October 20, 2000

One Size Doesn't Fit All

Ethnicity plays role in response to mental health treatment

Sacramento — National and state mental health experts gathered at the State Capitol Oct. 17, 2000, to discuss the need for cultural sensitivity in providing successful treatment for mental illness in the wake of recent dramatic expansions in state and local mental health care.

According to new research and data from community mental health programs expanded through AB 34 (Steinberg, 1999), culturally competent treatment relies on the ability to provide flexible services, including a variety of medications.

"We have the date to confirm that individuals and ethnic groups are unique when it comes to treatment for mental illness," said Rusty Selix, executive director of the Mental Health Association in California. "Community programs are so successful because they offer the tools needed to address cultural differences — individualized services and access to a variety of medications."

AB 34 provided $10 million in funding to create pilot programs in Los Angeles, Sacramento and Stanislaus Counties. These programs have provided comprehensive, community-based mental health services to more than 1,100 mentally ill homeless people over the last year, and have resulted in $20 million in reduced incarceration and hospital costs. Assembly-member Darrell Steinberg (D-Sacramento) also authored AB 2034 (2000) which resulted in the allocation of $55.6 million in the State Budget to provide additional counties with expansion funding.

"It is our duty to ensure that California's multicultural population is well-served," Steinberg said. "Community programs work so well because we recognize the need to provide individualized services and access to the newest and best treatments."

Rachel Guerrero, chief of the California Department of Mental Health, Office of Multi-cultural Services, spoke about the importance of cultural competency in mental health treatment, as well a the state's efforts to ensure cultural sensitivity.

Jeanette Jerrell, Ph.D, professor of neuropsychiatry at the University of South Carolina School of Medicine, was on hand to discuss her research into race differentials in responses to a typical antipsychotic medications. Her findings have shown that African Americans diagnosed with schizophrenia and related disorder respond better to Polixin and Zyprexa than other commonly used medications.

"We have known for years that individuals respond to medications differently, but this research indicates that we need to pay greater attention to the needs of ethnic groups," Selix said.

Added to the Medi-Cal formulary in 1997, atypical antipsychotics are considered by doctors to be the most effective medications to treat schizophrenia and related disorders. They have replaced older antipsychotics as the first line of treatment in most cases because they are more successful at treating mental illness without serious side effects. Even though atypical anti-psychotics are more expensive in the short-term, long-term-cost-savings are significant because individuals are less likely to be institutionalized, on welfare or incarcerated, and more likely to lead productive lives. There is a two-fold increase in their ability to return to the workplace.

Max Kosareff, a mental health consumer who has battled schizophrenia for more than half of his 46 years, often talks about the challenges he has faced in finding a medication that relieves his symptoms without severe side effects.

"It took more than 20 years to find the right medication," he said. "I haven't had an anxiety in two years and I can think clearly now."

Max is currently taking office administration courses at a Los Angeles area community college. He is also a member of The Village Integrated Services Agency in Long Beach where he takes advantage of the vocational rehabilitation program.

"I'm preparing to re-enter the workforce," Kosareff said. "Without my medication and my faith I would never be able to do that."

The success and expansion of culturally competent mental health treatment comes at a time when the California State Department of Health Services is reviewing the Medi-Cal formulary to determine if it will continue to cover all of the atypical antipsychotics (Clozaril, Risperdal, Seroquel and Zyprexa).

"The state has recognized that by including a variety of medications of the Medi-Cal formulary, individuals will get the care they need while taxpayers reap the benefits of cost savings to the state," Selix said. "This new evidence supports the continuing need to provide the most appropriate care for our ethnically diverse population."

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