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F I S C A L I M P A C T R E P O R T

SPONSOR Miera

ORIGINAL DATE

LAST UPDATED

2-6-06

HJM 41

SHORT TITLE Bilingual Behavioral Health Professionals

SB

ANALYST Collard

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY06

FY07

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates SJM 32

SOURCES OF INFORMATION

LFC Files

Responses Received From

Health Policy Commission (HPC)

Department of Health (DOH)

Public Education Department (PED)

SUMMARY

Synopsis of Bill

House Joint Memorial 41 requests HPC to conduct a study of bilingual behavioral health profes-

sionals in the state and the barriers to recruiting and retaining adequate numbers of such practi-

tioners. The memorial requests a multi-agency study address the impact of the current shortage

on the mental health of New Mexico residents and HPC submit a report of its findings and rec-

ommendations to the Health and Human Services Committee by November, 2006.

FISCAL IMPLICATIONS

Although there is no appropriation associated with the joint memorial, HPC indicates, depending

upon the strategy employed to quantify the degree of shortage of behavioral health professionals

in New Mexico, HPC may be required to expend resources for outside consulting and data com-

pilation assistance from an entity such as the Center for Health Care Work Force Studies.

House Joint Memorial 41– Page

2

SIGNIFICANT ISSUES

HPC notes a substantial and growing body of research (Kaiser Family Foundation 2002-06) indi-

cates that “race/ethnicity – independent of clinical and socioeconomic factors – continues to mat-

ter in the U.S. health care system. Racial/ethnic background continues to affect access to health

care and the quality of care obtained.” While the evidence varies for specific conditions and ra-

cial/ethnic minority groups, the data are sufficiently compelling to begin undertaking actions to

systematically and aggressively eliminate disparities in needed medical care through targeted

strategies of workforce development.

Additionally, New Mexico has a long history of health professional shortages, especially in the

behavioral health arena and especially in rural locations of the state. HPC studies in the past have

looked at and made recommendations regarding physicians, nurses, dentists, and other profes-

sionals. However, HPC has not done a study of behavioral health professionals. No firm data ex-

ists about the degree of shortage, much less the degree of shortage when factoring in bilingual

supply of behavioral health providers. The memorial asks that this be done in conjunction with

the impact that shortage has on New Mexicans health status.

DOH states the U.S. Census Bureau 2000 data indicates that 40 percent of New Mexico’s popu-

lation is Hispanic, 9 percent are Native American, and 1 percent are Asian or Pacific Islander.

Census data on language indicates that 37 percent of the population of New Mexico speaks a lan-

guage other than English at home (though not necessarily to the exclusion of English). The Of-

fice of Minority Health of the U.S. Department or Health and Human Services stresses that for

improved outcomes, from mental health and substance abuse treatment, services must be cultur-

ally competent and linguistically appropriate. The lack of availability of linguistically appropri-

ate services contributes to health care disparities experienced by these populations.

DOH also notes similar work has already been done by the Behavioral Health Workforce Group

in response to Executive order 2004-062. Issues proposed to be identified in the bill have al-

ready been identified in the workforce report and additional work in this area would be duplica-

tive.

Issues in the bill identified as areas to address will be included in an action plan developed from

the Workforce report and coordinated through the Behavioral Health Collaborative.

The Behavioral Health Collaborative will dedicate one staff member to work exclusively with

the Native American communities and will assure that work programs are developed to address

all cultural and language issues, as well as overall work force capacity problems.

The following statistics were provided by the Bilingual and Multicultural Bureau of PED:

•

There are 65,128 English language learners in New Mexico, some of whom may be

orally proficient in English but are unable to read and write with proficiency in English

(Bilingual and Multicultural Bureau of PED, 2005 data).

•

There are 10,996 known immigrant students in New Mexico (Bilingual and Multicultural

Bureau of PED, 2005 data).

•

There are 2,200 migrant students in New Mexico and about 50 percent of those are Eng-

lish language learners (Title I, Migrant population data 2005, PED).

House Joint Memorial 41– Page

3

•

In order to meet the behavioral health needs of the citizens of New Mexico it is critical

that an adequate number of bilingual professionals are available to address such issues as

substance abuse, suicide and other mental health issues in a culturally competent manner.

•

Hispanics make up 43.2 percent of New Mexico’s population (2003 population estimates

from the U.S. Census Bureau – New Mexico Selected Health Statistics Annual Report for

2003).

PED also notes data on the impact of the lack of bilingual behavioral health providers is lacking

and difficult to collect.

PERFORMANCE IMPLICATIONS

As the lead agency for this memorial, HPC indicates it will be responsible for providing inten-

sive staff support to facilitate meetings, follow up on task assignments, conduct research, as well

as drafting and distributing the final report. There will need to be a very close working relation-

ship with and participation of the Human Services Department, the Department of Health, the

New Mexico Hospital and Health Systems Association, statewide organizations representing be-

havioral health professionals, consumers, and others with knowledge and expertise in the field of

behavioral health.

DUPLICATION

House Joint Memorial 41 duplicates Senate Joint Memorial 32.

TECHNICAL ISSUES

HPC states, in order to quantify the shortage of mental health personnel, it may be helpful to add

the Office of Workforce Training and Development, a representative from the Governor’s Of-

fice, and a representative from the Children, Youth and Families Department named as agency

participants in the memorial.

OTHER SUBSTANTIVE ISSUES

HPC notes it, through the joint memorial, has been requested to conduct a study of the impor-

tance of and the barriers to meeting the need for recruiting and retaining an adequate supply of

bilingual behavioral health professionals in New Mexico. The study should also address the im-

pact of a shortage of bilingual health care professionals on the mental health of New Mexico

residents.

Currently, HPC notes there is no firm data with respect to the actual number of behavioral health

professionals by county actually in practice. Licensure data is not a reliable indicator of how

many behavioral health professionals are actually in practice and where the service is being pro-

vided. Consequently, the degree of shortage of behavioral health professionals itself, much less

bilingual behavioral health professionals, is not known. Both would need to be quantified before

a strategy could be established to resolve the shortage. The process of collecting this data will

likely identify many of the barriers to meeting the need for recruiting and retaining an adequate

supply of bilingual behavioral health professionals called for in the memorial.

Additionally, living in a diverse state inevitably requires working closely with people from a va-

House Joint Memorial 41– Page

4

riety of backgrounds. In healthcare, it means that providers must care for patients whose race,

ethnicity, and language are often different from their own. What this does to the often compli-

cated interactions that take place between a behavioral health provider and a patient is not

known. The memorial will attempt to answer this issue.

HPC states cultural competence is often defined as “the demonstrated awareness and integration

of three population-specific issues: health-related beliefs and cultural values, disease incidence

and prevalence, and treatment efficacy. But perhaps the most significant aspect of this concept is

the inclusion and integration of the three areas that are usually considered separately when they

are considered at all (Lavizzo-Mourey and Mackenzie, 1996).” The memorial will attempt to de-

scribe the impact of the lack of cultural competence and absence of bilingual providers has on

the health status of New Mexicans.

HPC data shows health care organizations—health plans, hospitals, community

health centers,

clinics, and group practices—can play

an important role in the elimination of racial/ethnic dis-

parities

in health care. There are now a number of examples of organizations

that have been suc-

cessful in reducing or eliminating disparities,

and a number of published examples of how quality

improvement

initiatives can improve care for members of targeted minority

groups, thereby con-

tributing to the elimination of disparities. (Health Affairs Volume 24 # 2).

Finally, HPC notes the quality of communication between patients and clinicians

can have a ma-

jor impact on health outcomes, and limited English

proficiency can interfere with effective com-

munication. According to Health Affairs, more

than ten million U.S. residents speak English

poorly or not

at all, constituting a language chasm in the health care system.

A study in Health

Affairs shows evidence on the link between linguistic

competence and health care quality and the

impact of particular

language-assistance strategies. Drawing on the experiences of

fourteen health

plans that have been at the forefront of linguistic

competence efforts, the study has lessons for

plans, purchasers,

policymakers, and researchers on ways to improve the availability

and quality

of interpreter services.

KBC/nt