The Colorado Trust

Many of the barriers that lead to mental health disparities can be addressed through mainstream, as well as culturally-traditional and -specific services with policy changes in financing and systems integration, education and direct service delivery, and data and research.

FINANCING AND SYSTEMS INTEGRATION RECOMMENDATIONS
The policy issue most frequently identified by participants at the 2006 Colorado Mental Health Disparities Summit was the issue of financing and integration, including reimbursement practices of culturally-traditional, indigenous, faith-based or alternative services within the mainstream mental health system. Participants felt this could be accomplished in a variety of ways, including the development of:

• Legislation to support payment for culturally-traditional and alternative services
• Methods for integrating culturally-traditional services within mainstream service delivery
• An expanded definition of health care that includes holistic health care services integrating mind, body and spirit in the reimbursement practices of public and private insurance
• Pilots to demonstrate success of culturally-traditional or alternative services.

Reimbursement and integration of culturally-traditional and other alternative services has been demonstrated in other states and is supported by the literature, including:

• In 1998, the Navajo Nation and Carl T. Hayden Medical Center agreed to reimburse traditional ceremonies through the VA.¹³⁹
• The Yup’ik and Cup’ik Eskimo of Southwest Alaska fund tundra walks and time with elders, culturally-traditional treatments of mental health and substance abuse, through Medicaid.¹⁴⁰
• Many examples exist of faith-based health and mental health interventions that serve as alternatives to the mainstream system.¹⁴¹ Aside from scheduled services, churches provide counseling services, groups and other programs that can address more than spiritual needs. Therefore, increased support, reliance and reimbursement for culturally-traditional providers and settings, such as the church and faith-based community resources, is needed.
• Some social work and divinity schools provide cross-training to increase the capacity of clergy and social workers to identify and provide mental health services within churches.¹⁴²
• Cultural brokers serve as a bridge between mainstream services and communities of color to design and negotiate treatment plans that are acceptable for communities of color, which establishes trust and a relationship between the individual and provider, and can result in improved health outcomes.^143,144
• Inclusion of community leaders may also serve as a critical link to communities and provide guidance to the mainstream mental health system in efforts to provide more culturally-appropriate services.¹⁴⁵

Another policy issue is the integration of financing and services across systems. Summit participants recommended improving integration by removing financial and regulatory barriers, providing incentives, encouraging collaboration and rewarding communities that integrate and utilize culturally-traditional services and best practices. Research supports integration of services across primary health care, mental health care, substance abuse treatment, education and other social services and systems of care to meet the individualized needs of communities of color, as follows:

• Recent research strongly supports integrated treatment, with services provided through one centralized provider or a team of providers to ensure consistency in treatment planning and coordination as the best treatment response.¹⁴⁶
• Specific to diagnostic issues, mental and primary health care providers need to be trained to recognize physical symptoms of mental illnesses. Primary care physicians should be trained in early detection and treatment and be ready to help patients access services.¹⁴⁷
• In areas with sufficient capacity, school-based health and mental health centers can help to integrate the different service systems. These centers might include psychologists, psychiatrists, medical doctors and other staff prepared to assess, diagnose, treat and refer children with mental health needs.¹⁴⁸ In Colorado, schools partner with community mental health centers and private therapists to provide onsite services.¹⁴⁹ A Wisconsin model ensures that therapists co-located in schools have training in education-based mental health interventions.¹⁵⁰
• Policies that address mental health disparities by supporting social factors, such as Section 8 housing assistance programs and the Earned Income Tax Credit, have been shown to help in the recovery of people with mental health needs.¹⁵¹
• Systems of care create an integrated, holistic, family-centered, individualized and culturally-responsive approach that build bridges between different systems and natural supports, providing services in a cultural, family and community context for individuals. The system of care approach to mental health services has been used throughout the country with children and youth of all cultures. System of care emphasizes involvement of children and families in identifying their needs and the services that will meet them. It includes services delivery approaches such as wraparound, where families and youth work with an interdisciplinary team including extended family or other culturally-traditional services to identify and engage a variety of formal services and informal supports.¹⁵²

Additional financing and integration areas identified by Summit participants included:

• Completing a cost-analysis study to look at the implications of health care parity (equal coverage for mental health and behavioral services with physical health services) through public and private financing streams. The study could help demonstrate the need for an expansion of Colorado parity laws. The follow-up study to Vermont’s parity law – the nation’s most comprehensive – found improvements in access to outpatient mental health services, reduction of spending on mental health and substance abuse services and no consequent increase in employers dropping coverage.¹⁵³
• Addressing financing issues for mental and physical health care services for offenders (individuals convicted of a state felony) transitioning out of corrections who currently are ineligible to apply for and receive Medicaid, Medicare and the Colorado Indigent Care Program health insurance. Without such health coverage, offenders who have routine, urgent and emergent physical and mental health needs will not be able to receive health care services and may return to correctional facilities where health care is covered by the state. The research demonstrates that in other states, including New York, Massachusetts and Texas, re-entry programs that provide continuity of medication and access to health care after release result in decreased recidivism and improved individual outcomes.¹⁵⁴