On July 1, 2017, Governor Jay Inslee declared statewide that July would be “Mental Health Awareness Month for People of Color.” The proclamation moves forward to address the need for culture-based mental health care within behavioral health agencies as well as other providers.
Michael Itti, executive director of Washington State Commission on Asian Pacific American Affairs, believes the proclamation will not only create greater awareness, but more culturally appropriate mental health care as well.
“How we talk about mental health care is different in different communities.” Itti said. Itti points to a 2011 research study with the National Alliance for Mental Illness (NAMI) which shows that of all cultural backgrounds, Asian Americans are the least likely to receive mental health care treatment. He also points out that one third of all Asian Americans have limited proficiency in English, increasing the obstacles to diagnosing and treating mental illness.
“Mental illness is a tough subject for everybody. We need culturally appropriate providers who can treat with a collective attitude,” Itti said.
Itti said that the responsibility for creating culturally-appropriate providers will lie heavily with the providers themselves. Itti stated that providers could develop cross-training for counselors through the help of those within the API communities. Itti also stressed the need for holistic health care embracing both the physical and mental sides of overall health. On a long-term basis, Itti hopes there can be legislative measures that will mandate “linguistically appropriate” providers. Intermediate goals are to create training for those working with immigrant and refugee families and clients. For now, simply creating open discussions and awareness about safe resources is key.
Yoon Joo Han, Director of Behavioral Health at Asian Counseling and Referral Service (ACRS), echoed Itti’s opinion. ACRS serves 2,000 API clients living with chronic mental illness. She said it is necessary to have cultural awareness in order to understand and serve the API communities effectively. For example, there may actually be no words in some languages to describe Western diagnoses, such as bipolar disorder or depression. Sensitive case managers work within these frameworks. Religious beliefs may deter recovery through Western methods. Again, case managers can encourage clients to take their medications to the temple to be blessed by their priest or develop safe rituals for healing.
“Mental illness is a biological, psychological, and social issue,” Han said. “With the right services, you can lead a good life.”
Brandon Hadi, co-founder of the API Mental Health and Wellness Summit, which was held at UW last year described barriers to mental health care within some API communities and a need for more awareness. The Summit, now in its second year, is expanding its outreach and working toward more inclusion of Pacific Islander communities, such as Micronesia. “How was your day?” leads the discussions on mental health awareness and mental health care during the conference for college-age API students throughout the day.
Hadi was careful to emphasize that he cannot speak for all API communities. He helped found the now annual Summit on behalf of his friend Jesse, who lost his life to suicide two years ago. Jesse’s departure, according to Hadi, was directly impacted by two core belief systems Hadi believes are a common thread within many API communities. Those beliefs are to be obedient and “save face” in order to protect your family.
“You are taught to suppress, not express. When you suppress long enough, something has to give,” he said. Hadi also said that profound sorrow and shame over one’s vulnerabilities within API cultures can lead to a diagnosis of depression.
“The scarcity of culturally-appropriate mental health care contributes to API’s being the least likely minority group, next to American Indian/Alaskan natives, to seek help—and the most likely to drop out of treatment.” Hadi said.
Phuong Tran, a high school counselor at Mount Rainier High School, said the “tough love” approach she experienced growing up with Vietnamese immigrant parents is also something many of her API students face. Tran said students are afraid to talk to their parents because they’re afraid their parents will get angry or punish them for not focusing entirely on good grades. She said that when her API students are suicidal, they don’t want parents to know, because they don’t want to get yelled at. Tran said that growing up, her emotional needs were ignored in favor of academic success. “As a child it is your duty to get good grades. There is no time for whining,” she said.
Tran is the lead staff member working within Mount Rainier High School with Forefront, a social impact center at the University of WA School of Social Work, which provides suicide-prevention awareness in schools and colleges. This will be the second year with ‘Forefront in the Schools,’ and Tran said she’s working on parent training curriculum for the new school year.
Tran offers the following advice: “Let your children know you are there for them. Have open discussions with them in the household. You are there to support and help as needed.”
She went on to say that unless the student has a defined plan for suicide, she is not required to contact their parents. Despite this, she makes every effort to work with the student in opening up to parents. She emphasized that API students need to learn how to advocate for themselves and open up discussions with their parents. In turn, parents need to move beyond intergenerational frameworks of fear and listen to their children.
“Just because they get a B doesn’t mean their child won’t go to college,” she said. She added that parents, too, need support and guidance to grow beyond past traumas and cultural norms.
Editor’s note (7/26 at 11:02 a.m.): A an edit was made to clarify that the Forefront is a social impact center at the University of WA School of Social Work, not a nonprofit. An edit was also made to clarify the name of the program, “Forefront in the Schools.”