Behavioral Health Disparities in Texas and the Lack of Workforce Racial/Ethnic DiversityShannon Moreno, MSWLauren Lluveras, JDCenter for the Elimination of Disproportionality and DisparitiesTexas Health and Human Services Commission

Image Source: https://techcrunch.com/2015/06/26/with-3-million-from-castlight-lyra-health-is-bringing-big-data-to-mental-health-care/

Challenges with Mental Health Data

▪ Under-reporting of persons living with mental health▪ Some cases of mental illness are

undiagnosed and/or not reported

▪ Data aggregated into “all persons” living with mental illness▪ Rarely broken down by race and

ethnicity▪ Rarely available at the county level

▪ Timeframe between available data▪ Most recent data is 2-3 years

behind the current calendar yearImage Source: http://www.cio.com/article/3012097/data-warehousing/take-testing-seriously.html

Mental Health Data in Texas

“Rich data sets exist throughout the Texas

behavioral health and other systems, but much is yet to be done toward developing

efficient technical and administrative processes to

link this information and make it available in useful

formats for timely decision making.”

Texas HHSC Statewide Behavioral Health Coordinating Council, 2016

Image Source: https://www.broadinstitute.org/news/3784

Mental Health Status in TexasAge-Adjusted Prevalence of "Mental Health Not

Good 5+ Days” in US & Texas, 2003-2012

Poor mental health dayswere reported by a smaller percentage of Texanswhen compared to the US except in years 2009-2010

Mental Health Status in Texas: Race/Ethnicity

Age-Adjusted Prevalence of "Mental Health Not Good 5+ Days“ By Race/Ethnicity in Texas, 2003-2012

Black individuals in Texas were more likely to report poor mental health days than other racial groups except in 2008

Workforce Data

“There are no systematically collected and uniform data on

the US mental health and addiction workforce. Information

on its size, demographic characteristics, geographic

distribution, and specialties can best be understood by piecing

together disparate information from professional associations,

licensing and certification boards, and scattered state and federal

sources.” Hoge et al., 2013

https://www.hc1.com/laboratory-informatics-and-data-silos/

National Demographics

▪ As indicated in Mental Health, United States, 2010 (SAMHSA, 2012a) report, racial minorities account for only:

▪ • 19.2 percent of all psychiatrists;

▪ • 5.1 percent of psychologists;

▪ • 17.5 percent of social workers;

▪ • 10.3 percent of counselors; and

▪ • 7.8 percent of marriage and family therapists.

https://www.yahoo.com/movies/talent-agencies-blamed-lawsuit-lack-diversity-television-192516304.html

Psychiatrist ShortageRatio of Texas population to psychiatrist, by county (2014)

The Health Status of Texas, 2014

Texas Demographics

SAMHSA, 2016

Ethnicity of the Texas population and psychiatrists (2014)

Gaps in Mental Health Service Delivery

▪ Transportation and access to treatment

▪ Shared and usable data

▪ Services for special populations

▪ Behavioral health workforce shortage

The Health Status of Texas, 2014

Mental Health Professional Shortage Areas (HPSAs) in Texas, as of June 2013

Gaps in Mental Health Service Delivery

Trying to Force “Compliance”

Image Source: https://www.yesleasing.com/news/tired-fit-square-pegs-holes/

Viewing People as “Hard to Reach”

Image Source: http://bradfordchristianacademy.org/spring-community-service-opportunities

Workforce and General Population Demographics

“The composition of our psychiatric workforce does not

mirror the Texas population. It is important that the state builds a

diverse workforce to meet the needs of Texas by promoting more of a shared experiential base…. There is evidence that

health care consumers who share a culture and race with a provider

develop a stronger therapeutic alliance and have higher

treatment retention rates.”

Hogg Foundation for Mental Health, 2016

https://www.timeshighereducation.com/blog/sorry-state-equality-uk-universities

Provider-Client Race/Ethnicity Matching

▪ Many studies have been conducted with mixed results of effects of matching

▪ Some studies show that a similar background and value set is a stronger predictor of positive outcomes than race/ethnicity alone

▪ Most studies make mention of the need for cultural humility the of provider regardless of a racial/ethnic match

Race Matching Studies Limitations

▪ Sample not representative of AA community as a whole

▪ Studies only involving members of AA community who are already engaged in treatment does not shed light on attitudes of those in need of treatment but not receiving it

▪ Variables that affect results: only race matched, type of treatment, mis-matches in other areas such as gender, samples are of clients already receiving treatment, etc.Source: http://blavity.com/therapy-is-not-just-a-white-persons-occupation-why-we-need-more-black-psychologists/

Lack of Diversity and Perceptions

“Apprehension about clashing with the values of worldview of

the clinician can cause ambivalence about seeking help,

and this may be especially true for the many who believe that mental health treatment was designed by White people for

White people. African Americans view the typical psychologist as

an older, White male, who would be insensitive to the social and

economic realities of their lives.” Williams, M.T., 2011

https://www.psychologistworld.com/freud/dora-case-study.php

Gaps in Mental Health Service Delivery

▪ Transportation and access to treatment

▪ Shared and usable data

▪ Services for special populations

▪ Behavioral health workforce shortage

Source: Texas HHSC Statewide Behavioral Health Coordinating Council, 2016

What would a mental health system created by

and for the African American community

look like?

Enhanced CLAS Standards

CLAS Resources and Recommendations

References

▪ Cabral, R. R., & Smith, T. B. (2011). Racial/Ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58(4), 537-554.

▪ Chao, R. C., Good, G. E., Flores, L. Y., & Wei, M. (2011). Race/ethnicity, color-blind attitudes, and multicultural counseling competence: The moderating effects of multicultural counseling training. Journal of Counseling Psychology, 58(1), 77-82.

▪ Chen, F. M., Fryer, G. E., Phillips, R. L., Wilson, E., & Pathman, D. E. (2005). Patients’ Beliefs About Racism, Preferences for Physician Race, and Satisfaction With Care. Annals of Family Medicine, 3(2), 138–143. http://doi.org/10.1370/afm.282

▪ Corrigan, P. W., Mueser, K. T., Bond, G. R., Drake, R. E., & Solomon, P. (2009). Principles and Practice of Psychiatric Rehabilitation: An Empirical Approach (p. 435). N.p.: Paperback.

▪ Field, C., & Caetano, R. (2010, February). The role of ethnic matching between patient and provider on the effectiveness of brief alcohol interventions with Hispanics. Alcoholism: Clinical and Experimental Research, 34(2), 262-271.

▪ Hoge, M. A., Stuart, G. W., Morris, J., Flaherty, M. T., Paris, M., & Goplerud, E. (2013, November). Mental Health and Addiction Workforce Development: Federal Leadership is Needed to Address the Growing Crisis. Health Affairs, 32(11), 2005-2012.

▪ Hogg Foundation for Mental Health. (2016). A Guide to Understanding Mental Health Systems and Services in Texas (3rd ed.).▪ Hook, J. N., Farrell, J. E., Davis, D. E., DeBlaere, C., Van Tongeren, D. R., & Utsey, S. O. (2016). Cultural humility and racial microaggressions in

counseling. Journal of Counseling Psychology, 63(3), 269-277.▪ Meyer, O., Zane, N., & Cho, Y. I. (2011). Understanding the Psychological Processes of the Racial Match Effect in Asian Americans. Journal of Counseling

Psychology, 58(3), 335–345. ▪ Office of Minority Health U.S. Department of Health and Human Services. (2013). National Standards for Culturally and Linguistically Appropriate Services in

Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice.▪ Swift, J. K., Callahan, J. L., Tompkins, K. A., Connor, D. R., & Dunn, R. (2015). A delay-discounting measure of preference for racial/ethnic matching in

psychotherapy. Psychotherapy, 52(3), 315-320▪ Texas Department of State Health Services. (n.d.). Texas Behavioral Risk Factor Surveillance System.▪ Texas Health and Human Services Commission . (2016). Texas Statewide Behavioral Health Strategic Plan: Fiscal Years 2017-2021. N.p.: Statewide

Behavioral Health Coordinating Council.▪ U.S. Department of Health and Human Services. (2013). Report to Congress on the Nation's Substance Abuse and Mental Health Workforce Issues.▪ Williams, M. T. (2011, November 2). Why African Americans Avoid Psychotherapy. In Psychology Today.

Contact Information

Telephone: 512-380-4340Fax: 512-380-4350Email: CEDD@hhsc.state.tx.us

Webpage: http://www.hhsc.state.tx.us/hhsc_projects/cedd/

Requesting Technical Assistance:http://www.hhsc.state.tx.us/hhsc_projects/cedd/training.shtml

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