Center initiatives and Project Summary

Integration of Health and Mental Health for People with Serious Mental Illness

Background and Significance

People living with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder) die 25 years earlier than the general population largely due to preventable medical conditions and poor quality of medical care.  Recent studies show that, compared to non-Hispanic Whites with SMI, racial and ethnic minorities with SMI have higher rates of obesity, hypertension, and other metabolic risk factors placing them at elevated risk of developing cardiovascular disease and diabetes.  These greater health risks are explained, in part, by racial/ethnic disparities in the receipt and quality of care for these conditions.  As a result, racial and ethnic minorities with SMI are at increased risk for unmet physical health needs.

Goals

To understand and improve the physical health and health care of racial/ethnic minorities with SMI.  To achieve these goals our work focuses on three areas:

1. Detection of physical health and health care disparities.
2. Understand determinants of disparities at the patient, provider and system levels.
3. Develop culturally appropriate interventions to eliminate racial and ethnic health and health care disparities among people with SMI.

Projects

• Community Assessment: Integration of Health and Mental Health Services.  Completed qualitative community needs assessment of the provision of culturally and linguistically competent physical health services to racially, ethnically, and linguistically diverse people with SMI in three northern Manhattan communities.  The aims of this project are to: 1) explore the provision of culturally competent physical health services to racial and ethnic minorities with SMI; 2) identify systemic and socio-cultural barriers to services integration; and 3) inform the development of culturally competent solutions for service integration.  

• Systematic Literature Reviews of the Physical Health of People with Serious Mental Illness
• Lifestyle Interventions for Adults with Serious Mental Illness: A Systematic Literature Review.  Psychiatric Services. (In Press).

• CECC synthesis report titled “Improving the Physical Health of People with Serious Mental Illness:  A Systematic Review of Lifestyle Interventions”.

• Prevalence of Cardiovascular Risk Factors among Racial and Ethnic Minorities with Schizophrenia Spectrum and Bipolar Disorders: A Systematic Literature Review. (In Preparation).

• Secondary data analyses of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).  The aims of these analyses are to examine racial and ethnic disparities in diabetes and other chronic medical conditions among people with psychiatric disorders.

Best Practices for Interpreting and Cultural

Brokering Services

Background and Significance

Approximately 18% of people in the U. S. speak a language other than English at home and 8% have limited English proficiency (LEP).  In New York State, these numbers increase to 28% and 13% respectively. Compared with English-proficient individuals, those with LEP have higher rates of medication complications and are less likely to have a regular source of health care, seek preventive care, access mental health services, or adhere to treatment. LEP individuals are also less satisfied with the consumer-provider relationship, have more difficulty developing rapport with providers, and show less understanding of medical diagnoses.  Effective communication between consumers and providers that reduce language and cultural barriers is essential to improve the quality mental health care and treatment outcomes.  Increasing the accessibility to bilingual providers and quality interpreter services as well as developing strategies to facilitate intercultural understanding between consumers and providers through the use of cultural brokers are necessary to improve the mental health care of the LEP population.

Goals

 To evaluate language access of OMH consumers and develop a novel model for expanding the cultural brokering function of interpreter services using teleconferencing technology to improve the quality of clinician-consumer communication.  This initiative focuses on improving language access as a key strategy to enhance treatment engagement in populations with limited English proficiency.  In addition, we are exploring the potential of interpreters to facilitate culturally-grounded clinical evaluations and reduce ethnic disparities in the quality of mental health care.

Projects

• Interpreter/Cultural Broker videoconferencing project.  Developing and testing an innovative interpreter/ cultural broker service model that utilizes videoconferencing technology to provide cultural and linguistically competent services to individuals receiving mental health care across New York State. The project targets Spanish and Mandarin speakers with serious mental illness. 

• Language Access Survey.  Under the auspices of the Bureau of Cultural Competence of the New York State Office of Mental Health (OMH), this survey assesses the scope, type, and quality of access that patients with limited English proficiency (LEP) have to mental health services in their primary language. Results will be used to assess need for language supportive services.

Cultural and Linguistically Appropriate Engagement Strategies Across the Lifespan

Background and Significance

Rates of consumer engagement in mental health services are low throughout the U. S. and even lower among racial and ethnic minority populations of all ages. Disengagement from mental health services is associated with higher morbidity and mortality, compromised quality of care and higher financial costs of medical care. Established engagement strategies often do not address the additional and unique barriers that racial and ethnic minorities encounter.  More research is needed to understand how to effectively increase the engagement of racial and ethnic minority population into mental health care.

Goal

To understand how to effectively increase the engagement of racial and ethnic underserved populations into mental health care.

Projects

• The Depression Fotonovela Project.   The aims of this project are to develop and evaluate a culturally and linguistically appropriate depression literacy tool based on a fotonovela format, for Latinos/as with limited English proficiency.  Fotonovelas are a health promotion tools that use posed photographs, text bubbles, simple text, dramatic soap opera narratives, and vivid pictures to engage audiences and raise their awareness about specific health issues (e.g., diabetes, depression) and combat stigma.

• The Right Question Project.  A collaboration with Cambridge Health Alliance- Center for Multicultural Mental Health Research at Harvard University to serve as research site for this NIH study. The Right Question Project is a novel method of consumer activation in mental health care to improve engagement and retention in mental health settings that emerges from practice-based evidence.