DMH Connections

The familiar New England term "wicked problems" is used to describe problems that seem intractable, that defy easy solutions. They tend to be interlocking with other deep-seated social and economic conditions. These problems present a special challenge because they defy precise definition, cut across policy and service areas, and resist solutions offered by the single-agency or "silo" approach (Robyn Keast, et.al, 2004). Click here http://eprints.qut.edu.au/4819/1/4819.pdf for the article.

The reduction of racial, ethnic and geographic disparities of mental health care is one of the major policy initiatives to address this "wicked problem." The interagency policy team of the Children's Behavioral Health Initiative (CBHI) agencies includes staff from the Departments of Mental Health, Children and Families, Public Health, Youth Services; MassHealth, the state's Medicaid agency; a family partner; and two peer leaders.

The short and long term outcomes of this policy initiative are:

1) Common data collection elements for race ethnicity and language across CBHI agencies

2) Specific performance indicators, outcome measures, contract language to ensure accountability for the reduction of disparities

3) A multi-pronged approach to increase language access to services

After two full days in June working on related actions on the proposed short and long term outcomes, the interagency team is now ready to develop the following:

1) A joint logic model to visually articulate disparity issues, organize and specify outcomes that are attentive to the needs of culturally and linguistically diverse populations and can be tracked and evaluated

2) A Strategic Action Plan on the Reduction of Behavioral Health Disparities

3) An interagency policy agreement and an evaluation plan on the policy impact on mental health care disparities in access, availability, utilization and outcomes

Members of the interagency team also participate on CBHI committees and working groups with the goal of expanding ownership and champions, gathering strategies and ensuring ongoing communication on the reduction of disparities agenda.

In order to tackle the "wicked problem," the team is using the learning collaborative model to support knowledge gathering and sharing, integrating the tools of cultural and linguistic competence to reduce disparities, as well as increase learning, collaboration and mutual support across state agencies.

Mental health care disparities are real. According to MassHealth, based on the Treatment Outcomes Package (TOP), a standardized clinical assessment tool for Medicaid members:

· Hispanic children and adolescents were highest on nearly every TOP clinical domain indicating greater disability and had lower service utilization despite needs;

· Black adolescents were lower on TOP indicating lower disability, but were more likely to have certain diagnoses, e.g. Conduct Disorders and Oppositional Defiant Disorder;

· Children and adolescents who preferred to use a language other than English were found to have higher or equal TOP clinical domain scores.

· Our Department service enrollment data also indicated that Asian youth tend to under-enroll in all DMH services, Blacks and Latinos under-enroll for some services. The Native American population though small in Massachusetts, significant outreach needs to be done.

Other at-risk populations also indicate a need of mental health interventions:

Latino students had the highest absentee and dropout rates, compared to white, black and Asian students.
In the child welfare system, Blacks and Latinos are disproportionately over-represented, making up 40% of the statewide total caseload.
In 2008, minority youth led the state's rates for juvenile detentions (25.9% Black and 26.4% Latino) and for juvenile commitments (27.3% Black and 27.5% Latino).
There is much variability in poverty and mental health needs among Asians. Refugees from Southeast Asian countries are at much higher risk for mental illness.

The U.S. House of Representatives proclaimed July as Bebe Moore Campbell National Minority Mental Health Awareness Month. The resolution was passed in recognition that improved access to mental health treatment and services and public awareness of mental illness are of paramount importance.

The time is now. Many of the lessons learned and that will be accomplished are highly transferable to Community Based Flexible Supports (CBFS), the cornerstone of the Department's community mental health system for adults. Short term and long term goals include ensuring data for race, ethnicity and language are collected for CBFS and developing the capacity to use data on demographics, prevalence data, service utilization, and geographic service availability to measure disparities and their contributing factors to inform policy and research development, program development and service delivery and clinical practices; and ensuring standards for cultural and linguistic competence that attend to performance and outcome measures are used and instituting performance measures for providers in contract language to eliminate disparities in access, availability, utilization and outcomes.