APIA Mental Health Headlines and the Global Outloo

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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”

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