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Download CRJ 312 Crisis Intervention and Management
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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