Diversity in mental health field still an elusive goal


Ana Ortiz, Ph.D., director of human services at the Hispanic Clinic at Children’s Hospital in Boston, Mass., says that “non-English speaking clients may have to wait six or seven months to see someone who speaks their language. (photo by Kathryn Hardy)

By Phyllis Hanlon

Twenty-four years ago, clinical psychologist Ana Ortiz, Ph.D., came to this country from Puerto Rico to earn her degree at Boston University (BU). In those two decades, she has seen a great influx of minority groups. Although the cultural and ethnic profile of the United States has become more diversified, the healthcare system - particularly mental health - still has a lot of catching up to do.

Ena Vazquez-Nuttall, Ed.D., associate dean and graduate director of Northeastern University's College of Health Sciences doctorate program, recently sat on a committee that created a report, "In the Nation's Compelling Interest," (see "Study Recommends more diversity"), which studied policies and procedures to help develop diversity in healthcare. She says that compared to the general population, the number of psychologists is significantly out of balance. Vazquez-Nuttall reports that nationally only 3.4 percent of psychologists are African-American, 3.4 percent are Hispanic, 2.2 percent are Asian/Pacific and less than one percent are Native American.

As director of human services at the Hispanic Clinic at Children's Hospital in Boston, Mass., Ortiz can testify to the accuracy of those figures. She says that the demand for services often outweighs the availability of appropriate providers. "Non-English speaking clients may have to wait six or seven months to see someone who speaks their language," she says. By the time these individuals gain access to a psychologist, their mental health problems have reached crisis levels, she adds. Roxana Llerena Quinn, Ph.D., who heads the Latino Treatment Team at Children's Hospital, points out that the psychological problems associated with immigrants and refugees who cross our borders present complex issues never seen here before. Some of those traumatic experiences include war, violence, abuse, rape and other tragic situations. By having access to a psychologist who understands their native cultures, languages and ethnic practices and perspectives of mental health, these individuals stand a better chance of weathering these emotional trials, she says.

According to Jessica Henderson Daniel, Ph.D., an underlying cause of the dearth of minority psychologists lies with academic institutions. Daniel is director of training at Children's Hospital in the department of psychiatry and adjunct professor at BU. "From a realistic viewpoint, the response needs to come from the graduate schools," she says. Daniel lobbies for hiring more faculty of color and promotes collaboration and inclusion in opportunities for psychological research. "The research route is important because it helps to determine our knowledge base and policy," she says. The presence of a diverse faculty also helps support and encourage students who might feel racially isolated, Daniel says. She emphasizes the need for more strident recruitment and retention efforts for both faculty and students.

Additionally, Daniel cites the need for diversity awareness programs, admitting that these initiatives require time and commitment. However, she believes that intense training will help providers serve all populations more effectively. "We need to train persons who are the current majority to deal with the emerging majority," Daniel says.

In 1994, Daniel chaired a committee instrumental in passing a law that requires all individuals to have some diversity training and instruction before becoming licensed, making Massachusetts a leader in promoting diversity.

Quinn adds that the healthcare system would greatly benefit by opening up specialty areas. "Minority providers can also work with the majority," she says. Her idea of diversifying includes better representation in all areas of healthcare. "It's a whole pipeline issue," Quinn says.

Ed K.S. Wang, Psy.D., director of the Massachusetts Office of Multicultural Affairs, explains that economic barriers may also inhibit ethnic students from applying to graduate psychology programs. "There is a high level of investment. Graduate schools, internships - it's a long educational process and you have high tuition bills," he says. "Mental health professionals don't make a lot of money compared to other business arenas." He points out that these "disincentives" influence a student's decision to enter a psychology graduate program. Wang applauds Simmons College and Boston University for promoting diversity in the classroom through a number of specialized programs.

In New England, diversity in general is found in scattered pockets. For instance, while 96 percent of New Hampshire is white, Manchester and Nashua contain high concentrations of minorities. William D. Walker, director of the Granite State's Office of Minority Health, says, "One trap of the system is that we look at statistics and say there is a small percentage [of minorities], so it's not a big issue. But if we look where the population works and goes to school, it paints a different picture." In Manchester, where a diverse language, culture and ethnicity prevails, specific steps have been taken to address mental healthcare needs. "There is a lot of cultural competency training going on here," he says. "There is a collaboration with minority community-based organizations to make services accessible to all."

To make solutions work though, we have to start from the top down, Walker says. His agency has made a number of changes designed to create a more diverse workforce. "We are diversifying our staff as much as possible, given budget cuts and hiring freezes. Staff members are language and culturally competent," he says. Additionally, to reduce language barriers, the state has translated eligibility forms and other vital documents into Spanish, Arabic, Vietnamese, Serbo-Croatian and French.

New Hampshire's Dept. of Health and Human Services has also installed a "language line" that converts English to the desired language for easier electronic communication.

Walker reports that for the last year and a half, administrators at St. Joseph's Hospital in Nashua - another highly diverse city - have worked to create a long-term plan that addresses language barriers, interpreter services and other cultural issues, in addition to diversifying its staff. Walker says, "Hospitals need to have a sense of the changing population to see the magnitude of what the demands are."

In addition to ministering to clients in an office or hospital setting, minority psychologists today are called upon to sit on committees, mentor children, present talks and perform other duties aimed at promoting diversity. These additional responsibilities compromise an already understaffed and overworked group of psychologists.

Diversity in mental health field still an elusive goal (May 2004 Issue)

Diversity in mental health field still an elusive goal
(May 2004 Issue)