Monday, December 7, 2009

Considering Ethnic Perspectives

On Friday, I attended a one-day conference on ethnic diversity in the older mental health community, put on by the Senior Mental Health Partnership, which is a program of NAMI San Diego. The emphasis was on the special needs of the many and diverse ethnic groups that call San Diego county their home. These needs include cultural and language barriers that pose a challenge to treatment, as well as the psychic horrors from atrocities that many must contend with, particularly older generations.

My friend Sally Shepherd MN of UCSD , who organized the conference and set the scene in an opening presentation, provided this salient example:

According to one study, 70 percent of southeast Asian refugees receiving mental health care met diagnostic criteria for PTSD. In a study of Cambodian adolescents who survived Pol Pot’s concentration camps, nearly half experienced PTSD and 41 percent suffered from depression ten years after leaving Cambodia.

Meanwhile, demographics are dramatically shifting. Ms Shepherd noted that in a matter of years, latinos in California will outnumber whites. By 2020, whites will comprise 37 percent of the population while hispanics will make up 41 percent, almost an exact reversal on current figures. By 2050, this “minority” will be in a “majority” at more than 50 percent of the population, with whites at one in four.

As one commentator remarked: “Few of their children in the country learn English ... the signs in our streets have inscriptions in both languages ... unless the stream of their importation could be turned ... they will soon so outnumber us, that all the advantages we have will not in my opinion be able to preserve our language, and even our government will become precarious.”

Ben Franklin said that, back in 1753, not Lou Dobbs. Franklin was expressing his alarm over Germans settling in Pennsylvania. Some things, Ms Shepherd pointed out, apparently never change.

Concepcion Barrio PhD of the USC School of Social Work talked about mobilizing “culturally salient protective factors” in working with latinos. These include strong family attachments, supportive community networks, and deep spiritual/religious convictions. For instance, according to a 1998 study, of those with severe mental illness, 75 percent of latinos and 60 percent of African-Americans lived with their families, as opposed to just 30 percent of whites.

A 2006 meta-analysis of 56 studies found that interventions targeted to specific cultural groups were four times more effective than non-targeted interventions and that those conducted in a client’s native language were twice as effective as those conducted in English.

Simply having providers employ ethnically-matched staff, along with other surface strategies, is only part of the picture, Dr Barrio argued. Deeper approaches incorporate the traditions of the ethnic group. She cited the well-known “Mexican Paradox,” which has to do with first-generation Mexican-Americans faring a lot better mentally than assimilated later generations.

In addition, Dr Barrio pointed out, families from third-world nations tend to manifest lower “expressed emotions,” such as hostilities. Acceptance and warmth in Mexican-American families, for instance, predict better outcomes from schizophrenia.

The catch, of course, is that mental health providers need to be making the effort. In this context, we hear terms such as “cultural competency,” which involves, among other things, not making false assumptions about others’ ways based on one’s own limited personal experience.

Not good in healthcare, Ms Shepherd concluded.

More later ...

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