Studies have shown that cultural factors may be protective of mental health status. When comparing Mexican immigrants with U.S. born Mexican Americans, researchers found that Mexican Americans and non-Hispanic whites born in the United States have a higher risk (a ratio of 2–3 to 1) for developing psychiatric disorders including major depressive episode than their foreign-born counterparts who have emigrated to the United States (Grant et al., 2004; Vega et al., 1998).

ENGAGING VULNERABLE POPULATIONS

The relationship between mental health disparities, access to care, and quality of care is complex. Behavioral health care in the United States is fragmented and fraught with barriers, regardless of the point of entry. For racial and ethnic minority populations it includes poor quality, limited access to care, and a lack of utilization and little care coordination—often leading to more chronic and disabling mental health conditions (Chapa, 2009; U.S. Department of Health and Human Services, 2003). Furthermore, the existing knowledge on the interrelationship of these three areas has not been translated into specific programs (Aguilar-Gaxiola et al., 2002).

When seeking to eliminate mental health disparities, treatment interventions and single-component interventions, such as physician education, depression screening (Gilbody et al., 2003), and facilitated access to care (Brown et al., 1999), alone are not effective at reducing disparity gaps. Poor treatment rates and outcomes may be due to a lack of minority representation in the mental health provider workforce. Research suggests that enhancing quality in mental health care could potentially lead to the elimination of mental health disparities (Miranda et al., 2008). A culturally respectful environment coupled with culturally and linguistically competent providers may be a key to disparities elimination, along with numerous, systemic, multicomponent, chronic disease management interventions.

Targeting the health care system was found to be effective at reducing disparities. One highly effective approach is clinical case management. This patient-focused strategy may be particularly beneficial for ethnic minorities because it assists patients unfamiliar with and at the margins of the traditional mental health care system to navigate the already fragmented health care system. Moreover, case managers contribute to mental health literacy, helping to assuage adverse attitudes toward depression treatment protocols and stigma, alternative explanatory models, and variations in symptom descriptions. Case managers assists marginalized groups, such as racial and ethnic minorities, throughout their involvement in depression treatment, maintenance, and completion.

The case managers’ specialized work involves serial conversations to address incremental barriers and provide ongoing guidance that is outside



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