Seriously Mentally Ill and Integrated Care Among Hispanic Populations

Abstract

Public Law 102-321 put forth by the Substance Abuse and Mental Health Services Administration funds programs and research for Serious Mental Illness (SMI), which they define as any DSM diagnosis (other than a substance-use disorder) with a duration of more than 12 months and functional impairment in at least two domains. Not all hospitals provide an integrated approach to treating SMI, which is ultimately detrimental to the patient and the hospital. When comparing an integrated approach to mental health treatment with a general medical approach within the same hospital, researchers found that the patients demonstrated not only greater satisfaction with the care received, but also greater participation in prevention programs. As discussed in the outset of this chapter, the most recent data indicates the prevalence rate of 3.5% for SMI in U.S. Hispanic populations, which is slightly lower than the 4.1 % prevalence rate of the overall U.S. population. This suggests a prevalence rate of SMI for Hispanics that approximate the overall population. Across treatment domains (e.g. mental health, substance use) a primary barrier to care has been the ability to pay for the services (Mojtabai, Chen, Kaufmann, & Crum, 2014), but it is proposed that the Affordable Care Act will address this issue of affordability. However, as will be discussed below, this assumption is problematic for some Hispanics. The second most commonly reported barrier, specifically relevant to SMI, was the fear of being committed, followed by a lack of information about where to get services, and finally the perception that an individual should be able to resolve their own mental health problems. The authors also described a lack of a perceived need as a potential additional barrier, specifically in the context of those individuals with comorbid disorders of substance use and mental illness. The WHO mhGAP (2010, 2015) provides a simple to use decision-making chart that uses color-coded decision trees and easy to identify alerts. mhGap is designed to be used within a system of care, thus it is assumed that the initial barrier of cost has initially been addressed once the system has been accessed. However, the aforementioned emphasis on what and not how to provide services helps to reduce costs, by allowing the administrator(s) to determine cost-effective models of specialized service. Further, because this process is one that emphasizes the protection of human it is designed to reduce unnecessary involuntary hospitalizations. The principle of communication along with processes that mobilize social supports help to reduce the stigma associated with mental health treatment, and again provides an opportunity to generate culturally appropriate interventions. Again, the actual implementation, of those culturally appropriate interventions would occur after the warm handoff, but serves primarily to reduce stigma as well as assuage concerns about hospitalization. (PsycINFO Database Record (c) 2017 APA, all rights reserved)