Individuals experiencing mental illness are more likely to have chronic conditions, such as hypertension, asthma, diabetes, stroke and heart disease, compared to those without.⁸ Patients who identify as Black, Indigenous, or People of Color (BIPOC) or Asian American Pacific Islanders (AAPI) can also be more susceptible to developing these chronic conditions. An approach that tackles both sides of the disparity may be needed for patients of these communities.
Behavioral Health Integration (BHI) is an effective practice providers can use to support BIPOC and AAPI patients’ mental health needs. A BHI team includes primary care and behavioral health providers, working together with the patient and the patient’s family. Housed within the BHI model is the Psychiatric Collaborative Care Model (CoCM). CoCM is an effective way to get the best mental health care for patients with complicated behavioral health needs. CoCM adds additional members to the primary care team, including a behavioral healthcare manager, a psychiatric consultant and a treating practitioner. BHI and CoCM effectively cover care for the body and mind of these patients.
Mental Health Disparities Among BIPOC/AAPI
Even though there are strategies to treat behavioral health patients, a gap in mental health care still exists for people of color. BIPOC and AAPI communities are two large diverse groups in the U.S. who struggle to receive the mental health support they deserve. Although the rates of depression and anxiety are much higher for whites than any other race, black and latino individuals experience more extreme and last longer periods of mental illness compared to whites. The American Psychiatric Association saw that among the major ethnic groups:
Rates of Any Mental Illness from 2008-2012 were:
- White: 19 percent
- Black: 16.8 percent
- Asian 12.4 percent
- Hispanic 15.3 percent
- Individuals who identify as two or more races: 24.9 percent
In 2015, the rates among individuals with any mental illness who received treatment were:
- White: 48 percent
- Black: 31 percent
- Hispanic: 31 percent
- Asian: 22 percent
- Individuals who identify with two or more races: 46 percent
As the numbers show, ethnic minorities delay or don’t receive the treatment they need when it comes to their mental health compared to white individuals. Reasons for this disparity could include lack of availability, transportation issues, bias, and/or language barriers. However, this disparity could also be attributed to stigmas in their communities surrounding mental illness. For minorities, stigma poses another barrier to obtaining care.
“Stigma is manifest in language, disrespect in interpersonal relationships, and behaviors. It is a barrier to those individuals who need mental health services, but who are reluctant or refuse to seek help because of the potential for discrimination and rejection by others,” defines this article in the Mental Health Nursing Journal.
The article continues to cite a U.S Department of Health and Human Services statement on stigma as “the most formidable obstacle to future progress in the area of mental illness and health.” With major concerns of prejudice and racial discrimination, individuals continue to suffer more as the lack of treatment for mental health persists.
With stigmas surrounding general mental health awareness already in place, further stigmas branching from BIPOC/AAPI communities are surely not encouraging for patients in them. Take for example this statistic from the National Alliance on Mental Illness, (NAMI), which states that 63 percent of black adults think that mental health issues were a sign of weakness. For many individuals in the black community, it’s difficult to acknowledge psychological difficulties, and if they are recognized, religion (e.g. pastoral guidance) is used as the preferred coping method.⁷ NAMI also found people who identify as asian-pacific islanders stated that they “didn’t want others to find out” about their mental health challenges or had confidentiality concerns.
63 percent of black adults think that mental health issues were a sign of weakness.
Beliefs like these are integral in communities, and must be recognized when approaching the topic of mental health care for BIPOC patients. It can be challenging to discuss with patients, but the right culturally sensitive tools can help you overcome these communication and care barriers. The conversation should allow these patients to see that mental health is an essential part of well-being, just as is diet, exercise and sleep.⁷
Mental Health Support Through BHI and CoCM
A collaborative, culturally competent approach can be a great asset for BIPOC mental health support. Efforts to improve care for mental health disorders in primary care can include screening for common mental disorders; education for primary care providers; development and treatment guidelines; and referrals to mental health specialty care. Each patient should be closely monitored on their progress. CoCM is a great solution to carrying out this collaborative approach. Within CoCM, psychiatric consultants provide support for the patient and the primary care provider. Psychiatrists and/or psychiatric nurses are the two types of clinicians qualified to provide the most care in a CoCM setting. Their responsibilities include regular caseload reviews, as well recommendations for patient treatment and wellbeing.
“The integration of behavioral health into primary care services would go a long way toward improving access to much-needed care,” says a study by researchers at the Boston University Medical Center. “Studies have shown that integration of behavioral health and primary care services can increase scheduled behavioral health service use by 14 percent and actual use by 9 percent.”
READ MORE: FQHC Behavioral Health Options: BHI & CoCM
One study cited by a Boston University review found that Latino adults with symptoms of depression who received integrated, culturally inclusive psychiatric consultation, used in conjunction with primary care, had higher rates of symptom reduction than Latino adults who did not. The same review cited another study which saw an association between integrated primary care intervention for older African American patients receiving pharmacological treatment and a decrease in depressive symptoms, as well as increased medication adherence for depression and hypertension.
The integration of behavioral health into primary care ensures patients can receive holistic care where it’s most accessible. Making physical and emotional wellness equally routine can help BIPOC and AAPI patients stay more on top of their care and connected, when they may be feeling down. When patients receive treatment for both, clinicians can begin to see improvements in one domain influence the other. Collaboration through services such as CoCM ensure the patient feels well-supported throughout their health journey.
Despite the benefits of BHI and CoCM for BIPOC communities, more work needs to be done in addition to these services. Engaging within communities and understanding racial trauma and mental health are key steps in understanding and helping improve BIPOC mental health.
For black patients seeking mental health services, NAMI recommends a set of questions for patients to ask providers, to ensure their needs will be met, equitably. These questions are great for any identity on the BIPOC spectrum to ask as well. Providers can ask themselves the questions below to gauge a sense of their consciousness surrounding mental health disparities.
- Have you treated other black people or received training in cultural competence for black mental health? If not, how do you plan to provide me with culturally sensitive, patient-centered care?
- How do you see our cultural backgrounds influencing our communication and my treatment?
- Do you use a different approach in your treatment when working with patients from different cultural backgrounds?
- What is your current understanding of differences in health outcomes for Black patients?
Collaborative care efforts, such as BHI and CoCM, can be used in tandem with culturally sensitive techniques to close mental care gaps for BIPOC and AAPI patients. With the right partner, it’s easy to get a program like this started.
How We Can Help:
By partnering with Certintell, founded on supporting underserved patient population, we can supply you with psychiatric consultants needed for your CoCM or general BHI services with our vast network of clinicians, as well as the secure HIPAA compliant portal for the whole care team, including the patient, to stay connected. The portal provides a centralized location for all needed tasks, including EMR review, patient-provider messaging and video visits. A transformative service like BHI or CoCM doesn’t have to be complex.
