Introduction

Data, Research and Limitations
Underlying many mental health disparities is a lack of consistent, comprehensive data to describe both the problem of mental health disparities and the success of different systemic solutions. Some data exist related to the similar prevalence rates of people of color and the general population, and the differences in utilization of culturally-traditional versus mainstream mental health services by communities of color.59,60 However, for many years research failed to explore how users experience the mental health system, eliminating any opportunity to understand utilization barriers.61 Though the quality and extent of studies on specific behavioral issues in communities of color has increased in the past decade, historically, the level of scientific knowledge focusing on mental health and specific differences by culture, race or ethnicity is “minimal.”62

Early research was restricted to a narrow range of ethnic groups and mental disorders, ignored differences within ethnic groups, did not examine the experiences of service users and “did not address culture in a broader sense beyond considering culture as a synonym for race.”63 Research in general, however, tended to reinforce the notion of universal European standards as norms or benchmarks for health.64,65,66,67,68,69,70 Some researchers suggest the core issue of cultural competency is impossible to successfully research, while others are concerned that the number of racial and ethnic minorities in clinical trials is too small for significant findings, requiring more theory driven research to understand needs and solutions.71 Successful first steps in research include studies that examine the effectiveness of culturally-traditional services. For example, the Historical Trauma and Unresolved Grief Intervention was initially developed for the Lakota tribe and is now being adapted for other tribes. It uses traditional healing techniques combined with information and awareness of historical issues to reduce mental health risk.72

Information on the differences in access rates is often lacking or of low quality. Although researchers may have documented details such as African American and American Indian’s overrepresentation in state mental health hospitals, Latino children’s under-representation in the children’s mental health system and African American children’s over-representation in the same system, researchers do not understand the reasons for the differing levels of service utilization.73

“Our attempts to simplify thinking by grouping people of color into larger racial and ethnic categories,” is a significant limitation of the data and research, which masks significant variations within these groups.74 In Colorado, the same limitations with data exist. While some data on mental health status by racial and ethnic groups exist, the information is limited. Although there may be statistically significant samples, this is accomplished by categorizing notably different cultural groups together and by capturing only data limited to persons accessing mainstream services.75
  • For example, Asian American and Pacific Islanders (AAPI) are one of the most diverse Census categories including people from over 30 Asian and 25 Pacific Island nations; however, in Colorado they make up only 2.5% of the state’s population. This makes it difficult to capture valuable information to distinguish the cultural nuances between and within this diverse population group, especially as they relate to accessing mental health services.76
  • The limitations of data collection and research for other communities of color parallel those with the Asian American and Pacific Islander community. Latinos, or Hispanics, include persons of Mexican, Puerto Rican, Cuban, Central and South American, and Spanish origins – all of very different cultural backgrounds. The diversity across Black and African American populations and immigrants from African and Caribbean nations as well as American Indians, Native Alaskans and Native Hawaiian populations is equally as diverse. All of these different groups have distinct languages, cultures, traditions, values and acculturation levels that makes categorization into single racial or ethnic categories for data purposes problematic.77

Despite these limitations in the research, a recent report, Racial and Ethnic Health Disparities in Colorado 2005, provided an initial understanding of mental health status and racial and ethnic disparities in Colorado.78 Additional Colorado data demonstrate that:
  • Mental health clinics specializing in serving the needs of specific ethnic populations (e.g. Asian Pacific Development Center) provide higher quality and more appropriate care for people of color and lead to an overall greater level of general satisfaction.79
  • Mainstream mental health centers are more accessible and result in increased participation with treatment planning.80
  • When surveyed across racial and ethnic groups, American Indians/Alaskans and respondents who specified their ethnicity as “other” had lower satisfaction than other ethnic groups with measures of access to, appropriateness and quality of mental health care provided in the mental health system and mental health outcomes.81
Finally, across all racial and ethnic groups, from 2002 to 2006, treatment durations have consistently increased, suggesting that budget cuts have resulted in increased denial of services for individuals with mild mental health needs and provision of services to individuals with severe mental health disorders who require lengthier treatment.82

Colorado can help to address the data gap by:
  • Making a concerted effort to collect better information on communities of color served by the mental health and other public systems, including their experience of the formal mental health system, culturally-traditional services and utilization of the two systems concurrently.83
  • Utilizing available data to enhance culturally-appropriate practice and services, and to inform public policy and funding decisions related to enhancing mental health services for communities of color.