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Special Programs and Initiatives

National Congress for Hispanic Mental Health

IV. National Agenda for Hispanic Mental Health

Overview

On March 20, 2000, a diverse group of Hispanic stakeholders convened to identify key policy and practice recommendations regarding Latino mental health promotion, early intervention, and treatment. Consisting of consumers, family members, providers of services, policymakers, members of national and local advocacy organizations, and researchers, stakeholders covered a wide variety of topics relevant to Latino mental health including research and mental health services. Discussions on mental health services were expanded to include standards of health care, human resources, consumer and family needs, cultural competence, and community education.

After much discussion on these topic areas, stakeholders came to the consensus that mental health services should be developed with FUERSA! (FUERSA is phonetically spelled for purposes of the linkage to the values. Correct spelling is fuerza, or strength). This acronym is defined as follows:

To ensure relevance, stakeholders worked within the context of Hispanic mental health in the United States. The most recent psychiatric epidemiological study conducted with 3012 Mexican Americans from Fresno, California found that 48% of those born in the United States developed a mental health or substance abuse disorder. In addition, the Center for Disease Control found in a nation-wide study that Hispanic youth had proportionally more suicidal ideation and specific suicidal attempts than Caucasians and African Americans. Specifically, 23% of Hispanics considered the possibility of suicide whereas 10% reported having attempted suicide.

Despite the considerable need for mental health and substance abuse services, Latinos are not accessing mental health services. Of those persons identified with mental disorders, less than 9% contacted mental health care professionals and less than 18% contacted health care providers. The problem is much worse for immigrants: less than 5% access mental health services whereas less than 11% utilize services from general health care providers. The available research on Hispanic adults and children clearly points out the considerable unmet need for mental health care.

Summary of Agenda Items and Themes

In accordance with FUERSA, stakeholders determined that Hispanics have a great need for mental health and substance abuse services that are socially, culturally, and linguistically appropriate.

Agenda recommendations were designed to address the need for socially, culturally, and linguistically appropriate mental health and substance abuse services. As a result, the following key objectives were identified: to increase funding for research, innovative service delivery, and gaps in services; to educate decision makers on the needs for mental health services, funding, and inclusion of Hispanics; to incorporate cultural competence across systems, including services, research, and academia; to ensure systems of care for prevention and early intervention across the life cycle in early childhood settings, community, schools, and homes; and to involve the faith-based community; to ensure inclusion of consumers and family members in research development, curricula development, accreditation, boards, and the mental health workforce; to implement standards, regulations, and accreditation for cultural competence, clinical access, and outcomes; and to ensure workforce development through recruitment and retention.

Key themes of the agenda-setting process were: a strength-based approach to prevention, the consumer as a partner, innovative approaches to service delivery and research, and a holistic approach to mental health, with the mind/body/mental health connection.

Detailed recommendations and explanations of the Agenda for Action for Hispanic Mental Health follow.

(1) CONSUMER, FAMILY & COMMUNITY EDUCATION

Key Issue:
Develop and implement nationwide Hispanic-specific mental health education and training programs in partnership with Hispanic community support networks (e.g. faith-based and community-based organizations and practitioners etc.).

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

• Public funds are not dispersed to any organizations that lack Hispanic representation
  
  
• Private mental health funding sources to only finance culturally competent programs.

Recommendation: Ensure funding for Hispanics proportional to the growing demographics and need to achieve goals.

• Twenty-five programs in 25 states annually until the goal is achieved.

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

• Hispanic cultural competency training for national, State, local government and elected officials
  
  
• Federally funded training of elected officials specifically on Hispanic cultural competency in mental health by a Hispanic organization.

Key Issue:
Create and finance a national Hispanic Mental Health Consumer and Family network.

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

• Funded programs must demonstrate the inclusion and incorporation of consumers and families in all design and implementation processes for initial receipt and continuation of funding

Recommendation: Train and educate Hispanic consumers and family members to become leaders in order to educate and inform Congress.

• Federally funded training of consumers and family members for leadership development.

Recommendation: Educate funding sources on the importance of supporting relevant Hispanic community issues for consumer/family driven community-based research.

(2) ACCREDITATION, STANDARDS, REGULATION AND HUMAN RESOURCES

Key Issue:
Human Resources

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

Recommendation: Actively recruit and retain a Hispanic mental health workforce at all educational and skill levels, inclusive of traditional and non-traditional service providers.

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

Key Issue:

Develop standards and accreditation to address cultural competence needs.

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

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

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

(3) PREVENTION AND EARLY INTERVENTION

Key Issue:
Develop an information and referral system.

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

Key Issue:
Train primary care providers.

Recommendation: Train primary care providers in the screening of mental health disorders with FUERSA.

Key Issue:

To develop a mental health community education system for prevention.

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

Key Issue:
To develop focus on positive development programs across the life cycle.

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

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

Recommendation: Provide community- and home-based mental health services for the care of older adults with a family and community focus from a strength-based perspective.

(4) MENTAL HEALTH SERVICES

Goal: In order to promote and foster the wellness of all Hispanics, mental illness is a health condition that must be understood in a social, cultural and linguistic context, and quality, comprehensive and effective services must be delivered in a manner that incorporates traditional and nontraditional interventions that are competent to meet the needs of Hispanic populations.

Key Issue:
Policy development

Recommendation: 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.

Key Issue:
Funding development

Recommendation: Public and private new and existing funding streams must close gaps and eliminate disparities in mental health services for Hispanics.

Key Issue:
Program development

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

(5) HISPANIC RESEARCH

Key Issue:
Promote research effective services and improved outcomes for Latinos

Recommendation: 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 for Latinos, consumers, families and the community.

Key Issue:
Latino Participation

Recommendation: Substantially increase the number of Latinos who conduct research in the field of mental health and substance abuse.(See also #2)

Key Issue:
Research Methodology

Recommendation: 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 ongoing feedback from consumers, communities and other stakeholders.