Furthering the Wellbeing of Black, Indigenous and People of Color through Integrated Care

July is Bebe Moore Campbell National Minority Mental Health Awareness Month – a month dedicated to growing public awareness of mental health, including mental illness among communities of Black, Indigenous and people of color (BIPOC), and the life of Bebe Moore Campbell, an author and advocate who worked to end stigma and promote education of mental health among diverse communities.

We have experienced tumultuous times in the past year – historic and ongoing environmental stressors, including the extrajudicial killings of George Floyd, Breonna Taylor and many others, as well as racial violence directed at Asian American Pacific Islander (AAPI) communities across the country. But the resistance and resilience of organizers and advocates from communities of color, such as Bebe Moore Campbell, have reminded us to continue to pursue racial justice and equity, especially in health care.

Due to the far-reaching effects of structural racism, as well as historic, intergenerational and ongoing environmental inequities in housing, community safety, employment and educational opportunities, access to health care and other factors within our social context affect the overall health and wellbeing of communities of color.

Many barriers to accessing quality health care still exist – especially mental health care – such as cost of care, lack of insurance or being underinsured, discrimination, stigma toward mental health challenges, lack of culturally and linguistically competent organizations, fragmented provision of services and mistrust of organizations. It’s no wonder various health disparities abound.

• African Americans face higher rates of severe depression and lower rates of treatment compared to white populations, though this gap is narrowing. For more reflection on mental health among communities of color, view our recent poll that gauged the COVID-19 impact among Black, Hispanic, Asian, Native American and LGBTQ+ persons, and read our Mental Health First Aid blog post.
• Native and Indigenous communities face physical and mental health challenges at higher rates than non-Indigenous people. Racial and ethnic communities of color face higher rates of chronic disease and premature death compared to their white counterparts, though this is not found among all communities of color and even subsets within communities of color.
• Black, Indigenous and people of color are less likely to have access to mental health services and seek out services, and more likely to receive poor quality of care and end services prematurely.

Despite these health disparities, we must acknowledge and celebrate the generational resilience and protective factors among communities of color, which undoubtedly promote healing, resistance and overall health among our communities. It is also important to note how many communities of color have organized around improving health care.

Integrating primary health, mental health and substance use services is one strategy to further health care equity among communities of color and others at the margins. Throughout recent decades, many health care organizations and payers have recognized the benefits of integrated health care to improve overall wellbeing of people of color, using cost-effective, systematically coordinated strategies and patient-centered methods, though related research is limited among specific communities of color.

Integrated care models and approaches must also consider social, cultural and linguistic nuances, as well as strengths and health care needs of communities of color. Two current national models of health care – Federally Qualified Health Centers (FQHCs) and Certified Community Behavioral Health Clinics (CCBHCs) – promote health equity among underserved communities by addressing these nuances.

Both models are required to provide care regardless of any inability to pay for services, and to provide culturally and linguistically relevant services through Cultural and Linguistically Appropriate Services (CLAS) standards that “respect the whole individual and respond to the individual’s health needs and preferences,” according to the U.S. Department of Health and Human Services, Office of Minority Health, especially when serving individuals who primarily speak languages other than English.

To further health equity, many CCBHCs have taken internal and external actions that uniquely support BIPOC staff and clients. Providing culturally relevant integrated care services is an overarching strategy to advance health equity, which many organizations, including FQHCs and CCBHCs, are taking –integrated care is a key element of the CCBHC model.

The National Council’s Center of Excellence (CoE) for Integrated Health Solutions has prioritized elevating health equity topics through several initiatives: first educate organizations on connections between inequities in physical health, mental health and substance use faced by communities of color, so participants may then work toward advancing health equity through strategies such as embracing culturally centered strategies and working in equal partnership with communities of color.

This month, our CoE team will conclude an ECHO focused on Health Equity, where sessions have provided a safe space for peer-to-peer learning and open discussions with a group of 30 regionally diverse health care organizations, using an “all teach, all learn” approach. These participating organizations have committed to creating and advancing diverse, equitable and engaging environments for all staff and clients within their organizations to reduce trauma, avoid re-traumatization, build resiliency and overall, improve the access to and quality of health services provided to historically marginalized communities. Access the curriculum on our Project ECHO website.

Additionally, our CoE team has held several recent Office Hour sessions focused on the topic of BIPOC wellbeing and related topics. Themes have included strategies to support retention of BIPOC staff, supporting leadership development of BIPOC staff and sustaining the momentum around diversity, equity, inclusion and engagement (DEIE) efforts undertaken by organizations recently.

One participant of an Office Hour session shared they “appreciated hearing various perspectives on systems change and centering efforts on providing an equitable environment for diverse staff and patients.” Another shared that they “really appreciated the thoughtful discussion and sharing by the panel, as well as the support of participants in the chat.” Our team continues to receive positive feedback from these thought-provoking and interactive discussions.

Given the success of these efforts and continued interest in furthering health equity, our CoE team will continue to emphasize collective learning around what it means to advance health equity among Black, Indigenous and people of color this month and beyond. Stay tuned for how your organization can learn from – and with – our team. In the meantime, we encourage you to visit our “Health Equity & Racial Justice” webpage for additional opportunities and resources.