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Divine and Conquer: Overcoming Mental Health Disparities

Divine and Conquer: Overcoming Mental Health Disparities. Pathways to Promise: Interfaith Ministries and Mental Illness 2009 Faith-Based National Summit Companions on the Road to Recovery from Mental Illness Pathways for the 21 st Century Belleville, Illinois September 30, 2009

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Divine and Conquer: Overcoming Mental Health Disparities

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  1. Divine and Conquer:Overcoming Mental Health Disparities Pathways to Promise: Interfaith Ministries and Mental Illness 2009 Faith-Based National Summit Companions on the Road to Recovery from Mental Illness Pathways for the 21st Century Belleville, Illinois September 30, 2009 Annelle B. Primm, M.D., MPH Director, Office of Minority and National Affairs American Psychiatric Association

  2. Major Diverse Racial Ethnic Groups in U.S. • Latinos/Hispanics - 15% • African Americans - 13% • Asian American/Pacific Islanders - 5% • American Indians/Alaska Natives - 1% U.S. Census 2007

  3. Ethnic and Racial Disparities • Mental Illness affects all • Striking disparities in MH Care for 4 major ethnic & racial groups • Less likely to receive services • Poorer quality of care • Underrepresented in MH research • Disparities impose great disability burden on these populations SG Report on MH, Supplement on Culture, Race & Ethnicity, 2002

  4. Culture Influences Mental Illness and Mental Health • Communication (verbal and nonverbal) • Manifestation of symptoms • Family and community support • Health-seeking behaviors • Support systems and protective factors • How people perceive and cope with mental illness • How doctors interact with people with mental illness • Stigma and shame associated with mental illness • Spirituality (predestination, views of illness, etc) (Surgeon General, 2001)

  5. Factors in Mental Health, Mental Illness and Service Use • Environmental factors • Economic impoverishment • Racism • Discrimination • Mistrust and fear U.S. Dept. of Health and Human Services Office of the Surgeon General, SAMHSA August 2001

  6. Historical Realities for Diverse U.S. Populations African Americans Middle Passage and slavery American Indians Forced dislocation Asian Americans Internment Hispanics Harsh immigration policies

  7. Disparities in Seeking Mental Health Care African Americans: more likely to use emergency services or primary care providers than mental health specialists. (Surgeon General, 2001) Asian Americans: only 4% would seek help from a mental health specialist vs. 26% of whites. (Zhang et al, 1998) Latinos: less than 1 in 11 with mental disorders contact mental health specialists, and less than 1 in 5 contact primary care providers. (Surgeon General, 2001) Native Americans: 44% with a mental health problem sought any kind of help, and only 28% of those contacted a mental health agency. (King, 1999)

  8. Mental Health Disparities • Underuse of community outpatient care • Use of alternative sources of help (faith, family, folk) primary care and alternative medicine • Later entry into treatment, especially at the crisis or emergency stage • High drop-out rate and fewer treatment sessions • High rates of inpatient care, especially involuntary Cultural Competence Standards, 1997

  9. Mental Health Disparities • Less access to bi-lingual services • More likely to be misdiagnosed • Less evidence based care • More inpatient hospitalizations • Less follow up after psychiatric hospitalization • More seclusion and restraint

  10. Vicious Cycleand High Need Populations Violence and Incarceration Poverty, Homelessness, Unemployment Substance Abuse Unmet Mental Health Needs Poor Physical Health STIs, DM, CAD, CA, etc

  11. Spirituality and Alternative Sources of Care • Spirituality has an important role in many diverse racial/ethnic communities. • Can promote mental health education and prevention • Key source of support (Surgeon General, 2001) • However, people of color may rely solely on spiritual support in lieu of professional treatment. • Propensity to use alternative care for religious or cultural reasons: 12% of African Americans 27% of Asian Americans 22% of Hispanics 4% of Non-Hispanic Whites (Collins et al, 2002) • Lifetime help-seeking from traditional or spiritual healer for psychiatric disorders in American Indians: • 37% and 20% males (Southwestern and Northern Plain tribes) • 41% and 19% females (Southwestern and Northern Plain tribes) (Beals et al, 2005)

  12. (Wintz and Cooper, 2003)

  13. Hispanics/Latinos

  14. Asian Americans

  15. African Americans

  16. American Indian and Alaska Native

  17. Culturally Competence Health and human services are offered and delivered in a way that are sensitive to the language, culture and traditions of non-native immigrants, migrants and ethnic minorities with the goal of minimizing or eliminating long standing disparities in the health status of people with diverse racial, ethnic or cultural backgrounds. (www.icfdn.org)

  18. Cultural Competence • “Cultural competence is a set of values, behaviors, attitudes, and practices within a system that enables people to work effectively across cultures.” (Office of Minority Health) • Cultural competence is the ability to work effectively and sensitively within various cultural contexts.

  19. Characteristics ofCultural Competence • Cultural self-awareness (introspection) • Awareness of the cultural context of the other • Understanding the dynamics of the differences • Development of cultural knowledge • Ability to adapt and practice skills to fit the cultural context(s) of others

  20. Recovery-Oriented Care It is important to convey a sense of hope and the fact that mental illness is treatable. “The American Psychiatric Association endorses and strongly affirms the application of the concept of recovery …. The concept of recovery emphasizes a person’s capacity to have hope and lead a meaningful life, and suggests that treatment can be guided by attention to life goals and ambitions. It focuses on wellness and resilience and encourages patients to participate actively in their care ….” (APA, 2005)

  21. Public Health Model • Population perspective – tip of the iceberg • Risk factors and protective factors • Prevention: • Primary • Secondary (early intervention) • Tertiary (chronic care, maintenance) • Determinants of Health • Individual Biology, Individual Behavior, Social Environment, Physical Environment, Access to Quality Care, Policies & Interventions

  22. Protective and Resilience Factors • High levels of religious involvement • Social participation and voluntarism (neighborhood, community, and professional organizations) • Social support from interpersonal relationships with family and friends

  23. Biopsychospiritualsocial Model (Torres) • Focus on spiritual dimension allows for a truly holistic approach • Importance of religious influences and involvement for wellness • Provides a common language for faith community and mental health community • Allows for culturally tailored care increasing access, quality and satisfaction with care

  24. Mental Health & Faith Community Collaboration • Mental illness affects a significant portion of the community and causes significant disability • Affected, religious individuals may have unmet needs in current mental health system • A significant percentage of affected individuals are within reach of the faith community (presence and TRUST) • Faith community role in providing support and connecting people with unmet health and mental health needs to appropriate services

  25. Interventions • Mental illness screening • Public education • Training among gatekeepers (primary care, schools, faith community) • Collaborative projects between mental health and the faith community • Use of educational videotapes such as Black and Blue and Gray and Blue featuring faith community leaders

  26. Spirituality and Stigma • “… other people who are of your faith who tell you, you don’t pray, you need to pray harder, that’s all you need to do. That’s not true.” • “My mother said, “Let go and let God, and you better not go to no doctor”

  27. Quote From Black & Blue “Being the spiritual young man that I am, I would go to God [for treatment of depression], and you know what God’s gonna do,he’s gonna send you to a doctor…”

  28. Quotes From Black & Blue “[Regarding depression]… I wouldn’t saydon’t pray, I would say don’t just pray. I would say, admit you have an illness… like other illnesses, put yourself in treatment, and stay in prayer.”

  29. Hispanic Mental Health DVD and Guidebook

  30. In Living Color: Treating Depression in Diverse Populations • CME curriculum to help primary care MDs better recognize and treat depression in ethnically and racially diverse populations • APA-NAMI collaborative utilizing consumers, MDs, and family members as trainers • Combining science plus “lived experience” • Seeking support to train more trainers (MDs, consumers, family members) and disseminate the program nationally: CA, FL, LA, MO, MS, TN

  31. All Healers Mental Health Allianceahmha.net • Psychiatrists, MDs of other specialties, faith-based leaders, social workers, nurses, psychologists, and other health advocates from across the nation • Formed as a result of Hurricane Katrina • Mobilized to facilitate long-term mental health response, resilience and recovery to disaster survivors and their caregivers

  32. All Healers Mental Health Alliance • Facilitate screening, referral, tracking, case management • Establish a network of culturally competent mental health professionals • Link with primary care, faith community, schools • Training and consultation to healers and caregivers (care for caregivers) face-to-face and using videoconferencing and other technologies

  33. What can you do to eliminate disparities? • Know your population • Demographics • Socio-environmental conditions • Epidemiologic vulnerabilities (health and mental health • Share information about mental illnesses • Provide services that promote mental health in the faith-based setting • Identify and link to “faith-friendly” mental health resources

  34. Examples of Faith, Health, Mental Health Integrative Efforts • Research on mental health and spirituality (Mattis) • Pastoral care/mental health system collaboration (Ronsheim) • Biopsychospiritualsocial model, PRAISE Project, Center for the Integration of Spirituality and Mental Health, Annual Mental Wellness Promotion Service Initiative, 1st weekend in October (Torres, thecismh.org) • Faith/health collaboration, boundary leadership, leading causes of life (Gunderson)

  35. Take Away Messages • Faith, spirituality and mental health are linked • In the face of physical and mental illness, many turn to the faith community for hope and help • Diverse racial, ethnic and cultural groups who may see mental illness as a failure of faith and often experience mental health disparities, rely heavily on the faith community and primary care because of trust and stigma of mental health help-seeking, respectively • Alignment and collaboration of faith, health, and mental health sectors is a potentially transformative public health strategy for optimizing health, longevity, mental health, wellness and recovery

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