Model Minorities and Mental Health

Hello All! I originally posted this blog for the clinic I work for, Freedom Institute, here. Addressing the concerns of the Asian American community in regards to mental health care is an issue I am passionate about. I hope you enjoy the post. 

May is both Asian American and Pacific Islander (AAPI) Month and Mental Health Awareness Month. I happen to be Asian American (or a Pacific Islander, I can never decide) and a mental health care professional.  I’ve read about theinitiatives being lobbied for in Washington on behalf of the AAPI community and several blog posts/articles about depression, suicide prevention, and substance abuse treatment. As this month comes to an end, the lack of mental health parity in this community, and all the reasons for it, gives me reason to reflect on my experiences as a clinician and as an Asian American. 

About a year and a half ago, a dear family friend was in need of a referral for a family member struggling with severe alcohol dependency.  The hurdle was that the person seeking treatment only spoke his native language. I knew it would be near impossible to find any clinician – regardless of specialty – that spoke the same language.  Recently, he passed away due to medical complications related to his alcoholism. It’s a tragic loss, and since I found out I’ve kept thinking, “If only I could have found someone.”

Yet, there may have been no one to find.

This experience is not unique to me. The lack of mental health care resources for the extremely diverse AAPI community is a silent plague impinging on our universal well-being.  This community, my community, is the fastest growing ethnic group in America according to the 2010 Census1.  AAPI’s are often identified as the, “model minority,” since popular perception is that AAPI are well-educated, law abiding, and gainfully employed, thus contributing to society at large. Yet, this conceptualization of AAPI’s masks underlying concerns: immigration laws that inadvertently contribute to family trauma, crime, and poverty, and a lack of culturally and linguistically appropriate mental health care services.  According to the National Asian American Pacific Islander Mental Health Association, only 1.5 % of psychologists, 2% of social workers, 0% of psychiatric nurses and .01% of marriage and family therapists are of Asian American, Native Hawaiian and Pacific Island decent. There is no data on bi-lingual clinicians2. Furthermore, among persons in need of alcohol or illicit drug use treatment, Asian Americans or Pacific Islanders were less likely than persons of other racial and ethnic groups to receive treatment at a specialty facility in the past year (5.3 vs. 10.4 percent)3

What does this mean for mental health care professionals? We must make a concerted effort to train and hire culturally competent clinicians. We must also work with advocacy groups to educate the Asian American community about mental health to alleviate the shame that so often prevents AAPI’s from seeking appropriate treatment. Often, and this is especially true of first generation immigrants, AAPI’s somaticize mental health concerns like depression. Thus, they may seek medical treatment from a primary care physician as opposed to a qualified mental health care practitioner. Lastly, sensitivities to the particular psycho-social stressors that affect second- and third- generation Asian Americans must come into the consulting room. As is the case with many hyphenated Americans, straddling two cultures with opposing world views can create challenges that lead to depression, anxiety, and substance abuse. 

We see this in the students of color we work with in the Independent Schools: there is often an unspoken added stress of being “other” on top of traditional school stresses. Interesting, in the Independent School population I often encounter students who are AAPI and have been adopted by non-AAPI parents. These students have candidly shared the obstacles they have encounter as they navigate their social worlds. For many students of color, the greater imperative to belong to a racially homogeneous social world increases their susceptibility to alcohol and/or drug abuse.

Complicating this issue further is inherent individualism engrained in American culture which directly opposes the family-centric sense of self found in Asian cultures.  For many Asian and Asian Americans, one’s own personal struggles (albeit with depression, anxiety or substance abuse) are direct reflections of their family’s self-worth. The desire to protect the family from humiliation, AAPI who are in need of treatment will not seek it out. As we see this with the AAPI adolescents we work with, education about what substance abuse is and how to appropriately treat it are often the first treatment goals. At Freedom Institute, our clinical focus on family treatment to address substance abuse enables us to work in a manner that is culturally attuned to the AAPI population.

The breadth of challenges related to AAPI’s underutilization of mental health treatment is far too intricate to delineate in this post. “The overall health and well-being of the Nation is improved by the extent to which the entire population has access to substance use treatment when it is needed. Understanding whether Asian Americans or Pacific Islanders seek and receive specialty treatment may help improve outreach and treatment programs for this population4.” Raising awareness about these challenges to all Americans is vital, the more we are aware of these issues, the more we can do to solve them regardless of race, color or creed.

References

1. Retrieved from http://naapimha.org/wordpress/media/NAAPIMHA-Immigration-and-Mental-Health-5-13-2013.pdf
2. Retrieved from http://naapimha.org/resources/fact-sheets/
3. Retrieved from http://www.samhsa.gov/data/2k13/NSDUH125/sr125-aapi-tx.htm
4. Retrieved from http://www.samhsa.gov/data/2k13/NSDUH125/sr125-aapi-tx.htm

When the Bullies are Home for the Holidays

I originally posted this on PsychCentral.com, you can see the original here. I wanted to share this on my site since I find that the bullies from within our families are the ones hardest to beat, especially when there is an added socital pressure to have "family time" between Thanksgiving and New Years. But what if family time causes you anxiety, depression or rage? Read on...

I hope everyone reading in the United States had a happy and healthy Thanksgiving Holiday last week! When I thought about what to write after taking the holiday week off, I contemplated the numerous discussions I had both in and out of the consulting room regarding people's varied feelings about being with family during the holidays.

Families bring up powerful feelings and interpersonal dynamics. It's inevitable that old family dynamics are stirred up around the dinner table and that's what makes the holidays so difficult, our past is present...AGAIN. Sometimes the bullies of our childhood were not kids on the playground but our siblings, parents, and extended family members.

As a child, you may have felt unable to find allies and keep yourself safe. Perhaps no matter how often you told your parents that your older sibling was being mean, it was dismissed. Or what if you were told to, "Turn the other cheek, it's your brother/sister. They don't mean it." Worse, what if your parent was the aggressor?

Fast forward to 2012 and you find yourself at the dinner table. You and your aggressor get into a disagreement. Suddenly you are transported back 10, 20, or 30 years! You feel attacked, taunted and suddenly ganged up on . You feel same anger, fear and perhaps rage as you did when you were young. How do you protect yourself now?

Take a deep breath. You are no long that child but an adult. It's extremely helpful that you can recognize you are being bullied in the moment and do not have to tolerate this behavior. When I've had clients discuss their concerns about managing destructive family dynamics during the holidays, we've come up with game plans ahead of time to keep themselves sane.

Here are some points that have been helpful. Some may seem quite obvious but the obligation to our families can often times make it difficult to make decisions that are in our best interest:

• If you are away over several nights make arrangements to stay somewhere you feel comfortable Just because your cousin Sue insists you stay with her does not mean you have to!
  


• Have a means to get yourself to and from anywhere. Have a car or be familiar with public transportation Often patients feel trapped in uncomfortable situations because they are dependent on family members to bring them places. 
  


• No one particularly likes confrontation, but if you find yourself being bullied as an adult by your childhood bullies you may feel able to assert yourself now. Find your version of this statement, "I will not tolerate being treated disrespectfully/inappropriately." And then leave the area to take a minute to center yourself. Call a friend, or let your partner know that if this happens to check in on you. I recognize this is much easier said than done. You can decide to stay or go once you feel more grounded. This is where having the means to travel independently is important.


• If seeing family is just too emotionally taxing, consider a day trip (if you live close to your family) as opposed to an overnight trip.


• If you are going to travel and will stay over night(s), make other plans besides seeing family. Catch up with old friends, visit local attractions.


• Only visit one holiday a year - you can pick! Go visit family for Thanksgiving, stay home for Christmas.


• Consider alternative holiday plans - dinner with friends, volunteering, something that will leave you feeling valued.


• If you do end up having a difficult time with family over the holidays, take some time out for yourself when you return home. Everyone de-stresses differently but find something that is soothing and rejuvenating.


• Lastly,who says you have to see family? When we free ourselves from the obligation to put ourselves in situations that are emotionally unsafe, we are free to see all the other alternatives. Take a vacation/staycation (a staycation is a vacation in your home town for those who are unfamiliar with the word)!

The holidays bring up so many, often conflicting, feelings. It's important to exercise self care and recognize that while some people may welcome all the family time, others may find they can't leave their families soon enough!

Busy Blogging...on PsychCentral.com

Hello Universe!

Been way too long since I've blogged on this site! Besides running my private practice and working at Freedom Institute I've been regularly maintaining a blog on PsychCentral.com  called Beating the Bully: Cope with Bullying at Any Age. This is a "hot button" topic right now, FINALLY. 

Be on the look-out for my post tomorrow about how to cope with the bullies in your family during the holiay season. 

On Drama Therapy

Here is a blog post on Psychology Today by a man I consider a mentor, Robert Landy. He wonderfully explains drama therapy. Great read!

http://m.psychologytoday.com/blog/couch-and-stage/201204/be-and-not-be

See My Blog on PsychCentral.com!

I'm so excited to announce that my blog *Beating the Bully: Cope With Bullying At Any Age* is now live! Click here to read it and see all PsychCentral.com has to offer.