Access to Mental Health Treatment by English Language Proficiency and Race/Ethnicity

University of California, Berkeley, Berkeley, California, United States
Journal of General Internal Medicine (Impact Factor: 3.42). 12/2007; 22 Suppl 2(S2):289-93. DOI: 10.1007/s11606-007-0345-7
Source: PubMed


Limited English proficiency (LEP) may contribute to mental health care disparities, yet empirical data are limited.
To quantify the language barriers to mental health care by race/ethnicity using a direct measure of LEP is the objective of the study.
Cross-sectional analysis of the 2001 California Health Interview Survey is the study's design.
Adults aged 18 to 64 who provided language data (n = 41,984) were the participants of the study.
Participants were categorized into three groups by self-reported English proficiency and language spoken at home: (1) English-speaking only, (2) Bilingual, and (3) Non-English speaking. Mental health treatment was measured by self-reported use of mental health services by those reporting a mental health need.
Non-English speaking individuals had lower odds of receiving needed services (OR: 0.28; 95% CI: 0.17-0.48) than those who only spoke English, when other factors were controlled. The relationship was even more dramatic within racial/ethnic groups: non-English speaking Asian/PIs (OR = 0.15; 95% CI: 0.30-0.81) and non-English speaking Latinos (OR: 0.19; 95% CI: 0.09-0.39) had significantly lower odds of receiving services compared to Asian/PIs and Latinos who spoke only English.
LEP is associated with lower use of mental health care. Since LEP is concentrated among Asian/PIs and Latinos, it appears to contribute to racial/ethnic disparities in mental health care. Heightened attention to LEP is warranted in both mental health practice and policy.

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    • "Previous studies with Latinos have documented a positive association between level of acculturation, or the degree of assimilation to the US mainstream culture and self-reported health status and use of some preventive services (Lara et al., 2005). Similarly, the level of English proficiency and primary language spoken at home, both commonly used proxy measures of acculturation, have also been found to be positively related to healthcare utilisation among immigrant populations in the USA (Sentell et al., 2007; Cheng et al., 2007). For Mexican migrants engaging in circular migration, regular exposure to both the USA and Mexico, length of time in the USA and language barriers are likely to result in lower rates of assimilation into the US mainstream culture compared to more established immigrant populations. "
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    11/2014; 1(1):57-108. DOI:10.1504/IJMBS.2014.065069
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    • "Barrier theory suggests that institutional barriers relating to characteristics of the mental health system (Kouyoumdjian, Zamboanga, & Hansen, 2003; Woodward, Dwinell, & Arons, 1992) and cultural barriers concerning cultural values and norms deter Latinos from using formal mental health services (Cabassa, Lester, & Zayas, 2007; Ramos-Sánchez & Atkinson, 2009). For example, insufficiencies in language of services within mental health facilities (e.g., lack of interpreters or lack of available information in the language of preference) are of concern for Latinos with limited English language proficiency trying to access mental health services (Alegría, Mulvaney-Day, Woo et al., 2007; Barrio et al., 2008; Sentell et al., 2007). Other barriers to mental health care include lack of insurance coverage, immigrant status, and poor economic resources (Alegría, Mulvaney-Day, Woo et al., 2007; Vega, Kolody, Aguilar-Gaxiola, & Catalano, 1999). "
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    • "Communication challenges lead to limited access to appropriate treatment, and lower retention once engaged in treatment [6]. These structural barriers to care may be particularly salient in mental health settings, where there are fewer non-verbal tests to assess for illness and good diagnosis often depends on clear, accurate descriptions of the symptoms [7]. Given the rising LEP population and these significant treatment challenges, it is imperative that we develop ways to reduce health care disparities among LEP individuals. "
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    ABSTRACT: To meet federal requirements under Title VI of the Civil Rights Act, the state of California instituted policies requiring that comprehensive mental health services in native languages be made available to limited English proficiency (LEP) populations when concentrations exceed "threshold" levels. This paper builds on promising results from quantitative evaluations by reporting on qualitative interviews with Latino and Vietnamese LEP clients in mental health services (N = 20) to examine the awareness, impact, and implications of these threshold language policies. Results suggest that, while individuals are often not aware of the policies themselves, the language-related services they receive that are prompted by the policies are critical to treatment initiation and retention. Results also convey the complexities of using interpreters for sensitive psychological topics, and suggest that, for LEP individuals seeking mental health treatment, providers who speak their native languages are generally preferred. Access to language-appropriate services seems to be an important part of why LEP populations seek out mental health treatment. However, there are multiple variables that factor into the usage and usefulness of such services.
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