"This is new for many of us who have not had the opportunity to work with people in these sorts of positions."
Health care reform’s emphasis on prevention and primary care also is likely to drive change for the better, she said, noting that people with serious mental illness die, on average, 25 years earlier than the general population. "The integrated care between primary care and mental health is particularly important with ethnically and racially diverse groups," she said. "There are very high rates of chronic disease and premature death, so this is another way in which these patients can benefit from having a ‘one-stop shop,’ to benefit from collaborative care."
In 2006, the APA and the National Alliance on Mental Illness embarked on a project to develop a 3-hour continuing medical education curriculum called "In Living Color: Depression Treatment in Primary Care." The curriculum was developed to equip primary care practitioners with the knowledge and skills to work more effectively with diverse populations.
"The approach in teaching this is innovative in that it involves physicians working with a person of color with a history of depression as well as with a family mental health advocate from a diverse background," Dr. Primm said. "So the primary care practitioners [gain] a full appreciation – not only of the science but also of the lived experience of what it’s like to be a person of color with a mental illness and to struggle with it." To date, the curriculum has been rolled out in California, Florida, Louisiana, Missouri, and Tennessee.
The recent proliferation of cultural competence training, and practitioner and organizational assessments, also are likely to result in improved access to quality mental health care. The Affordable Care Act "does pay attention to the issue of cultural competency training," she said. "Some states have taken the lead on this, including New Jersey, which requires cultural competency training for medical licensure and renewal. In addition, California requires that all CME programs include a cultural competence focus."
On the national front, the Department of Health and Human Services Office of Minority Health has launched a National Partnership for Action to End Health Disparities. According to its website, the mission of NPA is to "increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action." Efforts by the Patient Care Outcomes Research Institute to conduct comparative effectiveness research also will be key. "Perhaps this will be an opportunity to learn more about what sort of treatments work best in which populations and by which providers, et cetera," Dr. Primm said. "In terms of quality improvement, it’s important to have national indicators tracked by race and ethnicity."
Other quality standards focused on eliminating disparities include the National Standards on Culturally and Linguistically Appropriate Services, the National Quality Forum’s Healthcare Disparities and Cultural Competency Consensus Standards, and the National Committee for Quality Assurance’s Standards and Guidelines for Distinction in Multicultural Health Care. "These will all be more prominent going forward," Dr. Primm said.
Dr. Primm said she had no relevant financial disclosures.