Eliminating Disparities through the Integration of Behavioral Health and Primary Care Services for Racial and Ethnic Minority Populations, Including Individuals with Limited English Proficiency

Since the U.S. Surgeon General’s report on mental health (1999) declared mind and body to be inseparable, integrated health care has been gaining significant momentum across the nation as a preferred approach to care for people with comorbid physical health and mental health conditions. Primary care settings often are the gateway to health care for racial and ethnic minority populations and individuals with limited English proficiency (LEP) and, as such, it has become the portal for identifying undiagnosed or untreated behavioral health disorders. Many reasons have been cited for this trend, including lack of access to mental health specialists, income and insurance issues, stigma surrounding mental illness, and the trust of the relationship with the family physician (President’s New Freedom Commission on Mental Health, 2003; Unutzer, Schoenbaum, Druss, & Katon, 2006).

Various elements of integrated health care appear to have particular appeal for achieving greater outcomes with different minority groups (DwightJohnson et al., 2010; Ell et al., 2010; Jackson-Triche et al., 2000), with the most successful elements of this approach addressing the socio-cultural needs of the target population, such as family involvement in treatment (Bao et al., 2011). Empirical evidence of the overall effectiveness of integrated health care in reducing disparities among racial and ethnic minority populations and improving outcomes is limited due to a lack of available data collection and analyses using racial and ethnic population demographics as criteria (Bao et al., 2011; Butler et al., 2008).

Nonetheless, promising practices using key strategies exist and are being successfully implemented by integrated health care programs (Sanchez, Chapa, Ybarra, & Martinez, 2012; Sanchez & Watt, In press). The Institute of Medicine (2003) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, concluded that a variety of health care system issues appear to contribute to the persistence of health disparities for ethnic minority populations. Minority populations are underrepresented in health care professions and among those that are providing care, they are less likely to be board certified than are physicians who treat non-Hispanic white patients. In addition, access to high-quality subspecialists, diagnostic imaging and emergency hospital admissions is difficult to secure for ethnic minority populations. Finally, minority communities often have fewer sources of health care than non-Hispanic white communities or none at all (Institute of Medicine, 2003). Racial and ethnic disparities in health care do not occur in isolation (Alliance for Health Reform, 2006). They are part of the larger framework of discrimination and racism that exists in everyday American life.