Culture is briefly defined as a common set of beliefs, norms, and values. Cultures influence how patients communicate and manifest their symptoms, how they cope, the range of their family and community supports, and their willingness to seek treatment.
There are a few reasons why I believe racial minorities do not seek mental health treatment.
It is true that striking disparities in accesss, quality, and availability of mental health services exist for racial and ethnic minoroties. A history of racism discrimination, and economic impoverishment can combine with mistrust and fear to keep minorities from using services and receiving appropriate care. There are not as many practitioners who are of their own culture or speak their language. I can understand why people are afraid of seeking help.
In poorer racial groups and nations, social networks are a critical part of healing and recovery as patients continue to participate in rather than becoming isolated, as is often the case in developped nations like the US. Racial minorities can have different definision of "treatment". How do we as clinicians approach race specific treatment method?
I can speak from my own culture. In most Asian cultures, there is great shame and stigma associated with mental illnesses. Their suicide rate is very high, but many people are untreated. Things are slowly changing now, and mental illnesses are being more addressed. I thought it was interesting when I learned how Asian people with mental illness often present with more severe physical conditions than other ethnic groups do. I wonder if this suggests that the distress from the shame and stigma associated with mental illness could cause physical symptoms.
Has anyone had any experience with racial monorities with mental illness? What are the barriers? What do we as MSWs need to do to advocate racial minorities' healing and treatment in America's medical model?
Thanks for all of this information Yurika. I have not really had the opportunity to work with many minorities as an MSW but I have a few thoughts on the subject. I think that a few of the barriers that we face as clinicians are the fact that we have to "hurry up" with our patients (this is with all pts.). I currently work in a fee-for-service agency and we usually only have so many sessions to offer our pts. so we have to get right down to business. I think that in our line of work we don't get an opportunity to develop an in depth relationship which should be built on trust. This, I believe, hinders us from getting minority pts. to "buy in" to what it is we are saying. We don't get create a trusting relationship to push past the shame and stigma that Yurika talked about.
As clinician's I think that it is impossible to know a great deal about various cultures but I believe that we have a duty to be open and learn from our pts. We need to ask for help and seek out new information from others who may have more knowledge. I remember when I was doing my internship in grad school and we had to do a phone cunsultation with someone when we had a pt. that was a minority. For the most part, I think this was a joke, but at least it was something. The consultant gave very generic information but at least it was holding people somewhat accountable.
I think that it was interesting that I heard a radio advertisement today that was about what we are talking about on this blog. The advertisement was basically talking about wanting a Latino woman to get a mammogram but if she is informed that the dr. wants her get this testing, she may not return because she automatically associates this test with having cancer and may not return. The advertisement was talking about restating it something like this, it is important for you to come back and get this screening so that you can be around for a very long time to take care of your family. I think that this seems so simple but it really is not. I think I get so caught up in doing things the same way all the time, I could be doing a better job at watching the words I use with others.
My work with minorities comes moslty in the form of African Americans. I have worked a little with Hispanic population, moslty in the form of chemicald dependency. And within all of this, these populations have mostly been adolescents, therefore my work with an adult minority population is very limited. Well, now that I think a little more, my work with a minority adult population would mostly include lesbian/bi-sexual (again mostly in CD residential and IOP setting). My most vivid case though was the one I talked about a couple of groups back, the Chinese woman who came in with S/I secondary to depression and a DV relationship. I guess we also have to remember that working with females is a form of a minority as well, as we all know that there is a distinct priveledge barrier between the 2 genders. I think we have to educate ourselves. We will never know what it is like to walk in the shoes of a specific minority, but as therapists, it is our job to be empathetic and compassionate with excellent listening skills. We need to be aware of the cultural norms and the value system they are coming from and in turn even though it may be completely different from ours, we can provide listening skills and appropriate guidance according to the specific culture we are working with. It reminds me of working in the westernized american medical model.... pt's come in from different countries/religions/cultures and they are scared, resentful, hesitant and may not believe in the medical model we practice from. It is our job as advocates to help the interdisciplinary team understand this.... example: pt from another culture passes away/the family would like 24hrs with the body to pray and partake in religous ceremony..... this has the MD's, RN's upset because this is not "how we dot it" and the hospital needs the bed (again as I am a strong believer in after working as a medical social worker, everything is monetarily driven)...... maybe this person passed away unexpectedly and now here they are being forced to forgo their traditions (and to some this could be a matter of going to heaven/hell). I ran across this very example at Evergreen. Everyone was worried about the body smelling, cleaning the room etc. What about the pt and the family? The pt isn't just a "medical experiment"..... they are a hum with a soul. Everyone who we see in our practice is coming to us for support and guidance. We need to pay them respect and begin our journey with them by taking responsibilty to educate ourselves on their background and beliefs.
Yurika, I think you prompted an excellent discussion. So, many great things being discussed. I do think its interesting that many Asians will present c more physiological symptoms as it is more socially accepting in many Asian cultures than to present with actual psychiatric symptoms where there is a lot of shame attached. I have also had first hand experience with this deep kind of shame that many Asian families feel when there loved one's have been in the hospital for depression or hallucinations or delusions. In fact, on many occasions in these situations I have noticed a strong disconnect c patriarch and the client as by the time the pt's symptoms are acute enough to be in the hospital, they see their father as a barrier to getting well as they may feel they are unlikey to understand what they are dealing with. Team, Important for to test to know that Asians displaying psychotic symptoms respond to lower doses of Anti psychotics. My other thought on the issue is that with several asian cultures, families don't want the patient to have any suffering they want share take as much stress off the patient as they can which my actually be counter intuiative in a psych situation.
Team aslo recall questions on the tests, Adolescent Native American Males and African American males have high than average suicidal rates as well as gay and lesbian men and women
With Native American Populations, Family systems modalities are very effective. Family and extended family is very important in this culture. Providers/Clinicians have to be very careful in looking at his pt as an identified client to a whole family that needs treatment or needs to be highly valued considered in the treatment process. Irrespective of the environment whether in the hospital setting, outpt settings or private settings when we have a client referred to us we need to proactively involve the family otherwise we risk isolating this client within his family and we approach things with a very limited westernized approach without considering the holistic ideologies of their culture. Team keep in mind that Westernized Modalities can be very Eurocentric or engage in Universalism the idea that our way is the norm or standard for everyone or the Dichotomous way of thinking where differences are inferior vs diunital thinking where differences are just that, different but are able to co-exist with eachother
I think that one of the dilemmas I have when working with individuals from various cultures is that they do not necessarily identify themselves as they see their parents. The assessment questions that we ask are thorough and there is a section on how they identify themselves including cultural and ethnic groups. I mostly work with adolescents and they seem to usually always indicate whether they are Native American and/or Hispanic for example but they indicate that they don’t associate with their culture. Their families on the other hand, are usually puzzled because “they were not brought up that way.” I understand that many cultures are very private but for those few families that I have encountered, they appear to be truly upset about the decisions their child is making. Another barrier that we sometimes face is a language barrier. We have not had very good luck with the youth translating so we have to get an interpreter, which is difficult at times. I appreciate the time that we have in developing a rapport with the pt. and their families in the setting that I work in but I must say we don’t usually have success with people who are from various cultures.
I agree with using family systems theory with our pt. I think that it is incredibly important to educate families and to try to show the family members how their participation may benefit the pt. and their overall family. I also think that it is important to indicate that I may not know something and to allow those family to teach me.
Strong work Tara. There are a few Gems in your posting Tara. One of them being I think it is important to not only consider culture but where is your client developmentally in her life span and how does cutural play with that. An you are absolutely right, it isn't uncommon for their to be disconnect between adolescents from different cultural backgrounds who have English and American cultural norms, folkways, mores mastered and their parents who may not but still parent the way they were parented in their unique cultures. Then you bring up the idea of an interpreter. I think interpreters in these situations are absolutely necessary. As clinicians in these situations we get lazy when their is an English speaking relative particulary dtr or son, but we are doing both the pt and family member a diservice by not assessing them individually. Many adolescents are too young to be thrust upon this situation and this is just too much responsibility and it can also undermine the patient/parent. I would like to talk about this more in group. I love your idea about acknowledging your knowledge defecits with their culture because really humility breeds theraputic relationship building and allows people permission to open up to the clinician. In this situation, it is an excellent conscious use of self, and this concept does show up on the test
The scary thing for me is I really did not have any diversity until I went to college. I went to Woodinville High which I think there where 2 african Americans in my class. In the rec therapy field and now social work I hae worked with a varity of cultures, but the one that I have most experiene in is people with disabilites. I know this is a different population then what a lot of people think is diversity. Since I worked about 8 or so years with people with disabilites I am very passioniate about this culture. Even little things like not goign into a bathroom reserved for a person with a dsiability. When I was at the airport this weekend, the disabled stall was open and a person basically told me to use it and I said "Well it is reserved for people with dsiabilites and there response basically was wel they are not here so I am using it. I use to work at a a day center that servies people 18 years and older with a varity of disabilites and race. I remember one day we were visting the senior center and the active seniors were looking at my folks like they were ailens. I know part of it was they were facing what could happen to them anytime (ie peopel that have CVAs etc) but it was very sad to see them act thsat way. In the hospital setting, whever there is a person with a disability, the topic of hospice coems up all the time. This really upsets many of the families of these pts, many people see these folks and think they have no quality of life. My career has a recreation therapist was essential to this population, The field of social work is essentail for this field as well to advocate for the person and have peopel se the person and not the disability first. Currently I have a pt that is younger that has part of his brain removed years back and was somewhat active pwior to him comign to the hosptial. He wil need a SNF. Due to his disability, he had a impulaive moment and jumeped out of the cab because he didnt think he had enough money for the cab. So I am talkign with al these SNFs and rally advoating for him. Whenever I work with a person with disabily, tehy always seem to touch a special place in my heart. I hope thinking people with disabilits is a section of culteral diversity was okay. To add the mental health piece to folks with disabilites, this is pretty comon to see with many of the differnt populatons out here. Especailly if the person was totally indepent prioe to the event or has a progressive diease ( like Huntingtons, etc . People with Huntington diease has a high risk of suicide as well, because their mind is typcially one of the last to go so they know and see what is happening. Also yoou have 50% chance of giving it to a child if you decide to have children. Many times folks dont know they havfe it util they have in theri mid 30s and they already started a family..
Culture is briefly defined as a common set of beliefs, norms, and values. Cultures influence how patients communicate and manifest their symptoms, how they cope, the range of their family and community supports, and their willingness to seek treatment.
ReplyDeleteThere are a few reasons why I believe racial minorities do not seek mental health treatment.
It is true that striking disparities in accesss, quality, and availability of mental health services exist for racial and ethnic minoroties. A history of racism discrimination, and economic impoverishment can combine with mistrust and fear to keep minorities from using services and receiving appropriate care. There are not as many practitioners who are of their own culture or speak their language. I can understand why people are afraid of seeking help.
In poorer racial groups and nations, social networks are a critical part of healing and recovery as patients continue to participate in rather than becoming isolated, as is often the case in developped nations like the US. Racial minorities can have different definision of "treatment". How do we as clinicians approach race specific treatment method?
I can speak from my own culture. In most Asian cultures, there is great shame and stigma associated with mental illnesses. Their suicide rate is very high, but many people are untreated. Things are slowly changing now, and mental illnesses are being more addressed. I thought it was interesting when I learned how Asian people with mental illness often present with more severe physical conditions than other ethnic groups do. I wonder if this suggests that the distress from the shame and stigma associated with mental illness could cause physical symptoms.
Has anyone had any experience with racial monorities with mental illness? What are the barriers? What do we as MSWs need to do to advocate racial minorities' healing and treatment in America's medical model?
Thanks for all of this information Yurika. I have not really had the opportunity to work with many minorities as an MSW but I have a few thoughts on the subject. I think that a few of the barriers that we face as clinicians are the fact that we have to "hurry up" with our patients (this is with all pts.). I currently work in a fee-for-service agency and we usually only have so many sessions to offer our pts. so we have to get right down to business. I think that in our line of work we don't get an opportunity to develop an in depth relationship which should be built on trust. This, I believe, hinders us from getting minority pts. to "buy in" to what it is we are saying. We don't get create a trusting relationship to push past the shame and stigma that Yurika talked about.
ReplyDeleteAs clinician's I think that it is impossible to know a great deal about various cultures but I believe that we have a duty to be open and learn from our pts. We need to ask for help and seek out new information from others who may have more knowledge. I remember when I was doing my internship in grad school and we had to do a phone cunsultation with someone when we had a pt. that was a minority. For the most part, I think this was a joke, but at least it was something. The consultant gave very generic information but at least it was holding people somewhat accountable.
I think that it was interesting that I heard a radio advertisement today that was about what we are talking about on this blog. The advertisement was basically talking about wanting a Latino woman to get a mammogram but if she is informed that the dr. wants her get this testing, she may not return because she automatically associates this test with having cancer and may not return. The advertisement was talking about restating it something like this, it is important for you to come back and get this screening so that you can be around for a very long time to take care of your family. I think that this seems so simple but it really is not. I think I get so caught up in doing things the same way all the time, I could be doing a better job at watching the words I use with others.
My work with minorities comes moslty in the form of African Americans. I have worked a little with Hispanic population, moslty in the form of chemicald dependency. And within all of this, these populations have mostly been adolescents, therefore my work with an adult minority population is very limited. Well, now that I think a little more, my work with a minority adult population would mostly include lesbian/bi-sexual (again mostly in CD residential and IOP setting). My most vivid case though was the one I talked about a couple of groups back, the Chinese woman who came in with S/I secondary to depression and a DV relationship. I guess we also have to remember that working with females is a form of a minority as well, as we all know that there is a distinct priveledge barrier between the 2 genders.
ReplyDeleteI think we have to educate ourselves. We will never know what it is like to walk in the shoes of a specific minority, but as therapists, it is our job to be empathetic and compassionate with excellent listening skills. We need to be aware of the cultural norms and the value system they are coming from and in turn even though it may be completely different from ours, we can provide listening skills and appropriate guidance according to the specific culture we are working with. It reminds me of working in the westernized american medical model.... pt's come in from different countries/religions/cultures and they are scared, resentful, hesitant and may not believe in the medical model we practice from. It is our job as advocates to help the interdisciplinary team understand this.... example: pt from another culture passes away/the family would like 24hrs with the body to pray and partake in religous ceremony..... this has the MD's, RN's upset because this is not "how we dot it" and the hospital needs the bed (again as I am a strong believer in after working as a medical social worker, everything is monetarily driven)...... maybe this person passed away unexpectedly and now here they are being forced to forgo their traditions (and to some this could be a matter of going to heaven/hell). I ran across this very example at Evergreen. Everyone was worried about the body smelling, cleaning the room etc. What about the pt and the family? The pt isn't just a "medical experiment"..... they are a hum with a soul. Everyone who we see in our practice is coming to us for support and guidance. We need to pay them respect and begin our journey with them by taking responsibilty to educate ourselves on their background and beliefs.
Yurika, I think you prompted an excellent discussion. So, many great things being discussed. I do think its interesting that many Asians will present c more physiological symptoms as it is more socially accepting in many Asian cultures than to present with actual psychiatric symptoms where there is a lot of shame attached. I have also had first hand experience with this deep kind of shame that many Asian families feel when there loved one's have been in the hospital for depression or hallucinations or delusions. In fact, on many occasions in these situations I have noticed a strong disconnect c patriarch and the client as by the time the pt's symptoms are acute enough to be in the hospital, they see their father as a barrier to getting well as they may feel they are unlikey to understand what they are dealing with. Team, Important for to test to know that Asians displaying psychotic symptoms respond to lower doses of Anti psychotics. My other thought on the issue is that with several asian cultures, families don't want the patient to have any suffering they want share take as much stress off the patient as they can which my actually be counter intuiative in a psych situation.
ReplyDeleteTeam aslo recall questions on the tests, Adolescent Native American Males and African American males have high than average suicidal rates as well as gay and lesbian men and women
With Native American Populations, Family systems modalities are very effective. Family and extended family is very important in this culture. Providers/Clinicians have to be very careful in looking at his pt as an identified client to a whole family that needs treatment or needs to be highly valued considered in the treatment process. Irrespective of the environment whether in the hospital setting, outpt settings or private settings when we have a client referred to us we need to proactively involve the family otherwise we risk isolating this client within his family and we approach things with a very limited westernized approach without considering the holistic ideologies of their culture. Team keep in mind that Westernized Modalities can be very Eurocentric or engage in Universalism the idea that our way is the norm or standard for everyone or the Dichotomous way of thinking where differences are inferior vs diunital thinking where differences are just that, different but are able to co-exist with eachother
ReplyDeleteI think that one of the dilemmas I have when working with individuals from various cultures is that they do not necessarily identify themselves as they see their parents. The assessment questions that we ask are thorough and there is a section on how they identify themselves including cultural and ethnic groups. I mostly work with adolescents and they seem to usually always indicate whether they are Native American and/or Hispanic for example but they indicate that they don’t associate with their culture. Their families on the other hand, are usually puzzled because “they were not brought up that way.” I understand that many cultures are very private but for those few families that I have encountered, they appear to be truly upset about the decisions their child is making. Another barrier that we sometimes face is a language barrier. We have not had very good luck with the youth translating so we have to get an interpreter, which is difficult at times. I appreciate the time that we have in developing a rapport with the pt. and their families in the setting that I work in but I must say we don’t usually have success with people who are from various cultures.
ReplyDeleteI agree with using family systems theory with our pt. I think that it is incredibly important to educate families and to try to show the family members how their participation may benefit the pt. and their overall family. I also think that it is important to indicate that I may not know something and to allow those family to teach me.
Strong work Tara. There are a few Gems in your posting Tara. One of them being I think it is important to not only consider culture but where is your client developmentally in her life span and how does cutural play with that. An you are absolutely right, it isn't uncommon for their to be disconnect between adolescents from different cultural backgrounds who have English and American cultural norms, folkways, mores mastered and their parents who may not but still parent the way they were parented in their unique cultures. Then you bring up the idea of an interpreter. I think interpreters in these situations are absolutely necessary. As clinicians in these situations we get lazy when their is an English speaking relative particulary dtr or son, but we are doing both the pt and family member a diservice by not assessing them individually. Many adolescents are too young to be thrust upon this situation and this is just too much responsibility and it can also undermine the patient/parent. I would like to talk about this more in group. I love your idea about acknowledging your knowledge defecits with their culture because really humility breeds theraputic relationship building and allows people permission to open up to the clinician. In this situation, it is an excellent conscious use of self, and this concept does show up on the test
ReplyDeleteThe scary thing for me is I really did not have any diversity until I went to college. I went to Woodinville High which I think there where 2 african Americans in my class.
ReplyDeleteIn the rec therapy field and now social work I hae worked with a varity of cultures, but the one that I have most experiene in is people with disabilites. I know this is a different population then what a lot of people think is diversity. Since I worked about 8 or so years with people with disabilites I am very passioniate about this culture. Even little things like not goign into a bathroom reserved for a person with a dsiability. When I was at the airport this weekend, the disabled stall was open and a person basically told me to use it and I said "Well it is reserved for people with dsiabilites and there response basically was wel they are not here so I am using it.
I use to work at a a day center that servies people 18 years and older with a varity of disabilites and race. I remember one day we were visting the senior center and the active seniors were looking at my folks like they were ailens. I know part of it was they were facing what could happen to them anytime (ie peopel that have CVAs etc) but it was very sad to see them act thsat way.
In the hospital setting, whever there is a person with a disability, the topic of hospice coems up all the time. This really upsets many of the families of these pts, many people see these folks and think they have no quality of life. My career has a recreation therapist was essential to this population, The field of social work is essentail for this field as well to advocate for the person and have peopel se the person and not the disability first. Currently I have a pt that is younger that has part of his brain removed years back and was somewhat active pwior to him comign to the hosptial. He wil need a SNF. Due to his disability, he had a impulaive moment and jumeped out of the cab because he didnt think he had enough money for the cab. So I am talkign with al these SNFs and rally advoating for him. Whenever I work with a person with disabily, tehy always seem to touch a special place in my heart.
I hope thinking people with disabilits is a section of culteral diversity was okay. To add the mental health piece to folks with disabilites, this is pretty comon to see with many of the differnt populatons out here. Especailly if the person was totally indepent prioe to the event or has a progressive diease ( like Huntingtons, etc . People with Huntington diease has a high risk of suicide as well, because their mind is typcially one of the last to go so they know and see what is happening. Also yoou have 50% chance of giving it to a child if you decide to have children. Many times folks dont know they havfe it util they have in theri mid 30s and they already started a family..
Okay sorry I hope I didnt go off on a tagent