Download CRJ 312 Crisis Intervention and Management

Crisis Intervention Training
Mental Illness, Diversity and Cultural
Awareness
1
Why Cultural Awareness?
• Crisis intervention usually involves quick actions to restore a
victim's equilibrium to safe and predicable living.
• As such, crisis intervention is usually an immediate and
temporary intrusion into the life of a person with referral to
after-care remediation if needed.
• Typically, the focus of crisis intervention is directed to such
personality factors as coping mechanisms and individual
resilience, as well as to such environmental factors as the
sources of emotional support.
2
Culture insensitivity is the lack of knowledge or disregard of
someone’s social appropriate behavior and manners
.
• On the other hand, cultural sensitivity is being aware that
cultural differences and similarities between people exist
without assigning them a value – positive or negative, better
or worse, right or wrong.
• It simply means that you are aware that people are not all the
same and that you recognize that your culture is no better
than any other culture.
• A challenge, if you ask me, for members of dominant
cultures.
3
Dominant Cultures
• In life and work environments we frequently face situations where
there is a dominant and a secondary culture.
• For instance, in the U.S. the European American is the dominant
culture whereas Hispanic, African American and Chinese cultures
are all secondary.
• Cultural sensitivity implies that both groups understand and respect
each other’s characteristics.
• Of course, this is always a challenge and even more so in large
institutions, such as law enforcement where the dominant culture is
the one Cops are expected to adopt.
• Remember, the Cop coming into a house is operating under the Use
of Force continuum and is so interpreted as such by the family.
4
Given dominant culturalism, the cultural context of crisis
events is often neglected
• This may increase the level duress already underway in the
encounter, without the Officer actually doing or saying
anything at the onset.
• Culture has a subtle but powerful influence of culture upon
the appraisal of victims and circumstance.
• In this regard, helping the victims of trauma requires crisis
interveners to become aware of their own cultural
assumptions; demonstrate an ability to communicate an
understanding, acceptance and appreciation of cultural
differences; and identify available resources from the victim's
culture to assist with crisis resolution and aftercare.
5
Concerning Interventions in General
• Crises occur because helpers/significant others of mentally ill
people in crisis often do not know what to do
– In which case, they respond to their own cultural
underpinnings to inform or guide their behavior.
• Yet, they still need social support systems, case management
and collaboration like anyone else.
• Often times there will be denial and they resist your attempts
to support them.
• In which case, you need to be prepared for culturally different
reactions that range from fear, repulsion, anxiety,
embarrassment and avoidance to achieving meaningful
collaboration with the helpers with the sick one.
6
If you find yourself unprepared of affronted by multicultural
responses to psychiatric based crisis
• Then honestly reflect on your own attitudes and the affront
you are feeling concerning the difference in responses you are
seeing in other people, relative to their gender, culture or
ethnic origin.
• Denial, Defense and Minimization is at work!
7
Denial
• At this stage of cultural sensitivity, people don’t recognize
cultural differences and experiences.
• They believe their culture is the only “real” one and they tend
to interact in homogenous groups and to stereotype everyone
else.
• Example: People who say,
– “We are all the same and I don’t understand why we have
to learn about the different groups in the company. Why
don’t they just learn how we do things in America? ”
8
Defense
• At the defense stage of cultural sensitivity, people recognize
some differences, but see them as negative because they
assume their culture is the most evolved, the best one.
• Example:
– People who say, “Hispanics…you can’t just get to the point
and talk business. They want to tell you their life story. I
don’t understand why they can’t just learn to be more
direct and save everyone time.”
9
Minimization
• Individuals at this stage of cultural sensitivity are unaware that they are
projecting their own cultural values.
• They see their own values as superior.
• They think that the mere awareness of cultural differences is enough.
• These people think we are all the same because we are more similar than
different and, in the end, we all have similar physical, biological,
psychological needs etc.
• They think they are wonderful because they see people as people but they
are actually denying the influence of culture in every person’s experience.
• Example:
– Statements such as, “In the end, we all want to be liked,” or, “We are
all people.”
10
Achieving Acceptance
• At this stage of cultural sensitivity people are able to shift
perspectives to understand that the same “ordinary” behavior can
have different meanings in different cultures.
• They may not agree or even like the differences they observe but
they are interested in finding out and learning about another
culture.
• They are able to identify how experiences are influenced by one’s
culture.
• Example:
– People who approach others with genuine interest and curiosity
about how they experience the same situations.
– They ask questions such as, “What would your family do in a
situation like this?” Or, “How do Latinos do it?”
11
For instance, and in general, culturally sensitive issues facing you
with 3 minority groups in dealing with Mental Illness will be:
Asian-Americans:
• Feel Shame and Obligation
• Endure Rigid family roles and structures
• Hence, you interventions should be problem focused and formal
Mexican-Americans:
• Are Enmeshed family structure
• There are Language Barriers
• Different Levels of Acculturation
• Rely on a strong Catholic religious focus when in crisis
African-Americans:
• Have a History of enduring racism dating back to slavery
• Group with the most salient differences from mainstream group
• Distrust of mainstream Institutions, such as Cops
• Use the clergy as traditional support system when in crisis
12
Specifically speaking, Asian Americans &
Mental Health
• Many Asian Americans to include the Hmong have
considerable conceptual difficulties regarding the Western
notions of mental illness and mental health services.
• Asian Americans frequently experience and express mental
illness very differently from Westerners, often emphasizing
somatic (i.e. bodily) rather than psychological or psychiatric
symptoms
• Individuals such as Asians who embrace the theory of mindbody holism often experience great difficulty distinguishing
between psychological and physical ailments.
13
Asian Americans & Mental Health
• Asian Americans and Hmong are often uncomfortable with
the concept of examining and discussing one’s inner thoughts
and feelings
• The commonly held Asian belief that the best way to deal
with mental illness is to avoid morbid thoughts and repress
emotions.
• In many Asian cultures, a mentally ill family member or friend
is considered a disgrace and in some cases, the family quietly
encourages and or approves of that person committing
suicide, to spare the family the disgrace.
14
Asian Americans & Mental Health
• It follows, there is a consistent pattern of underutilization of
mental health services among Asian Americans has been well
documented for several decades.
• Those who do receive mental health treatment are often
greatly delayed in help-seeking, and thus tend to be more
severely ill upon treatment initiation, oftentimes taking place
following a crisis situation
• Be prepared…you may have resistance connecting with some
Asians when your recommend their sick ‘significant other’
seek professional help.
15
Asian Americans & Mental Health
Beliefs Specific to Chinese Culture
• Mental illness may be viewed as retribution for the
misdeeds of ancestors or immediate family
• Interpretations of causes of depression include fate,
imbalance of energy in the body or disharmony in natural
forces
• Suicide, a potential result of depression, is discouraged in
Chinese society.
• However, it is not considered a sin—if the death is
viewed as relieving the family of a burden
16
Asian Americans & Mental Health
Beliefs Specific to Japanese Culture
• The values most respected in Japanese-American
culture are self reliance, self-control, independence
and family honor.
• Mental health issues have been a taboo subject
fraught with stigma and associated with shame
17
Older Japanese Americans have coped with trauma
associated with internment based on their own
resources.
• “Shikata go nai,” translated as “it can’t be helped,” is
a dominant coping strategy, which continues to
affect family communications and behavior
associated with identity and control
• Suicide has historically been more accepted as an
honorable alternative to shame.
• In the face of depression, suicide may be seen as
more honorable than facing the shame of mental
illness.
18
Asian Americans & Mental Health
Beliefs Specific to Hmong Culture
• Once a life event that may have resulted in nyuaj siab
(depression) is passed and a healing ceremony has been
conducted to relieve the depression, nyuaj siab will no longer
exist
• If this normal depression—nyuaj siab—continues, the
individual risks the label of “crazy,” resulting in reluctance to
seek assistance either physically or mentally
19
Asian Americans & Mental Health
A few facts to know:
• Asian American adolescent boys are twice as likely to have
been physically abused
• Asian American women aged 15–24 and 65+ have the highest
suicide rates in the U.S. out of all racial and ethnic groups
• 40% of Southeast Asian refugees suffer from depression, 35%
from anxiety, and 14% from posttraumatic stress disorder
(PTSD)
• The suicide rate among Chinese American elderly women has
been found to be 10 times higher than for Caucasian elderly
women
20
Specifically, African Americans & Mental Health
• Historical and contemporary negative treatment has led to
mistrust of authorities, many of whom are not seen as having
the best interests of African Americans in mind
• You as a uniformed officer may suggest even more trouble for
them at the onset in dealing with the crisis due to this fact
alone.
• Therefore, understanding why African Americans with mental
illness may reject treatment is essential to breaking down
barriers and helping them get the care they need
21
African Americans & Mental Health
• The proportion of African Americans who fear mental
health treatment is 2.5 times greater than the proportion
of Whites who do so… this stigmatized existence leaves
many African Americans wide open to anti-psychiatry
campaigns…
• Some messages warn black communities of a genocidal
plot to place African-American children on Ritalin…
• Others convey that psychiatry is evil and destroys religion,
which is very important to African Americans
•
Source: http://pn.psychiatryonline.org/cgi/content/full/36/20/19
22
African Americans & Mental Health
• Blacks of all ages are more likely to be the victims of
serious violent crime than are whites…
• The link between violence and psychiatric symptoms
and illness is clear…
• One study reports that over one-fourth of African
American youth who have been exposed to violence
have symptoms severe enough to warrant a
diagnosis of PTSD
23
African Americans & Mental Health
• Although schizophrenia has been shown to affect all
ethnic groups at the same rate, Blacks in the United
States are more than four times as likely to be
diagnosed with the disorder as whites
• Only 16 percent of African Americans with a
diagnosable mood disorder see a mental health
specialist, and fewer than one-third consult a health
care provider of any kind
24
African Americans and Mental Health
• Only 16 percent of African Americans with a
diagnosable mood disorder see a mental health
specialist, and fewer than one-third consult a health
care provider of any kind
• African Americans are thought to make extensive use
of alternative treatments for mental health problems.
• This preference is deemed to reflect African American
cultural traditions developed partly when African
Americans were systematically excluded from
mainstream health care institutions
25
Latinos & Mental Health
• Stigma and embarrassment remain major barriers to
care among Latinos of all age groups
• In Latino culture, people think that you are mentally
retarded, not mentally ill if they know you see a
psychiatrist.
• In the Latino culture, they often confuse mental
illness with mental retardation
26
Latinos & Mental Health
• Many Latinos do not view mental illness as a medical problem
and as a result, do not seek help when they experience
mental health problems.
• Latinos may rely on home remedies “remedios caseros” and
prayer when they are experiencing a mental health crisis
instead of seeking medical care.
• Maintaining family members with disabilities in the family
home is often an important goal for Latino families, who are
less likely to place their family member in an outside facility
27
Latinos & Mental Health
• Mental Health is often viewed as the result of balance among
one’s faith, nutrition and how one has lived his or her life
• Folk concepts of disease relate to the effects of intense
negative emotions such as anger, envy and fright. Treatments
can include rituals based on purification, social reintegration
and penance
• Susto or fright illness is one of the adult folk illnesses that
have some overlapping symptoms with depression such as
nervousness, listlessness, loss of appetite, or insomnia.
28
Latinos & Mental Health
• A few facts to know:
• Although schizophrenia has been shown to affect all
ethnic groups at the same rate, Latinos in the United
States were more than three times as likely to be
diagnosed with the disorder as Whites
29
Native Americans & Mental Health
• The diversity among Native American must be noted. There
are over 500 federally recognized nations, tribes, bands and
Alaskan Native villages
• Some tribal groups attach little stigma to mental disorders
because no division exists between physical and mental
illness.
• Other groups identify mental health problems as shameful
• Some traditions view depression as a form of spiritual
possession, whereas others may see mental illness as
imbalance with the natural world
30
Native Americans & Mental Health
• Some Navajo elders view physical and mental illness as
disharmony caused by an external force, such as a person
or spirit
• Western treatment traditions of personal insight,
awareness or self-actualization often run counter to
Indian traditions that value the balance of the physical,
mental and spiritual, interrelationships over
independence, and a shared sense of trauma.
• Healing comes from identifying stress in the community,
and is resolved through community ceremonies and
traditional practices
31
Middle Eastern and Arab Americans & Mental Health
• Mental illness is considered to bring shame to the family.
While honor, or sharaf, plays an important protective social
role in many Arab-American families, actions perceived as
shameful can be ignored or hidden
• Family tradition places the male in the role of breadwinner.
• Unemployment often affects men more than women
deeply, triggering mental distress
• Isolation for refugees and immigrants due to economic
hardship, language and assimilation barriers, separation
from other family members, and loss of status may lead to
mental health crisis
32
Subgroups, the Disabled Population
• For the disabled elderly: intervention must be
holistic.
• Alzheimer’s dementia are stressful for entire
family
• About half of the elderly suffer from at least
one severe disability
33
People with Disabilties
• Physical or mental impairment that substantially
prevents or restricts the ordinary course of human
development and accomplishments.
• Often viewed as weak, dependent, abnormal and
inferior.
• Americans with Disabilities Act (ADA) challenges
discrimination against disabled
34
Mentally disabled people
• Are also protected by the ADA
• Include disorders such as major depression,
bipolar disorder, schizophrenia, panic disorder,
obsessive compulsive disorder, anxiety
disorders, and PTSD.
35
Gays, Lesbians, Bisexuals and Transgender (GLBT’S)
People
• Gay: typically refers to male homosexuals
• Lesbians: female homosexuals
• Bisexuals: male or females who are attracted to same
sex and opposite sex partners
• Transgenders: People who feel that they were born
the wrong gender and change from male to female
or female to male
36
Some drivers for GLBT Psychiatric Issues
• Suicide
• Fear of being discovered
• Family crises because expectations won’t be
met
• “Coming out”
• Sex-change surgery
37
Developmentally Disabled People
• Mental retardation, cerebral palsy, epilepsy,
autism
• Rights are a big issue
• Living to be elderly now
• Need extensive and complex treatments
38