Tuesday, July 16, 2013

Mental Health & Minorities


The Statistics

African Americans
   African Americans are 20% more likely to have serious psychological distress than non-Hispanic Whites.
   African Americans are half as likely as non-Hispanic Whites to receive antidepressant prescription treatments.
   The suicide rate among African Americans ages 10 to 14 increased 233% from 1980-1995, as compared to 120% of Non-Hispanic Whites.

American Indians/Alaska Natives
   Adolescent American Indian/Alaska Native females have four times the death rate due to suicide than non-Hispanic White females in the same age group.
   In 2009, suicide was the second highest cause of death among American Indian/Alaska Natives between the ages of 10-34.
   Violent deaths (i.e. unintentional injuries, homicide, and suicide) make up 75% of all deaths during the second decade of life among American Indian/Alaska Natives.

Asian Americans/Pacific Islander
   Asian American women over 65 years old have the highest suicide rate of all women in the same age group in the United States.
   Southeast Asian refugees are prone to suffer from post-traumatic stress disorder (PTSD) as a result of immigrating to the U.S. One study found that 70% of Southeast Asian refugees receiving mental health care were diagnosed with PTSD.
   (National Native Hawaiian/Pacific Islander mental health data is limited at this time.)

Hispanic/Mexican American
   Suicide attempts for Hispanic high school girls are 70% higher than for non-Hispanic White girls in the same age group.
   Hispanics are half as likely as non-Hispanic Whites to received mental health treatment.

Serious psychological distress among adults 18 years of age and over, percent, 2009-2010
African Americans
American Indian/ Native American
Asian Americans
Hispanic
Mexican American
Non-Hispanic White
3.8
5.2
1.6
3.6
2.8
3.1

Suicidal ideation among students in grades 9–12: Percent of students who seriously considered suicide

African Americans
American Indian/ Native American
Asian Americans
Hispanic
Non-Hispanic White
Male
7.8
14.3
17.1
10.7
10.5
Female
18.1
29.9
21.1
20.2
16.1

Suicidal ideation among students in grades 9–12: Percent of students who attempted suicide

African Americans
American Indian/ Native American
Asian Americans
Hispanic
Non-Hispanic White
Male
7.7
10.0
7.0
6.9
4.6
Female
8.8
19.9
15.0
13.5
7.9
Total
8.3
14.7
10.8
10.2
6.2


Why are minorities disproportionally affected?

According to the Office of Minority Health (OMH), evidence points to a constant inequality in the health status of minorities when compared to the general population of the United States.  In part, this is attributed to the much higher rates of poverty among minorities (when compared to non-minorities).  A report by the U.S. Surgeon General indicates that living in poverty has the greatest impact on mental illness rates; poor people are two to three times more likely to have a mental illness.  This means that not only are minorities more likely to be poor, they are also more likely to have a mental illness as well.

Other factors that contribute to the higher rates of mental illness among minorities include: racism, discrimination, lack of access to health care, lack of preventative care, lack of insurance, and lack of culturally/linguistically competent health care providers/services.  In many cases, lack of access to preventative care and lack of insurance delays diagnosis.  When minorities finally seek medical care, their illness may be more chronic and require more care than non-minorities.

Possible Solutions

While racism, discrimination, shame, and stigma prevent many members of minority populations from seeking help, those who seek medical care go to a primary care setting.  Therefore, it is important that primary care physicians go through training that gives them the tools they need to help these patients.  In addition, it is important to have culturally and linguistically competent health care providers at primary care settings.  
While these options may help solve some problems, they do not completely eliminate health inequities among minorities.  Policies related to social determinants of health have a great influence on health care use.  Therefore, policy advocacy is also an important factor to achieve health equity through social justice.
           
Community Organization at Work

The California Reducing Disparities Project (funded by the Mental Health Services Act) focuses on reducing disparities among minorities.  Specifically, they focus on five populations: African Americans; Asian/Pacific Islander; Latinos; Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ); and Native Americans.  To help reduce disparities, a Strategic Planning Workgroup (SPW) was created for each population to provide the California Department of Mental Health with community-defined evidence and strategies that are population-specific.
The Latino SPW consists of researchers, policy makers, public mental health leaders, consumers and advocates, community health leaders, ethnic services managers, and education professionals.  Together they have developed a long-term research and policy agenda to help reduce disparities in mental health services for Latinos in California.  The Latino SPW has created several goals including:

Short-term Outcomes
• Increase knowledge and awareness of systems, providers, communities, schools, and resources toward prevention and early intervention
• Infuse Latino SPW recommendation into all MHSA funded programs
• Conduct a series of statewide workshops and training sessions on implementation of Latino SPW recommendations
• Design metrics and measures to assess the impact of community defined solutions
• Establish local capacity-building panels aimed at reducing Latino mental health disparities

Long-term Outcomes
• Access to timely and high quality health care services
• Develop a culturally and linguistically competent mental health workforce
• Design integrated mental health and primary care services that are culturally and linguistically appropriate
• Employ community capacity building that promotes the connection of community strengths and health
• Create an educational campaign designed to reduce stigma and social exclusion
(Aguilar-Gaxiola, Loera, Méndez, Sala, Latino Mental Health Concilio, & Nakamoto, 2012, p. 12)

Latino SPW Matrix of Organizations with Community-Defined Evidence Programs
(Aguilar-Gaxiola, Loera, Méndez, Sala, Latino Mental Health Concilio, & Nakamoto, 2012, p. 47-50)

Information provided by:
U.S. Department of Health and Human Services Office of Minority Health
Mental Health Data & Statistics
Mental Health 101
&
University of California Davis Center for Reducing Health Disparities
Community-Defined Solutions for Latino Mental Health Care Disparities: California Reducing Disparities Project
http://www.ucdmc.ucdavis.edu/newsroom/pdf/latino_disparities.pdf

Friday, June 28, 2013

The Stigma Behind Mental Health- PSA


“There is a very large group that I think of as the silent successful—people who get well from psychiatric illness but who are afraid to speak out. This reluctance is very understandable, very human, but it is unfortunate because it perpetuates the misperception that mental illness cannot be treated.”                                          -       Kay Redfield Jamison


People that suffer from mental health issues are stigmatized.  This means they are labeled as different from others, or “less than” others.  Stigma was defined by Goffman as “an attribute that is deeply discrediting,” where a person is diminished “from a whole and usual person to a tainted, discounted one.”  Stigma leads to negative side effects that include social isolation, lower academic achievements, less access to treatment, and limited opportunities (Tsao, Tummala, & Roberts, 2008). 


Stigma not only affects people with mental illness, but their family as well.
-       Parents are often blamed for causing mental illness in their children through poor parenting.
-       Children are often perceived as being somehow tainted by their parents’ mental illness.
-       …Survivors of suicide, as compared with other bereaved persons, experience more guilt and less social support. (Tsao, Tummala, & Roberts, 2008, pp. 1)

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”                                      - Bill Clinton

Stigmas add barriers to recovering from mental health illnesses.  There are three campaign approaches commonly used to fight stigma.
1.    Protest:  These campaigns try to have stigmatizing media messages withdrawn.  Since media has a very powerful role in influencing public opinion, it is important that health professionals work with local media to make sure that appropriate media messages are passed on.
2.    Education: These campaigns increase the knowledge of the public and provide accurate information.
3.    Contact:  This type of campaign involves positive interactions with people that suffer from mental illness.
All these approaches have been shown to reduce stigma. By increasing knowledge and awareness of mental health issues we can reduce the stigma associated with seeking help for mental health illnesses (Tsao et al., 2008). 


This PSA was made in Canada, but all the information is very relevant to mental health everywhere.

Reference
Tsao, C. P., Tummala, A., & Roberts, L. (2008). Stigma in mental health care. Academic Psychiatry, 32(2), 70-72.