Textbook on Diversity and Cultural Sensitivity in Mental Health

This dangerous prospect threatens our society, our health care system, and the mental health of the patients we serve. The health care system—and especially mental health facilities—must be immune to this toxin.

Quotation Page

Nadina Persaud, for the opportunity to edit a second edition of the 2014 The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health – their guidance has been invaluable. In addition, we would like to thank both Marc Nivet, EdD, MBA, and Monica Ramirez Basco, PhD, for reviewing our textbook and providing insight from their multiple professional lenses in the preface and foreword, respectively.

Acknowledgments

Finally, we would like to acknowledge Jerrold Rosenbaum, MD, the series editor of the textbook and chairman of the Department of Psychiatry at Massachusetts General Hospital/Harvard Medical School.

Innovative Ways to Understand Diversity

Specific Populations

Contributors

Heidi Ellis, PhD Department of Psychiatry, Boston Children’s Hospital/

Anne Emmerich, MD Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Zayas, MD Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Hospital, Boston, MA, USA.

Diversity Dialogue

Workplace diversity initiatives in the United States arose out of the cultural and regulatory changes of the 1960s. One of the most fundamental factors affecting intercultural dialogue in the United States is segregation.

Table 1.1 Cross’ five step black identity development model [34]

Getting to Know Each Other”

Each diversity dialogue helped me move forward and open my mind to the next group's experiences. I am grateful that the safe spaces created by the diversity dialogue exist and privileged to be a part of it.”

Didactic/Cognitive Learning In our early Diversity Dialogue workshops,

Common themes are stories about countries of origin, religious traditions, cross-cultural marriages, lost loved ones or hobbies that led to a community that became family. Younger members, such as students and house staff, often share stories about study abroad years when they felt an awareness of their own heritage while immersed in the environment of another culture.

Building Awareness/Small Group Discussions

2-minute introduction of themselves, without reference to their professional activities or accolades, with the prompt “tell a story about where you come from – geographical, spiritual, cultural, ethnic, socio-economic, your home culture or any other cultural theme that matters have contributed to making you the person you are today.” Participants are encouraged to bring a small object that they believe symbolizes an aspect of their cultural history to accompany this introduction.

Large Group Reflections and Intention

Diversity Dialogue does this with tools that have been associated in the literature with successful diversity efforts. The process of cultural competence in health service delivery: a model of care.

The Engagement Interview Protocol (EIP): Improving

Trinh (reds.), Die Massachusetts General Hospital Handbook on Diversity and Cultural Sensitivity in Mental Health, Current Clinical Psychiatry,.

EIP uses a streamlined approach focused on bridging patient and clinician understanding of the illness to overcome cultural barriers with the goal of engaging patients in psychiatric care. Both the patients' illness narratives and answers to the questions about illness beliefs are explored in this section of the EIP.

Cultural and Diversity Issues in Mediation and Negotiation

The mediator may be informed that one of the parties is considered fanatical by the other parties. Finally, the mediator may call for a recess and discuss what has happened to each of the parties.

Table 3.1 Gender and race discrimination in car sales White

Providing Medical Care to Diverse Populations

When the aforementioned processes do not occur, understanding interactions becomes problematic, and from a black perspective, questions of category require motive, i.e., the social history of the group creates caution. In such a scenario, the cognitive construct of the patient held by the decision maker is open to interpretation. Social identity connects the individual with those who are considered "the same". The identity (social or individual) that dominates is situational, however, and the theory suggests social comparison as a third aspect of the overlapping dynamic in the dyad of identity concepts.

It is instinctive to look at the person speaking, i.e. the interpreter; however, the focus of an interpreter-facilitated clinical interaction remains the connection with the patient rather than the interpreter. Paying attention to the patient allows observation of the patient's response to the questions and any concerns related to the answers. Thus, situational awareness and self-awareness serve as the second part of the culturally competent care equation.

Fig. 4.1 Treatment dichotomy: cognitive construct for treatment decisions involving the ethnic minority patient4 Providing Medical Care to Diverse Populations

Cultivating Courage, Compassion, and Cultural Sensitivity in News

Most studies conducted in the early to mid-2000s on media and mental health appear in psychiatric and medical journals rather than in literature written by and for the academic journalism community. Additional studies specific to mental health and shootings in the United States are emerging in the areas of law, criminal justice, and forensics. When journalists report on active shootings in the United States, racial, ethnic and mental health stereotypes are often associated.

Mental health professionals' input into the media can help reduce the stigma associated with mental illness and increase the data available to the public about treatment options. Experiencing mental health issues that affect such a large part of the population allows us to understand the faces and stories associated with mental illness through first-hand accounts. This openness from the very people who live and sometimes struggle with mental health issues can yield greater understanding, so that the level of tolerance and inclusiveness can increase.

Illegal, Alien, and Other: Cultural Competency and Migration

It is then important to determine which languages are spoken by each person, which languages are spoken in the home (can the children understand, e.g. their parents?), and levels of fluency and competence in the language(s) of the host country . The consequences of this for mental health can be enormous and require sensitivity to differences, without necessarily assuming what those differences are. Assimilation, one model for adaptation, has been defined as the process by which "the culture of origin is rejected and the host culture is largely adopted, with the loss of language and customs of origin" [29], while acculturation, a second model, is a process of immersing oneself in the host country without the complete loss of language and customs, often with a goal of "biculturality" in which the person remains part of one's culture of origin, but can function in and participate in the host culture.

Epilepsy knowledge, attitudes, and practices (KAPE): a survey of Chinese and Vietnamese adults in the United States. Stigma keeps poor young immigrant and US-born black and Latina women from seeking mental health care. Lay beliefs about emotional problems and attitudes toward mental health care among parents and youth: exploring the impact of immigration.

Psychiatry for People of African Descent in the USA

Even at this time, misdiagnosis of African Americans was identified as a major problem [13, 14], which continues today [15]. Adults of two or more races are more likely to use mental health services compared to whites and African Americans. There are four key goals in assessing, treating, and nurturing mental well-being in African Americans.

African Americans report that they are more likely to receive support from their church or religious institution than from mental health professionals [34]. Research has shown that the incidence of poor metabolizers is 1.9-7.3% in African Americans compared to 3-10% in Caucasians. Mental health of African Americans and Caribbean blacks in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Table 7.1 Mental illness in PAD Mental illness a

American Indian and Alaska Native Mental Health

This appears to be true of the delivery of mental health services in general as well as in the American Indian and Alaska Native case [64]. Numerous American Indian and Alaska Native mental health practitioners and scholars assert that American Indians and Alaska Natives believe that individuals choose their state of well-being. American Indian and Alaska Native children and mental health: Development, context, prevention, and treatment.

Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature. Identifying effective mental health interventions for American Indians and Alaska Natives: A literature review. Mental health services for American Indians and Alaska Natives: Needs, utilization, and barriers to effective care.

Mental Health of Arab Americans

Cultural Considerations for Excellence of Care

Mental health services in the United States are often underutilized by immigrant populations [ 7 - 9 ]. However, in recent years, Arab Muslims became one of the fastest growing populations in the United States [1]. In addition, Arab Americans may have a general disbelief in the benefits of mental health services.

Lack of mental health services in the home country can result in a lack of perception of the need to seek professional help [3]. Shannon PJ, Vinson GA, Cook TL, Lennon, Mental Health Service Use Among Immigrants in the United States: A Systematic Review E. The health of Arab Americans living in the United States: a systematic review of the literature.

Table 9.1 Demographic description of Arab Americans

An Approach to Mental Health in Asian Americans

According to the groundbreaking 2001 Surgeon General's Mental Health Report, there was little adequate data on the prevalence of mental health disorders in Asian Americans. Extensive studies have provided useful data on the prevalence of mental health diagnoses among Asian Americans and the use of mental health services. More recent studies have questioned the assumption of a relationship between somatization and perceived need for mental health treatment in Asian Americans.

Based on data analyzed from the NLAAS study, physical symptoms in Asian Americans were associated with a greater sense of need for mental health treatment [24]. However, somatization alone cannot explain Asian Americans' lower use of mental health services [ 24 , 25 ]. While some Asian Americans with somatization seek mental health care, others may seek help in primary care or in a medical specialty.