Mental Health: the hidden face of the model minority

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Mental Health the hidden face of the model
minority

• Howard Liu, M.D.
• Resident Psychiatrist
• University of Michigan
• January 2007

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Why should you listen to this talk?

• Mental illness is common
• APA community has specific needs
• You will be in a position to help

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What does it mean to be a model minority?
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SAT scores?
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Precocious musical skills?
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Medical breakthroughs?
Dr David Ho - Times Man of the Year 1996
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Model minority myth

• Highlights the superlatives
• Propagated not just by media, but by APA
  community itself
• Narrow definition

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Headlines which did not make the cut
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• Published May 8, 2001

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BBC News April 2, 2004
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BBC News November 22, 2004
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Overview

• Mental Health needs
• Barriers to care
• Solutions

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I. Mental illness is not exotic

• National Latino and Asian American Study
  (Takeuchi)
• 2095 Asian Americans nationwide
• Overall lifetime rate of any disorder 17.3
• 12 month rate 9.19
• Men poor English proficiency had higher rates
• Women native born had higher rates than
  immigrants of most disorders

Source Takeuchi, DT et al. Immigration-related
factors and mental disorders among asian
americans. Am J Public Health Jan 2007 97, 1.

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Depression

• CAPES Study 1993-1994
• 1700 Chinese Americans LA
• 6.9 lifetime prevalence dep.
• 16.9 in national sample adults

Source Mental Health Culture, Race, and
Ethnicity US Dept Health Human Services 2001.
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Suicide

• Lester 1994 suicide rates per 100,000
• Caucasian 12.8
• Asian Americans overall 7.0
• Japanese American 9.1
• Chinese American 8.3
• Filipino American 3.5
• 1999 DHHS - APA women gt 65 have highest suicide
  mortality rate of all groups
• Young women from southern India?
• Source Mental Health Culture, Race, and
  Ethnicity
• US Dept Health Human Services 2001.

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(No Transcript)
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Suicides in young people in rural southern India

• Worldwide suicide rate in 2000 14.5 per 100,000
  
• Vellore India population 108,000
• 10 year mortality rates 1992-2001 for age
  group10-19
• Female suicides 152 per 100,000
• Male suicides 69 per 100,000

Source Aaron et al. Suicides in young people in
rural southern India. Lancet 2004. 3631117-18.
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PTSD

• Southeast Asia
• Cambodia Khmer Rouge
• gt 1.5 million deaths
• 1975-1979
• Vietnam War 1965-1973
• US soldiers gt 58,000 killed
• 5 million dead all sides
• 50 population homeless
• 1/5 farmland forests devastated

Source Beiser, Psychological Medicine, 2004
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PTSD in SE Asian Refugees

• Blair 2000 Cambodian American community sample
  N 124
• 45 PTSD
• Kroll et al. 1989 404 SE Asian refugees initial
  psych eval
• 73 major depression
• 14 PTSD
• 6 anxiety somatoform disorder

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December 26, 2004 Tsunami
150,000
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New PTSD generation?

• Indonesia
• Thailand
• Sri Lanka
• Maldives
• India

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Intimate Partner Violence

• China 13 of new moms had experienced IPV
• Boston Chinese Am. Women
• 181 women survey 1996-1997
• 42 knew an abused Chinese woman
• 14 had experienced IPV themselves
• Conflicts with relatives, alcohol

Source Hicks, Madelyn Hsiao-Rei. Prevalence and
characteristics of intimate partner violence in a
community study of Chinese American women. J
Interpersonal Violence Vol 21 No 10, October
2006, 1249-1269.
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IPV South Asian Women

• How common?
• 2 in 5 ever had sexual/physical IPV
• 208 Boston S.A. women (91 immigrant)
• 21 reported IPV in current relationship
• Victims at higher risk of
• Poor physical health
• Depression suicidal ideation
• Anxiety

Source Himelfarb Hurwitz, EJ et al. Intimate
partner violence associated with poor health
outcomes in US South Asian Women. J of Immigrant
Minority Health, Vol. 8, No. 3, July 2006.
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II. Underutilization

• Underrepresented in mental health clinics
• Seattle 1977 1st documented
• LA County 1991 similar results
• Treatment delay? Controversial
• 1982 study longer treatment delay than African
  Americans Caucasians
• 2000 study by Okazaki in LA average delay 17.34
  months

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III. Barriers to Care

• Language
• Lack of culturally competent practitioners
• Stigma

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A. Language Barriers

• 61.9 of APA are foreign born
• APA population speaks over 100 languages and
  dialects
• Linguistically isolated households
• Definition
• Breakdown 35 Asian Americans
• 61 Hmong, 56 Cambodian, 52 Laotian, 44
  Vietnamese, 41 Korean, 40 Chinese

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B. Culturally competent practitioners

• 1998 study 70 APA mental health providers
  available per 100,000 Asian Americans in US (1/2
  ratio caucasians)
• Utilization rates increased in outpatient centers
  tailored to Asian Americans

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C. Stigma

• Stigma against mental illness in APA community
• Leads to lower utilization
• May delay treatment

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IV. Solutions

• Language CLAS guidelines
• 1964 Civil Rights Act Title VI
• CLAS standards 2000
• Free
• Written verbal rights
• No minors
• Stigma Education
• More culturally competent mental health
  practitioners

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V. What you can do

• Remain culturally sensitive
• Attitude
• Knowledge
• Skill
• Advocate in your family and your community
• Use the model minority
• Educate others
• Refer

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In conclusion

• Confucius says
• I hear and I forget
• I see and I believe
• I do and I understand