Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

• Published in: Psychiatric services (Washington, D.C.) Vol. 58; no. 12; pp. 1555 - 1562
• Main Authors: Gilmer, Todd P, Ojeda, Victoria D, Folsom, David P, Fuentes, Dahlia, Garcia, Piedad, Jeste, Dilip V
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Association 01-12-2007; American Psychiatric Publishing, Inc
• Subjects: Adult; Biological and medical sciences; Bipolar disorder; California; Communication Barriers; Databases as Topic; English language; Ethnicity; Female; Health care access; Humans; Language; Logistic Models; Male; Medical sciences; Mental depression; Mental Disorders - ethnology; Mental Disorders - therapy; Mental health; Mental health care; Mental Health Services - utilization; Organization of mental health. Health systems; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotropic drugs; Public Sector; Schizophrenia; Severity of Illness Index; Social psychiatry. Ethnopsychiatry; United States; North America; America; California; United States > US; Social environment; Human; Accessibility; Linguistic barrier; Use; Mental health; Health service; Ethnic group; Physician patient relation; Information communication; Sociodemographic factor; Minority; Mental disorder; Psychopathology; Initiation; Public health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/ps.2007.58.12.1555

Few studies have examined the effect of limited English proficiency on use of mental health services by persons with mental illness from ethnic minority groups who are uninsured or publicly insured. This study examined how indigent or publicly insured Latino and Asian adults with limited English proficiency initially accessed the public mental health system and how their use of services changed over time compared with English-proficient peers.
Data from San Diego County for fiscal years 2000-2005 were used to examine point of first contact and use of inpatient, emergency, and outpatient services in the 18 subsequent months among 9,243 clients with a psychiatric diagnosis of schizophrenia, bipolar disorder, or major depression. Multivariate regression models were used to compute standardized estimates of utilization.
Latino and Asian clients with limited English proficiency were significantly less likely to first access the system through emergency services and more likely to access the system through outpatient services (p<.001 for each comparison). In two outpatient programs that were focused on delivering services to clients with limited English proficiency, clients had a higher intensity of outpatient service use than clients in clinics that did not have such a focus (p<.05 for each).
The initial pattern of service use was favorable for both groups. However, over time this pattern persisted for Asian clients with limited English proficiency but not for Latino clients with limited English proficiency. Findings suggest that ethnically focused programs may be an effective approach to engaging populations that are underrepresented in the mental health system.