The Concept of Mental Health in Communities of African Descent: The Need for Culturally Inclusive Practice

Conference held at Belmont Center for Comprehensive Treatment on October 6, 2004

New Directions in Geriatric Behavioral Health: Serving Older Persons of Different Cultures The Mental Health Association of Southeastern Pennsylvania

Norma D. Thomas DSW LSW ACSW
President
Center on Ethnic & Minority Aging, Inc.

[Slides used during presentation]

UNDERSTANDING AGING AND MENTAL HEALTH THROUGH THE EYES OF OTHER CULTURES

AFFIRMATION

I attract who and what I am.
All change is from the inside out.
My life is a reflection of the conflict
Between who I am and who
I must become to be a better citizen of the world.
I can seek refuge in new pleasures, people or places, but I can never escape myself.
I will learn who I am and then I will learn about you.

(Author Unknown)

THE CREATOR GAVE US DIVERSITY FOR A REASON. ONCE WE LEARN TO EMBRACE THIS FACT AND UNDERSTAND OUR DIFFERENCES, WE WILL BE EQUIPPED TO EMBRACE THE COMMONALTIES OF OUR HUMAN CONDITION. THE CIRCLE THEN WILL BE UNBROKEN.

UNDERSTANDING OURSELVES

YOU CAN NOT WALK IN SOMEONE ELSE'S SHOES UNTIL YOU LEARN TO WALK IN YOUR OWN.

WHAT IS CULTURE

Culture: Influences our psychological, physiological and sociological responses to everything in the world.

• Beliefs
• Values
• Attitudes
• Mental Maps
• Worldview
• Learned and shared
• Ancient
• Passed down from generation to generation
• Insures the survival of a people

FEELINGS

SOMETIMES I FEEL LIKE A MOTHERLESS CHILD

Sometimes I feel like a motherless child
Sometimes I feel like a motherless child
Sometimes I feel like a motherless child
A long ways from home
A long ways from home

Sometimes I feel like I'm almost gone
Sometimes I feel like I'm almost gone
Sometimes I feel like
I'm almost gone
A long ways from home
A long ways from home

Sometimes I feel like a motherless child
Sometimes I feel like a motherless child
Sometimes I feel like a motherless child
A long ways from home
A long ways from home

from American Negro Spirituals by J. W. Johnson, J. R. Johnson, 1926

IMMIGRANT/REFUGEE EXPERIENCE

• LANGUAGE BARRIER
• TRAUMATIC EXPERIENCES IN COUNTRY OR ORIGIN
• FAMILY SEPARATION
• ECONOMIC DEPENDENCE
• LACK OF TRUST
• LOSS OF INDEPENDENCE
• CHALLENGES IN RETAINING CULTURAL AND RELIGIOUS IDENTITY

WHAT IS MENTAL HEALTH?

Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society.

Surgeon Genera's Report

HEALTH/MENTAL HEALTH CARE BELIEFS AND PRACTICES

• Health/Mental Health is a "state of well-being"
• Causes of disease/illness linked to offending God or other spirits
• Common beliefs in "evil eye"; demonic possession; hexes; etc.
• Emotional problems blamed on nerves
• First line of cure often prayer or seeking natural healers

Value Differences

• Ethnocultural Groups
  • Elder Veneration
  • Group Welfare/Collective
  • Harmony With Nature
  • Fate
  • Being
  • Personal Interaction Dominates
  • Cooperation
  • Past/Present Orientation
  • Formality
  • Indirectness/Ritual (Face)
  • Spiritualism

CROSS-CULTURAL WELL-BEING

WELL-BEING IS THE HOLISTIC CONNECTION OF THE MIND, BODY AND SPIRIT FUSED TOGETHER THROUGH THE LENS OF ONE'S CULTURAL WORLD VIEW.

STATISTICS-OVERVIEW:

OLDER ADULTS AND MENTAL HEALTH

• 7% INPATIENT SERVICES
• 6% MH SERVICES FROM

HEALTH CENTERS

• 9% PRIVATE PSYCHIATRIC

CARE

• 3% OF MEDICARE REIMBURSEMENT IS FOR PSYCHIATRIC CARE

National Consumer Supporter Technical Assistance Center, January, 2000.

STATISTICS

Philadelphia

• 32,000 cases of Alzheimer's Disease or 10% of the elderly age 65-84
• 9% (1 in 10) of older adults report a diagnosis of a mental health condition

Philadelphia Corporation for Aging, 2004

STATISTICS

SOUTHEASTERN PENNSYLVANIA

• 11.7%

OVERALL REPORT DEPRESSIVE SYMPTOMS

• 60-64 13.2%
• 65-74 10.3%
• 75+ 14.9%

Philadelphia Health Management Corporation, 2002 Household Health Survey

Alzheimer's Disease

• ONSET ALMOST 7 YEARS EARLIER IN LATINO POPULATIONS AS COMPARED TO EURO-AMERICANS
• THREE TIMES MORE LIKELY IN AFRICAN AMERICANS THAN EURO-AMERICANS AGE 65-85; 1.5 TIMES HIGHER 85+

Reported at the Alzheimer's Disease Conference, Phila., Pa. 2004

DIVERSITY IN THE OLDER POPULATION 65+

• 3,048,055 >4.75% AFRICAN DESCENT
• 1,051,640 >17.72% ASIAN
• 2,055,352 >15.65% LATINO/HISPANIC
• 4,366,174 >14.03% FIRST NATIONS/ALASKAN NATIVE
• 305,524 >15.23% HAWAIIAN/PACIFIC ISLANDER

U.s. Census Bureau, 2000-2003 Annual Estimates

MENTAL HEALTH AGING AND PEOPLE OF COLOR

• LESS ACCESS TO AND AVAILABILITY OF MENTAL HEALTH SERVICES
• LESS LIKELY TO RECEIVE NEEDED MENTAL HEALTH SERVICES
• POOR QUALITY OF TREATMENT
• UNDEREPRESENTED IN MENTAL HEALTH RESEARCH

BARRIERS TO MENTAL HEALTH SERVICES

• MISTRUST
• SELF-RELIANCE
• LACK OF BILINGUAL/BICULTURAL WORKERS
• TREATMENT MODALITIES & DIAGNOSTIC TOOLS BASED ON EURO-AMERICAN MODELS
• LACK OF RESOURCES/INSURANCE
• COMMUNITY STIGMA
• PHYSICIANS DON'T REFER
• THINK BEYOND A "UNITED STATES" PERSPECTIVE
• SYSTEMS AREN'T WELCOMING

WAYS TO OVERCOME

• PLACE SERVICES WHERE PEOPLE ARE;
• WORK WITH PRIMARY PHYSICIANS
• PARTNER WITH NATURAL HEALERS IN COMMUNITIES INCLUDING RELIGIOUS LEADERS
• EFFECTS OF RACISM ARE CUMULATIVE-IN ORDER TO HAVE A SUCCESSFUL OLD AGE, YOU MUST HAVE SUCCESS THROUGHOUT YOUR LIFE.

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