Considering Ethnic Perspectives - Part II

In a recent blog piece, I reported on some of the things that came up at a one-day conference I attended on ethnic diversity in the older mental health community. The conference was put on by the Senior Mental Health Partnership, which is a program of NAMI San Diego. To continue ...

Martina Portillo RN, MPH, who is a member of the Hopi Tribe and has had a distinguished career in the Indian Health Service, reported that 57 percent of 3.3 million American Indians/Alaskan Natives now reside in urban areas. “This is a complete reversal since I was little,” Ms Portillo observed. Indians are moving to the cities for the same reasons the rest of us do - jobs and education.

Indian life expectancy, at 72.3 years, is about four years less than non-natives, a “complete improvement” according to Ms Portillo. Where the death rates are significantly higher: TB (750% higher), alcoholism (550% higher, but lower among older men than their counterparts among other races), diabetes (190% higher), unintentional injuries (150% higher), homicide (100%), and suicide (70%, very high in the young population but lower in elders than the general population).

Elders in the Indian population recall their culture being looked down upon as “bad”, with forced boarding schools, banned spiritual practices, and loss of land by the allotment system. Barriers to mental health include differences in cultural beliefs about mental illness, cultural labeling of different emotions, lack of mental health professionals in the system (101 per 100,000 compared to 173 per 100,000 in non-native populations, lack of large scale studies, and lack of cultural orientation for providers (such as in the healing traditions). Rarely do elders seek out available mental health services.

Shifting gears ...

A panel of presenters - Dixie Galapon PhD, Agnes Hajek MSW, and Emily Wu PsyD - from the Union of Pan Asian Communities (UPAC, which serves a vast range of Asian and Pacific Island communities in San Diego) reported that, among other things, Asian elders are confronted by a difference between how Asians and Americans view the elderly. The family matriarch, for instance, rather than enjoying an exalted seat of honor. may suddenly find herself a stranger in a strange land, even within her own family, especially if dealing with Americanized children and grandchildren.

Asian Americans whose families experience a high interpersonal conflict have a three-fold greater risk of attempting suicide compared to the general Asian population. This is true even among those who never had a history of depression. As the panel noted, this points to the strength of family values in Asian communities. Family harmony, they noted, is a value coming from Confucianist (stressing values) and Taoist (stressing balance) beliefs.

An intervention UPAC is working on includes “Problem Solving Treatment” aimed at older adults. Since depression is often caused by problems in life, the object is to help clients regain a sense of control and thereby improve their mood. For instance, people who are engaged in social activities at least two times a week have less depression than those not engaged.

Wrapping up ...

Look around you. Look within your family. The view is probably much different than it used to be. Lot of things to consider ...

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 ...