“The current mental health system

has neglected to incorporate, respect

or understand the histories, traditions, beliefs, languages and

value systemsof culturally diverse groups.”

“The current mental health system

has neglected to incorporate, respect

or understand the histories, traditions, beliefs, languages and

value systemsof culturally diverse groups.”

The President’s New Freedom Commissionon Mental Health: Achieving the Promise:

Transforming Mental Health Care in America.Final Report, July 2003.

The President’s New Freedom Commissionon Mental Health: Achieving the Promise:

Transforming Mental Health Care in America.Final Report, July 2003.

EXPLANATORY MODELS OF HEALTHWestern vs. Eastern

Paradigms

EXPLANATORY MODELS OF HEALTHWestern vs. Eastern

ParadigmsWESTERN PSYCHIATRIC

• Scientific epistemology

• Biochemical/Genetic etiologyof illness without consideringsoul or spiritual origins

• Defines illness as physicalor mental – discrete linesbetween mental and physical

• Verbalization of problemsviewed as a necessary partof treatment

WESTERN PSYCHIATRIC

• Scientific epistemology

• Biochemical/Genetic etiologyof illness without consideringsoul or spiritual origins

• Defines illness as physicalor mental – discrete linesbetween mental and physical

• Verbalization of problemsviewed as a necessary partof 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.

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 ofUS Civil Rights Act of 1964

“Discrimination Based on National Origin”

TITLE VI ofUS Civil Rights Act of 1964

“Discrimination Based on National Origin”

How Title VI affects healthand human service provisions

for those with limited-English proficiency

(LEP)?

How Title VI affects healthand human service provisions

for those with limited-English proficiency

(LEP)?

National Origin IncludesNational Origin Includes

Birthplace, ancestry, culture,

linguistic characteristics common to

a specific ethnic group, or accent

Birthplace, ancestry, culture,

linguistic characteristics common to

a specific ethnic group, or accent

Definition ofLimited-English Proficient

(LEP)

Definition ofLimited-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.

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-EnglishProficient Americans

Limited-EnglishProficient Americans

Nearly 30% of Asian andLatino Americans say they

do notspeak English “very well.”

Nearly 30% of Asian andLatino Americans say they

do notspeak English “very well.”

Civil Rights andLanguage Access to

Healthcare

Civil Rights andLanguage 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

US Supreme Court Case Law:

Lau Vs. NicholsEstablished 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. NicholsLogic 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."

"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)

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)

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 LinguisticallyAppropriate Services Standards

(CLAS)

Culturally and LinguisticallyAppropriate 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 intendedto 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).

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 intendedto 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 Culturallyand Linguistically Appropriate Care

(Office of Minority Health, Dept. of Health and Human Services)

National Standards for Culturallyand Linguistically Appropriate Care

(Office of Minority Health, Dept. of Health and Human Services)

STANDARD 4

Health care organizations must offerand provide language assistance

services, including bilingual staff and interpreter services, at no cost to each

patient/consumer with limited English

proficiencyat all points of contact, in a timely

manner during all hours of operation.

STANDARD 4

Health care organizations must offerand provide language assistance

services, including bilingual staff and interpreter services, at no cost to each

patient/consumer with limited English

proficiencyat all points of contact, in a timely

manner during all hours of operation.

National Standards for Culturallyand Linguistically Appropriate Care

(Office of Minority Health, Dept. of Health and Human Services)

National Standards for Culturallyand 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 Culturallyand Linguistically Appropriate Care

(Office of Minority Health, Dept. of Health and Human Services)

National Standards for Culturallyand Linguistically Appropriate Care

(Office of Minority Health, Dept. of Health and Human Services)

STANDARD 6

Health care organizations must assurethe 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 assurethe 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 Culturallyand Linguistically Appropriate Care

(Office of Minority Health, Dept. of Health and Human Services)

National Standards for Culturallyand 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 Burdenof Health Inequities

The Economic Burdenof 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 (2003-2006). 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 (2003-2006). 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