SAMHSA helps address disparities and the unique needs of diverse population groups across the nation.
Behavioral Health Disparities and Cultural Awareness
Being culturally competent and aware is to be respectful and inclusive of the health beliefs and attitudes, healing practices, and cultural and linguistic needs of different population groups. Behavioral health practitioners can bring about positive change by better understanding the differing cultural context among various communities, and being willing and able to work within that context. For more information on this important issue, refer to the SAMHSA’s Behavioral Health Equity page. In addition, SAMHSA’s Strategic Prevention Framework offers guidance on culturally appropriate practices.
SAMHSA-affiliated organizations focusing on cultural awareness and competency include:
- The National Network to Eliminate Disparities in Behavioral Health (NNED) is dedicated to promoting equality in behavioral health services for individuals, families, and communities. NNED, with help from SAMHSA and the National Alliance for Multi-Ethnic Behavioral Health Associations, builds coalitions of racial, ethnic, cultural, and sexual minority communities and groups dedicated to removing disparities in behavioral health care. Learn more about what NNED offers to support culturally competent practices.
- National Standards for Cultural and Linguistic Appropriate Services (CLAS) in Health and Healthcare is a strategy that aims to help reduce health disparities and achieve health equity by molding services to an individual’s cultural beliefs and language.
- Funded by the SAMHSA Center for Substance Abuse Treatment, the Addiction Technology Transfer Center (ATTC) Network’s website provides many resources, guides, and publications about cultural awareness.
- The SAMHSA-Health Resources and Services Administration (HRSA) Center for Integrated Health Solutions (CIHS) provides guidelines on how to provide culturally relevant services.
- The National Technical Assistance Center for Children’s Mental Health (TA Center) in the Georgetown University Center for Child and Human Development focuses on children and youth at risk for mental health challenges. Read about the TA Center’s resources, trainings, webinars, and initiatives and about its cultural and linguistic competency component.
For additional guidance on advancing and sustaining culturally and linguistically appropriate services for the workforce, SAMHSA’s Center for the Application of Prevention Technologies (CAPT) lists the elements of a culturally competent prevention system.
A number of efforts to address behavioral health disparities in the United States, including the Mental Health Parity and Addiction Equity Act, the Affordable Care Act, and other mechanisms, are described in SAMHSA’s report, Behavioral Health, United States, 2012, which analyzes the changing landscape of mental health and substance use care for Americans of all ages.
SAMHSA Administrator’s Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues – 2013, Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015-2018, and Action Plan for Behavioral Health Workforce Development – 2007 (PDF | 1.9 MB) all provide compelling data on the populations that SAMHSA’s various programs, initiatives, and technical assistance centers serve.
SAMHSA has a number of programs and initiatives in place to increase the number of minority group members in the behavioral health workforce:
- SAMHSA’s Minority Fellowship Program (MFP) seeks to reduce disparities in health care. About 260 MFP Fellows are trained in an average year under the program.
- In response to the request in the President’s Budget, Congress appropriated expansion of the MFP to support master’s level trained behavioral health providers in the fields of psychology, social work, professional counseling, marriage and family therapy, addiction counseling, and nursing. This expansion will allow for an increase of 240 trained professionals with a focus on youth and an increase of 60 trained professionals focusing on addiction counseling.
- SAMHSA’s grant program for Historically Black Colleges and Universities (HBCU)-Center for Excellence is dedicated to continuing the effort to network the 105 HBCUs throughout the United States. The HBCU-Center for Excellence promotes workforce development by expanding knowledge of best practices and leadership development to enhance the participation of African Americans in the substance abuse and mental health professions.
- The National Hispanic and Latino Addiction Technology Transfer Center Network provides workforce development resources, manuals, webinars, and curricula in an effort to increase the substance use disorder workforce’s skills in providing culturally and linguistically sensitive services and increase the number of Hispanic and Latino individuals in the substance use disorders workforce.
- Three Addiction Technology Transfer Centers, focused on workforce development and the use of evidence-based practices, are located at Minority Serving Institutions (Morehouse University School of Medicine, Universidad Central de Caribe, and University of Illinois Chicago).
However, as outlined in the 2013 SAMHSA report to Congress, more needs to be done to develop this sector of the behavioral health workforce. For instance:
- The substance use disorders treatment workforce is primarily female, older, and Caucasian, differing from their predominantly young, male, and minority clientele.
- There is a scarcity of providers who can render culturally competent services for minority populations. This behavioral health workforce issue contributes to the current disparities in mental health and substance use treatment and services.
- According to a 2010 report (PDF | 757 KB) on the strategic development of a mental health workforce for Latinos published by the Department of Health and Human Services’ Office of Minority Health, there is a severe shortage of Latino professionals working in behavioral health. For instance, Latino clinical psychologists only comprise about 1% of that sector of the U.S. health care workforce.
American Indians and Alaska Natives
To better coordinate SAMHSA’s internal resources in support of American Indians and Alaska Natives (AI/AN), SAMHSA has established the SAMHSA American Indian and Alaska Native Team (SAI/ANT). The SAI/ANT ensures positive behavioral health outcomes of AI/AN people are addressed through the agency-wide coordination of resources and services. SAI/ANT membership includes leaders; managers; and project, grant, and policy staff who strive to ensure SAMHSA’s resources are culturally appropriate and accessible to tribes/tribal organizations and the AI/AN population at large.
The SAMHSA Center for Mental Health Services and Center for Substance Abuse Prevention collaborate on suicide prevention and mental health promotion programs for American Indians and Alaska Natives. For tips on how to enhance cultural awareness while providing services to American Indians and Alaska Natives, visit CultureCard: A Guide to Build Cultural Awareness – 2009.
The National American Indian and Alaskan Native Addiction Technology Transfer Center provides workforce development resources, manuals, webinars, and curricula in an effort to increase the substance use disorder workforce’s skills in providing culturally and linguistically sensitive services and increase the number of American Indians and Alaskan Natives in the substance use disorders workforce.
However, more needs to be done to develop this sector of the behavioral health workforce. According to the American Indian/Alaska Native Behavioral Health Briefing Book – 2011 (PDF | 2.7 MB):
- Reservation hospitals often lack the mental health resources needed to serve them.
- There are about 101 Native American mental health care professionals for every 100,000 Native Americans, in contrast to the 173 available for 100,000 non-Natives. This may contribute to the low rates of American Indians and Alaska Natives seeking services.
Financing the Workforce
Working closely with a variety of federal and other partners, SAMHSA is exploring the use of coverage and payment levers to incentivize cost-effective use of the health care workforce. Some of the issues to be addressed include:
- Within behavioral health, reimbursement levels are often determined by practitioner rather than service type. In an effort to increase the efficiency of behavioral health workforce financing, barriers and opportunities for ensuring that payment better aligns with services delivered and expected outcomes could be explored. For example, in a fee-for-service environment, Medicaid, Medicare, or commercial insurance may pay rates based on the license of the delivering practitioner rather than on the quality of the service or outcome for the client.
- Within substance abuse treatment, many direct care workers started as people in recovery. In many states, credentialing bodies do not credential peer workers, and services delivered by peers are not billable to Medicaid, Medicare, or private insurance. As an approach for expanding the behavioral health workforce, there is a need to explore strategies for developing payment mechanisms that incentivize hiring and credentialing peer workers, and credentialing or allowing billing by mid-level workers who have a lot of experience but perhaps not the usual academic credentials, especially for substance abuse services.
Mental and Substance Use Disorder services are not always covered by state Medicaid, Medicare, or private insurance, and even when covered they are often funded at inadequate levels that do not meet the costs. SAMHSA has successfully engaged with Medicare to address same day billing issues and is now working to address those issues with Medicaid as well.
Data on the Workforce
Through a number of activities and initiatives with HRSA, SAMHSA will utilize available data to determine how many of what kinds of behavioral health practitioners for what kinds of populations need to be developed and variances from availability of actual practitioners need to be tracked and reported
- When tracking workforce related data, service location information is not routinely collected making it difficult to identify the range of settings in which providers are practicing. To address these and other data issues, SAMHSA and HRSA are collaborating to implement a Minimum Data Set (MDS) that will allow for more specific tracking of behavioral health workforce patterns and outcomes. This effort needs resources to continue and expand to understand the behavioral health workforce needs for today and the future.
- In order to track the complexities of the issues in the behavioral health workforce, efforts need to be made to track and identify when and where general practitioners, such as family physicians, internists, pediatricians, nurses, and others work, whether primarily in behavioral health settings or with persons with behavioral health needs. Similarly, behavioral health practitioners, such as social workers who are working in education or human services settings rather than in behavioral health clinical services, also need to be tracked.