Marshala Lee, MD, MPH


Harrington Trust Physician Scholar; Harrington Value Institute Community Partnership Fund Director, Christiana Care Health System, Newark, Delaware

Dr. Lee recently completed her residency in the department of family medicine at the University of Maryland Medical Center, Baltimore, MD.  Dr. Lee has focused on health disparities, especially those related to cardiovascular disease.  As a Jackson Heart Study Scholar during 2007-2008, Dr. Lee served as principal investigator in training in the “Know Your Numbers Campaign,” and her 2005 research for the Jackson Health Study was entitled, “The Effect of Oral Contraceptive Usage on Cardiovascular Functioning in Participants in the Jackson Heart Study.”  She also co-organized POWER KIDS, a childhood obesity program.   During 2005, Dr. Lee was a University of Washington, Multidisciplinary International Research Training Program (MIRT) Fellow.  Dr. Lee received her medical degree with a concentration in advocacy and activism from Brown Medical School in Providence, RI in 2011.


The Role of Community Health Workers in Addressing Mental Health Disparities: Policy Recommendations for Expanded Care in Massachusetts


The primary goals of this project were to research the burden of mental health disparities in the United States, identify ways in which community health workers could facilitate in decreasing these disparities, investigate key barriers that limit their expanded role, and to formulate policy recommendations for expanded care.


Despite the inability to clearly quantify the exact magnitude of undiagnosed mental illness in communities of color, there is a clear abundance of data that reveals that disparities exist in access to mental health clinical services, effectiveness of treatments, and retention in care. Additionally, minority patients are more likely to reside in areas defined as being mental health professional shortage areas.  Innovative and effective workforces must be adopted to extend these services to communities in which these shortages exist. Studies have shown the effectiveness of community health workers in reducing health disparities for a number of chronic conditions by increasing access to healthcare services and providing culturally appropriate care. Unfortunately, behavioral health services have not been widely performed by community health workers. Thus their potential to decrease mental health disparities has not been adequately researched.


A structured review of literature was conducted to collect relevant data and analyze prior research on mental health disparities and community health workers.  Federal and state policies, regulations and statutes were reviewed for precedence and models relating to expanding roles for community health workers. We worked directly with the Massachusetts Community Health Worker Advisory Council to identify barriers that currently limit the role of community health workers. Policy recommendations were formulated to address the identified barrier. Results were compiled into a structured policy brief and will be presented to key stakeholders in Massachusetts.


Resources must be invested to better quantify the exact burden of mental health disparities in communities of color. Culturally sensitive screening tools must be employed to fully identify undiagnosed mental health conditions. Research identified the need to develop a multi-tiered behavioral health services team that fully integrate behavioral health services into the primary care team and surrounding communities. Innovative mental health community worker programs were identified and remaining sustainability barriers were further investigated. Policy recommendations were formulated and grouped into 5 key categories:  community engagement, research, workforce development, financing, and liability concerns.

Future Directions:      

It is our goal that this policy brief will serve as a guiding resource in the creation of sustainable community mental health workers programs that will be influential in reducing mental health disparities. Although these recommendations were specifically designed for the state of Massachusetts, they may also be largely employed in others states as well.


Margarita Alegria, PhD
Director, Center for Multicultural Mental Health Research
Professor of Psychology, Department of Psychiatry, Harvard Medical School