Mental Health: the hidden face of the model minority : Mental Health: the hidden face of the model minority Howard Liu, M.D. Resident Psychiatrist University of Michigan January 2007


Why should you listen to this talk? : Why should you listen to this talk? Mental illness is common APA community has specific needs You will be in a position to help


What does it mean to be a model minority? : What does it mean to be a model minority?


SAT scores? : SAT scores?


Precocious musical skills? : Precocious musical skills?


Medical breakthroughs? : Dr David Ho - Times Man of the Year 1996 Medical breakthroughs?


Model minority myth : Model minority myth Highlights the superlatives Propagated not just by media, but by APA community itself Narrow definition


Headlines which did not make the cut … : Headlines which did not make the cut …


Slide9: Published May 8, 2001


Slide10: BBC News April 2, 2004


Slide11: BBC News November 22, 2004


Overview : Overview Mental Health needs Barriers to care Solutions


I. Mental illness is not exotic: 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.


Depression : 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.


Suicide: 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 > 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.


Suicides in young people in rural southern India : 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. 363:1117-18.


PTSD : PTSD Southeast Asia Cambodia Khmer Rouge > 1.5 million deaths 1975-1979 Vietnam War 1965-1973 US soldiers: > 58,000 killed ~5 million dead – all sides 50% population homeless 1/5 farmland & forests devastated Source: Beiser, Psychological Medicine, 2004


PTSD in SE Asian Refugees: 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


December 26, 2004 Tsunami: December 26, 2004 Tsunami 150,000


New PTSD generation?: New PTSD generation? Indonesia Thailand Sri Lanka Maldives India


Intimate Partner Violence: 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.


IPV: South Asian Women: 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.


II. Underutilization: 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


III. Barriers to Care : III. Barriers to Care Language Lack of culturally competent practitioners Stigma


A. Language Barriers : 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


B. Culturally competent practitioners: 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


C. Stigma: C. Stigma Stigma against mental illness in APA community Leads to lower utilization May delay treatment


IV. Solutions : 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


V. What you can do: 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


In conclusion : In conclusion Confucius says: “I hear and I forget I see and I believe I do and I understand”