I recently pinned this brief to the LA County Department of Mental Health’s Countywide Under-Represented Ethnic Population (UREP) committee when the discussion of disparity within the mental health system favored Asian Pacific Islanders and Latino’s.  The Countywide UREP members consists of department of mental health executives and community representatives.  Subcommittee UREPs are represented by American Indian (AI), African/African American (AAA), Asian/Pacific Islander (API), Eastern European/Middle Eastern and Latino.  I represent both AAA & Latino UREP subcommittees.   Critical to transform delivery of services to rebuild the no longer existent economic “safety-net” the following must be considered.

DISPARITY

In 1963 when Eugene “Bull” Connor, Birmingham, Alabama’s public safety commissioner, turned the fire hoses and attack dogs on its black citizens and children who were demonstrating against Jim Crow’s segregation and their second class citizenship, the nation woke up and realized that it could no longer tolerate the abuses that were being inflicted upon African Americans.  Today, the mental health system has become a symbol of the New Jim Crow as African Americans have become adversely represented across systems, i.e. mental health, health, education, prison, probation and foster care systems.  To that end, African Americans have the highest unemployment and poverty rates by population with several local and national foundations launching initiatives targeting Black Male Achievement.  As “the” root cause of disparity, the African American experience resulting from historical trauma perpetuated since slavery and further suppressed by no American system designed to support non-whites leaves little debate as to the underrepresented ethnic population at greatest risk during this profound opportunity for system restructuring.

CULTURAL COMPETENCE

I noticed agenda item in the Action Notes gathered from the Systems Leadership Team Ad Hoc Committee meeting on Thursday, Nov. 14, 2013.

II. Review – System Creation vs. Systems Improvement.

We are not creating a system like we did with CSS?

Prop 63 MHSA is specific: Transform delivery of services. Impossible if you don’t transform the system that distributes such services.  System Leadership Team members have expressed their displeasure with the Department of Mental Health which represents as much stigma as contracted service entities.

How does the CSS integration of physical health and substance abuse care in association with federally qualified health centers allow DMH to create and sustain mental parity per the Federal Affordable Care Act Law?   Strapping wings on a caterpillar doesn’t make it a butterfly any more than attempting to plug innovative PEI and ISM practices into a fragmented operating system going to revive or prepare the mental health system for parity.  The mental health system does not need improvements it requires whole-system transformation.  Any effort short of laser-like focus to develop a fully integrated and comprehensive culturally competent mental health system is critically short sighted and risk the legitimacy of DMH and its System Leadership Team.

ACCESS

Each UREP has identified three similar barriers to services cross cultures.

Stigma – Mental health stigma is a mindset, not process.  To date, I have seen no specific nor significant funding allocated to develop culturally competent outreach and engagement processes for individual UREP’s.  Stigma & Discrimination funding targets consumers and does little for individuals trauma exposed and/or in jeopardy of onset.  As long as DMH favors current services providers to deliver PEI practices despite the MHSA calling on new agencies, stigma will prevail.

Inability to serve children and transition aged youth – Every child must pass through K-12 education. Current school based mental health services reek of stigma are fragmented and inappropriately diagnose African American youth whom otherwise endure behavior issues.  The Early Start School Mental Health Initiative resulted nothing more than a process to police our youth.  The project consisted of teams of law enforcement and clinicians…This is not a PEI practice however, a screening process to justify billing requirements as school based mental health services has for over two decades under the current medical model to diagnose and treat.

Lack of a seamless integrated work process – It is inefficient and ineffective to place service providers under one roof “single-site” with multiple billing processes.  Without a process to effectively coordinate core support work process and internal social structure, integrated services will unlikely yield intended outcomes and decrease mental health sustainability.

QUALITY OF CARE

African Americans are constantly identified as overly aggressive, divisive, uncooperative, lazy and uninspired while controlled by unfavorable systems and its leadership that gives little to no account of the generational suppression that has creating such mindset.  Therefore, we lack faith and trust in system leaders and service providers who suggest they understand, yet continue to implement reactive processes that will never meet our community’s needs. Quality of care begins when the system is transformed though an open and transparent processes that intentionally engages the African Americans community in such transformation.

SUSTAINED MENTAL HEALTH OUTCOMES

Over the past decade African Americans fled South LA to Moreno Valley, Palmdale and Lancaster in search of employment at military bases that have since closed.  Sold on the idea of home ownership being the American Dream, African Americans yet again was manipulated by the financial system and its leadership losing its most valued asset.  Failure to simultaneously address systemic, culturally and economic needs in the African American community leave little doubt we will see ever see sustained mental health outcomes as the African American community is slowly but visually being eradicated post America’s worst economic downturn.

The following questions should be consideration by the System Leadership Team and Mental Health Oversight and Accountability Committee going forth.

QUESTIONS

  • Will operationalizing the 3 year program and expenditure planning process be placed for bid?  And, if so, what minimum mandatory requirements will the contracting agency be required to possess, given “systems transformation” has no relevance toward providing care?
  • How will integration of the 3 year plan be sustained for continuous improvements? May the ongoing 5% of innovation reserves be utilized to sustain transformation?
  • Given cultural competence is imperative, what population and/or community will DMH launch transformation of the 3year plan? Or is this decision one based on the logic of the contracted entity?
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