of Medicare pharmaceutical benefits is crucial to improving mental health services for all older Americans, including Hispanics. Other specific action items include:

Recommendation 4.1: Create and/or change Federal, State, and local policy to eliminate Hispanic health disparities and support the delivery of efficient, effective, and innovative mental health services in all settings.

Discussion: The workgroup determined that in order to promote and foster the wellness of all Hispanics, mental illness needs to be seen as a health condition that must be understood in a social, cultural, and linguistic context. In addition, quality, comprehensive, and effective services must be delivered in a manner that incorporates traditional and nontraditional interventions that competently meet the needs of Hispanic populations.

Recommendation 4.2: New and existing public and private funding streams must close gaps and eliminate disparities in mental health services for Hispanics.

Recommendation 4.3: Programs must deliver quality, comprehensive, efficient and effective mental health services, providing innovative interventions that are culturally and linguistically competent to all Hispanics.

Recommendation 5.1: Make Latino mental health and substance abuse research an immediate priority for funding agencies in order to promote effective, culturally/linguistically competent services and outcomes directly relevant to Latinos, consumers, families, and the community.

Recommendation 5.2: Substantially increase the number of Latinos who conduct research in mental health and substance abuse.

Recommendation 5.3: Identify, develop, evaluate, and disseminate innovative research models and methods that are appropriate for use in Latino communities. These multi-modal and multi-disciplinary research models should include built-in mechanisms for receiving ongoing feedback from consumers, communities, and other stakeholders.

The National Congress completed its National Agenda for Hispanic Mental Health and the first iteration of its Action Plan. The Steering Committee identified several specific priorities requiring short term attention. These priorities are described below and were presented to Mrs. Gore at a briefing session on June 7, 2000.

Assuring Access to Mental Health Care and Supportive Services - A number of steps can be taken to reduce barriers to care. Such steps can address health policy and institutional barriers. With regard to health policy barriers, health insurance that provides coverage for mental health services is imperative for Hispanics. Without such insurance, economic barriers will continue to prevent Hispanics from seeking care.

Health policies must ensure prevention and early intervention services that are responsive to the Hispanic community and culture are available in order to improve mental health and reduce demands on the service systems.

With regard to institutional barriers, facilities must be operated in a manner that ensures providers and all staff reach out to consumers and their families within their communities and homes and across all service systems, such as community health centers, substance abuse treatment services, welfare, criminal justice, and foster care, in order to treat persons from low income communities.

To further address institutional barriers, close gaps, and eliminate service disparities, cultural competence standards must be incorporated into all service systems, effectively making every door an open door to culturally relevant and appropriate care.

Conducting Relevant Research to Inform Service Delivery - Considerable gains have been made in developing pharmacologic and psychosocial interventions for the general population. Collaborative research efforts must be undertaken to insure the effectiveness of these state-of-the-art treatments for Hispanics. With regard to psychosocial interventions, that is, those treatments in which patients and their families learn how to successfully address their illnesses, it is critical that such interventions can be validated both culturally and linguistically for Latinos. With regard to psychopharmacological treatment, clinical trials of existing and new medications must be carried out with Hispanics to insure their effectiveness with this ethnic group.

Services exist to effectively treat a wide range of mental health problems. Validation of such treatments both culturally and linguistically is imperative for Hispanics. Further, such efforts are needed to learn which specific interventions work best for Hispanics and the conditions and contexts under which best care is possible, from faith community and family to home and community.

Improving Human Resources and Training the Next Generation - The mental health service needs of a growing Hispanic community must be met with a significant infusion of culturally competent and linguistically appropriate personnel into community-based systems across the country. Most important, Hispanics need to be appointed to key leadership positions at the national, State, and local levels, with a specific commitment to work towards a Federal government workforce that is representative of the U.S. population. Hispanics must be recruited actively to work at all skill levels within the mental health workforce. Staff who are culturally and linguistically competent and are knowledgeable of the socio-cultural basis of Hispanics' daily lives are essential. Initiatives should be undertaken to increase the numbers of bicultural and bilingual professionals. Further, strategies must be developed to attract Hispanic youth to mental health careers.

Primary care providers -- not just mental health professionals -- must be trained to provide appropriate and regular screening for mental health disorders, using a strength-based, culturally competent approach. In addition, establishing collaborative relations between primary care providers and mental health specialists can increase accessibility to mental health care and improve consumers' mental health status. This is particularly critical because Hispanics with mental disorders are more likely to seek care from primary care providers than mental health specialists.

Finally, cultural competence training should be a part of all training and educational curricula and a requisite for licensing and credentialing for all workers in the field of mental health.

Ensuring Accountability - Performance measures and outcome-based accountability across systems of care must be put into place to ensure that the Hispanic community's mental health needs are being met. Actions taken must ensure that mental health cultural competence standards and national performance measures are included in all regulations, professional accreditations, grants/contracts, State-based certifications, and college/university credits. Such accountability must extend beyond the mental health service system to other systems that interface with mental health, including justice, welfare, education, housing, and primary care.