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Stigma of Mental Illness Among Ethnic Minority Populations Hispanic Children and Youth : Stigma of Mental Illness Among Ethnic Minority Populations Hispanic Children and Youth Christina Leal, RN, BSN, Doctoral Student SAMHSA Fellow The University of Texas Health Science Center at San Antonio School of Nursing This research was funded by the Substance Abuse and Mental Health Services Administration


Objectives : Objectives List barriers to mental health care for Hispanic children and youth Discuss the stigma of mental illness as it related to Hispanics and mental health Describe findings from the National Inpatient Stay Data as they relate to Hispanic children and youth Apply culturally competent alternative approaches to the care of Hispanic children and Youth Recommendations for future Research Clinical practice Public policy


Background and Significance : Background and Significance Healthy People 2010 Goal “Increase the proportion of children with mental health problems who receive treatment. For many children aged 18 years and under, lifelong mental disorders may start in childhood or adolescence. ” (U.S. Department of Health and Human Services, 2000, Mental Health and Mental Disorders section). Surgeon General’s Report Mental Health: Culture, Race, Ethnicity An examination of studies of mental health problems reveals a generally consistent pattern: Latino youth experience a significant number of mental health problems, and in most cases, more problems than whites show. (U.S. Department of Health and Human Services, 2001, p. 135)


Demographics : Demographics About 35 million Hispanics live in the United States making up 12.5% of total U.S. population (U.S. Census Bureau, 2000) About 12 million Hispanic children and youth live in the United States making up 34.96% of the total Hispanic population (U.S. Census Bureau, 2000) 29% of the U.S. uninsured population under age 18 are Hispanic children and youth (Aguirre-Molina, Molina & Zambrana, 2001)


Barriers to Mental Healthcare for Hispanic Youth : Barriers to Mental Healthcare for Hispanic Youth Language Stigma of mental illness Parental level of knowledge of mental illness Parental perceptions of mental illness and its corresponding treatment Limited empirical data about mental health service utilization among Hispanics Little known knowledge about Hispanics’ mental help seeking behaviors


Stigma Related to Hispanics and Mental Health : Stigma Related to Hispanics and Mental Health Stigma is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, and or avoidance. Stigma: Reduces patients’ access to resources and opportunities Creates low-self-esteem, isolation, and hopelessness among patients Deters the public from desiring to pay for mental health care Friends and neighbors may withdraw from the labeled individual Leads to societal discrimination and abuse (Scheffer, n.d. and Aguirre-Molina, Molina & Zambrana, 2001)


Methods : Methods Database from U.S. hospital inpatient stays 32 states 986 hospitals Stratified sample Designed to approximate a 20% sample of U.S. community hospitals


Setting : Setting All nonfederal , short-term, general, and other specialty hospitals, excluding hospital units of institutions Pediatric and public hospitals, and academic medical centers Settings that were excluded from the sample Short-term rehabilitation hospitals Long-term hospitals Psychiatric hospitals Alcoholism/ chemical dependency treatment centers


Sample : Sample Description of the Sample size 55,520 Hispanic children and youth ages 2-17 2, 868 Hispanic children and youth with a Psychiatric Diagnostic Related Group (5.17%)


Admission Source of Hispanics : Admission Source of Hispanics


Slide16 : Mean Length of Stay in Days


Stigma Related to Hispanic Children and Youth and Mental Health : Stigma Related to Hispanic Children and Youth and Mental Health Caregivers’ perceptions Community’s perceptions Society’s perceptions


Slide19 : Future research should focus on The implications of early diagnosis and treatment on outcome Document mental health providers attitudes and behaviors toward Hispanic children and youth on Medicaid with psychotic disorders Explore school-based mental health services utilization programs (Clauss-Ehlers & Levi, 2002) as an approach to removing the stigma of mental health and enhancing care Implications for Research


Clinical Practice : Clinical Practice All providers should screen Hispanic children and youth for mental illness Limit the amount of time of a diagnosis as well as the amount of time spent hospitalized Use the phrase “children who have. . .” (1993, de Leon)


Public Policy : Public Policy The largest number of Hispanic children hospitalized have Medicaid and a DRG of psychosis. There needs to be public policy that guides and directs comprehensive health care for Hispanic children and youth who receive Medicare and have a Diagnosis Related Group of psychosis There needs to be public policy that focuses on developing culturally competent providers and programs that target Hispanic children and youth who are at risk for developing psychiatric illnesses. There needs to be a public policy about access to care where Hispanic children and youth can receive comprehensive mental health care from providers who speak their language, know their culture, and who will provide them access and continuity of care.


Thank You : Thank You


References : References Aguirre-Molina, M., Molina, C., & Zambrana, R. E. (Eds.). (2001). Health issues in the Latino community. San Francisco: Jossey-Bass. Clauss-Ehlers, C. S., & Levi, L. L. (2002). Violence and community, terms in conflict: an ecological approach to resilience. Journal of Social Distress & the Homeless, 11(4), 265-278. de Leon Siantz, M. L. (1993). The stigma of mental illness on children of color. Journal of Child & Adolescent Psychiatric & Mental Health Nursing, 6(4), 10-17. National Institute of Mental Health (1980). Attitudes toward the mentally ill: Research perspectives. Scheffer, R. (n.d.). Review of literature on stigma and mental illness. Retrieved May 12, 2004, from http://www.camh.net/pdf/Review%20of%20Literature%20on%20Stigma%20and%20Mental%20Illness.pdf U.S. Census Bureau (2000). Census 2000 Summary File 1 (SF 1) 100-Percent Data. Retrieved April 28, 2004 from American Fact Finder database: http://factfinder.census.gov/home/saff/main.html?_lang=en U.S. Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity- a supplement to Mental health: a Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services U.S. Department of Health and Human Services (2000). Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health [Electronic version]. 2 vols. Washington, DC: U.S. Government Printing Office.