10/04/2011: In 2009, a Yale survey found substantial racial and ethnic disparities among Connecticut mental health inpatient services. Relative to other groups, African Americans were more likely to drop out of treatment against medical advice, despite being more likely to self-refer for inpatient care.
Tasked with responding to these and other disparities is the Office of Multicultural Affairs within Connecticut’s Department of Mental Health and Addiction Services (DMHAS). In February of this year Commissioner Patricia Rehmer appointed Miriam Delphin-Rittmon, PhD, Assistant Professor of Psychiatry at Yale School of Medicine, to head this important office.
Dr. Delphin-Rittmon also serves as Director of Cultural Competence and Health Disparities Research and Consultation at Yale's Program for Recovery and Community Health, which is affiliated with the Connecticut Mental Health Center (CMHC).
"Connecticut faces the same challenges as the rest of the country. Shifting demographics require us to re-imagine mental health and substance abuse services in order to make them more accessible and appropriate for diverse individuals and communities," stated Dr. Delphin-Rittmon. "The office's work addresses culture at the direct care, organizational, and systems levels and aims to dismantle institutional biases and stereotypes that often serve as obstacles to equitable care."
Prior to her appointment as director of the DMHAS Office of Multicultural Affairs (OMA), Dr. Delphin-Rittmon worked closely with the office as a consultant on its Health Disparities Initiative and as a member of the DMHAS Multicultural Advisory Council (MCAC).
Dr. Delphin-Rittmon's interest in multicultural mental health issues is rooted in her personal story. Her family is a reflection of the ever-present force of culture. "My parents were immigrants from Haiti. Branches of my family tree extend through that country as well as Venezuela, Spain, and the United States." She describes family functions as "a fusion of cultures as represented by food, music, language, and the way we interact with each other."
An experience during Delphin-Rittmon's early adulthood—her doctor made assumptions which led to a misdiagnosis—opened her eyes to the impact of biases held by caregivers. "Health care providers are not immune to cultural filters and stereotypes," she said. "Reflexive decisions can have a negative impact on quality of care and health outcomes." The belief that the best care considers all aspects of a patient, including that patient's culture, continues to drive her professional and research interests.
Over nearly fourteen years, OMA has marked some major accomplishments including a series of strategic plans, "best practice" standards for culturally competent healthcare, multicultural trainings for staff at all levels of government, and the establishment of the Latino Outreach Initiative, among others.
A current project funded by the Connecticut Health Foundation that is being piloted at CMHC tests the long-term efficacy of cultural competency training for staff and providers in the DMHAS system. The two-day training explores cultural identity, worldview, and various dynamics of difference that can emerge in interactions between providers and consumers. The programming paves the way for more in-depth institutional planning, policy review, and strategic goal setting. Subsequent follow-ups will measure the impact of the training and implemented organizational-level changes on patient health outcomes.
Delphin-Rittmon sees her work at OMA as a natural extension of her academic research at Yale where she has been a member of the psychiatry department faculty for nearly a decade. "There is significant overlap between my research at Yale and my work at OMA. Having consulted with numerous institutions, promoting cultural competence at the direct care and organizational levels, I am thrilled to have the opportunity to implement these same reforms and best practices across the DMHAS system."
When discussing challenges to accomplishing OMA's mission, Delphin-Rittmon points to dwindling resources, but also to a more fundamental point, "An ongoing challenge is helping people to see the importance of addressing cultural beliefs and values as a routine part of care. Culture is intimately tied to a person's health and healing. Given this, there is often a basic education and awareness component underlying all of our efforts."
Dr. Delphin-Rittmon is the former Interim Executive Co-Director of the National Leadership Council on African American Behavioral Health, Inc. (NLC) and currently serves on the Board of the NLC. She is a Steward Group member of the Substance Abuse and Mental Health Services Administration (SAMHSA) National Network to Eliminate Disparities and a former Fellow of the American Psychological Association Minority Fellowship Program (MFP). Dr. Delphin-Rittmon currently serves on the MFP Training Advisory Committee.