Since colonial times, the United States has been a country populated by migrants. Despite the longevity of this natural phenomenon, the United States has struggled with the development of policies to allow migrants fair and equal treatment. Rather than developing policies to allow cultures from other countries to integrate into the United States, policies have been written to promote assimilation, thus leading to discrimination and isolation among these inhabitants. The article will examine how the delivery of mental health services to migrant populations is impacted as a result.
Historically, issues with mental health policies included the prevention of maintaining each cultural group’s uniqueness, acceptance of culturally differing groups, the lack of recognition of emotional problems within differing cultures, and emphasis on stigmatizing and pathologizing mental disorders. Focus remained on justifying all forms of mental disorders rather than understanding cultural characteristic differences. Another problem is conforming individuals are permanently categorized in a lower social class and hence depicted as inferior. Thus services are distributed in a fashion that reinforces inferiority with culturally differing groups. The assimilative attitude of society over an integrative stance is clearly depicted with institutionalized care. Psychological aspects were progressively ignored as factors in the development of serious disorders, such as schizophrenia.
The current concerns associated with the delivery of mental health care is cost. Mental health care is a constant target for decreased disbursements of health care dollars. Despite increased cultural diversity, delivery systems are regrettably moving away from proposals that recognize the intricacy of consumer problems. Delivery systems continue to be simplistic in regards to ethnic and cultural standpoints.
There appears to be a contradiction in terms to national understanding. One perspective takes the side of personal responsibility and the ability to handle conventional structures that blur or ignore distinctive needs. On the other side is a need to be concerned with the requirements of all persons and to develop polices that are in step with diversity. Deinstitutionalization is an instance of this. Institutions were regarded as costly and an inappropriate forms of effective care. Conversely, community care was recognized as an effective means to care for individuals with severe and persistent mental disorders. Institutions closed as a result of this cost saving idea, however, community based care continued to be closed or downsized instead for increased funding to support the ever growing populations requiring mental health care and its needs. As a result of this ambivalence patients are left without adequate care.
Problems associated with de-institutionalization effect the minority community because of the relationships between health, wealth and minority status. The trends between lower social economic status and minority groups are a researched fact. These populations are less likely to improve in regards to mental health because they will get inferior service relative to higher status groups.
Barriers to the development of culturally relevant services are predominantly led by funding. The ability to shift funds from hospital care to community based agencies has proved challenging. Another variable is insurance payouts favour hospitalization rather than outpatient services. Medicaid is a prime example of these disproportionate allocations of resources. Medicare allocates a much higher percentage of its budget for inpatient treatment and consistently pays low rates for outpatient reimbursement. As a result services are plagued with problems of overlapping, gaps and a lack of responsibility for services. The services are difficult for patients to access and pilot through. Therefore, mental health community agencies have problems implementing services that diverse populations warrant. In order for the shift of funding dissemination to occur there has to be an emphasis from legislation.
Regardless of funding problems and de-institutionalization the goal is to meet the needs of all culturally diverse populations in mental health. This is an easier proposition in theory rather than practice; nonetheless strides must be made toward this declaration. In order to reach this goal the implementation of the following needs to take place: equal access to services, subsidy to the poor to pay for services, an even distribution of resources throughout communities, customization of services, training to clinicians to understand culturally diverse behaviour, values, beliefs and customs. Training the clinician is not expensive. However, training is involved and requires the clinician to be culturally sensitive.
The minority population is a quarter of the total population, and is expected to increase over time. Financial considerations for the future remain on a decline for mental health services. Even though it is clear that there is a need to increase services to the financially disadvantaged minority populations, services remain limited. The change that is required of the mental health system is different from anything of the past. It is apparent that assimilation has not solved the problem of ethnic tension. In order for assimilation it must provide equal access to all cultures, regardless of socio economic status.
In conclusion, my personal experience as a former representative for the Department of Children and Families for Adult Mental Health in Miami-Dade County, I feel that community agencies are aware of the cultural diversity that influences psychological care. An example of this is a program that I did oversee for Cuban and Haitian immigrants funded on a national level. Cuban and Haitian immigrants have been identified as a population in Miami in need of mental health services. Regardless of documentation status, services are provided to this population and others during the time I was with the department. It is true that the community mental health agencies are not at a point where they are culturally sensitive to all diverse populations, but I believe that at least in South Florida there is a movement in that direction. Funding is a major issue in mental health today. As clinicians I believe that we have to be the ones to educate legislators and policies so the arena of mental health is taken seriously and funding is given to this very important area of health care and all races, religions, creeds and identities are represented in dissemination of services.