Chapter 3. Mental Health Care of Hispanic Immigrant Children

Abstract

This chapter addresses the mental health care of Hispanic immigrant children within a school-based context. The school system is presented as a natural support agent that is psychologically, culturally and geographically accessible for the delivery of culturally competent mental health services. The development of a multifaceted New York City public school-based program created, by the first author of this chapter, in response to the psychosocial needs of Hispanic immigrant children is discussed as a viable approach that may be used in the provision of ethnic-sensitive mental health care.     

Chapter 4. Concepts of Mental Health and Mental Illness in Older Hispanics

Abstract

The effect of cultural context in symptom expression and interpretation among older Hispanics, and how they experience psychological distress are not well-understood. We use the illness representation model to learn about older Puerto Ricans' and Dominicans' conceptions and causes of positive mental health, the causes of emotional problems, the conceptions and causes of depression and anxiety, the distinction between depression and anxiety, and the relationship between age and depression. Greater understanding of the meaning of symptoms and syndromes of depression and anxiety might help to define more culturally-sensitive mental health treatments and service delivery systems.     

Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Chapter 7. Mental Health Intervention with Dominican Immigrants

Abstract

Dominicans are a significant force in the changing composition of Hispanic immigration in the United States, and all indications are that they will continue to be in the years to come. A framework has been applied in which Dominican culture, psychosocial strengths and risks, and treatment implications are explored in the context of how Dominicans appear to be similar to and different from other Hispanic groups in the U.S. Much more needs to be done in terms of elaborating this combination of homogeneity and heterogeneity. Mental health practitioners who are open to such inquiry, and to keeping an open mind regarding the possibilities of modifications in therapeutic techniques and modality choices, will find Dominicans to be a clinically responsive, and an enjoyable population to work with.     

Mental Health Intervention with Hispanic Immigrants

Abstract

The underutilization of mental health services by Hispanic immigrants has been well documented in the literature. Hispanic immigrants encounter numerous obstacles which prevent them from successfully navigating through the mental health system. This reality is further compounded by the fact that research appears to suggest an increased rate of mental health disorders among Hispanics. This article underscores the importance of understanding the influence of a Hispanic client's worldview, language, and religion on the provision of mental health services. A case vignette is presented as a means of illustrating key conceptual points. Practice principles or conclusions drawn from this article should be used as a general guide by mental health practitioners.     

Chapter 11. The Future of Culturally Competent Mental Health Care for Latino Immigrants

Abstract

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigrants must be linked to both practice-based research efforts and timely diffusion of best practice innovations. Cultural competence must be integrated as a valued component of the organizational structure of mental health systems of care.     

Health Services Considerations Amongst Immigrant Populations

Abstract

The foreign-born population comprised 11.5% of the U.S. population in 2002. Immigration to the U.S. has grown substantially and continues to grow. A close examination of the immigration data shows that immigrant community in the U.S. is not homogeneous and in fact is very diverse both within itself and from the native-born population. U.S. Census Bureau data reveal that these differences create pockets of divergent populations within the country. How these populations assimilate into the U.S. healthcare system is not clearly understood. Cultural values, beliefs, and practices often juxtapose the immigrant to the healthcare system. Religious differences coupled with educational and income disparities add to the challenge of developing and implementing healthcare programs. This paper concludes with suggestions for more research in healthcare to immigrants.     

An East-West Approach to Serving Chinese Immigrants in a Mental Health Setting

Abstract

This article discusses the unique design of a community day treatment program that addresses the issues of loss and acculturation for a Chinese American immigrant population who suffers from chronic mental illness. The program utilizes an integrated, multi-cultural milieu of staff and clients to create a microcosm of the diversity of American society, and reflects the agency's belief in the affirmation of the clients' cultural heritage as a more effective way of supporting clients in their recovery process. Case vignettes are used to illustrate the importance of helping immigrant clients who are marginalized in society to feel accepted, empowered and hopeful in their lives in a new country.     

An Examination of Mental Health and Psychiatric Care among Older Prisoners in the United States

Despite that prisons in the United States (and other high-income countries) have witnessed an increase in the proportion of older inmates, and that prison populations exhibit high rates of psychiatric illness, there is limited knowledge on the nature of older inmates’ psychological health and use/provision of psychiatric care. The present study addresses these gaps, analyzing a nationally representative sample of 1,907 male and female older inmates (age range = 50–84 years; M = 56) housed in U.S. state and federal prisons. The results highlight: (a) the prevalence of psychological issues among older prisoners; (b) factors associated with certain mental disorders and symptoms of mental health issues; (c) the prevalence of psychiatric treatment before and during imprisonment for those with (and without) reported psychological health issues; (d) similarities and differences between male and female older inmates in relation to psychological health, factors associated with psychological issues, and the use/provision of psychiatric care. Discussion points toward recommendations for managing inmate mental health, as well as direction for further research on older inmate mental health and psychiatric care.     

Knowledge Utilization in Canadian Health Service Organizations: A Path Analysis

The aim of this article is to study direct and causality effects of variables involved in knowledge utilization (KU) explanations. Based on a survey of 928 managers and professionals in Canadian health service organizations (HSOs) (ministries, regional health authorities, and hospitals), the results of the path analysis indicate that the extent to which research results are used in policy and practice is influenced by the format of research results, by organizational and contextual variables (e.g., research culture and absorptive capacity), by the formal partnership activities initiated between the producers of research and users (formal linkage mechanisms), and by the user’s relational capital (informal linkage mechanisms), among other variables. Formal and informal linkage mechanisms have a positive and significant impact on KU in different causal explanations. The article shows that utilization processes are interdependent in their causes and effects, and thus complicated to study.     

Investigating the Refugee Health Disadvantage Among the U.S. Immigrant Population

Much health-disparities research focuses on race and ethnicity, but nativity has proved to be a crucial factor in explaining the immigrant health advantage. Foreign-born subgroups with certain immigration statuses, such as refugees, may have an initial disadvantage. Using nationally representative survey data, we explore differences in health outcomes by analyzing two visa category subgroups in the United States: refugees and nonrefugee immigrants. Our findings show that refugees have a significant disadvantage across multiple health outcomes. This suggests that current refugee health-screening practices should be changed to take into account broader issues, such as chronic disease and functional limitation.     

Resilience in the Face of Adversity: African Immigrants' Mental Health Needs and the American Transition

The aims of this qualitative study were to explore key sources of emotional distress and coping strategies among West African immigrants. Thirty-eight adult West African immigrants participated in six semistructured, open-ended focus group sessions. Focus group data were analyzed using a grounded theory approach. While participants reported high levels of psychological distress associated with racial/cultural discrimination, intimate partner violence, parenting, extended-family demands, and problematic immigration status, they demonstrated resilience and the ability to identify a range of coping strategies that draw on their cultural heritage. Only two of the participants reported having used psychological services; both outcomes were negative. The findings of this study are considered in terms of their clinical implications.     

Job Satisfaction Among Swedish Mental Health Nursing Staff: A Cross-Sectional Survey

There is limited amount of empirical studies concerning job satisfaction in inpatient psychiatric care. However, job satisfaction has several implications on public administration and management. The objective of this study is to identify factors having positive impact on job satisfaction among Swedish psychiatric nursing staff in an inpatient psychiatric clinic. The cross-sectional study is based on Herzberg’s motivation-hygiene theory. The survey was distributed among nursing staff at a psychiatric university hospital clinic in Western Sweden. Overall, job satisfaction was rated relatively high, and salary was rated the lowest of all factors investigated. Unlike the premises in Herzberg’s theory, salary showed a positive correlation with job satisfaction and not only in preventing dissatisfaction. Hospital managers must be attentive to salary levels and staff turnover. Psychiatric nursing personnel in Sweden lack competitive salaries, and hospital administrators should encourage nursing staff to improve relationships between staff and managers and establish good relationships among colleagues.     

Chapter 8. The Mariel and Balsero Cuban Immigrant Experience

Abstract

This chapter focuses on the differential family reunification issues experienced by Cuban Marielitos and balseros upon entrance into the United States. Treatment recommendations, aimed at ameliorating the emotionally laden reunification issues, are presented within a family systems and ecological context. The overall intent of this chapter/article is to assist mental health practitioners in their therapeutic work with members of a relatively small but distinct Hispanic ethnic group. Two case vignettes are presented as a means of illustrating the key family reunifications issues that have impacted-and continue to affect-Cuban Marielitos and balseros.     

Spending the Golden Years Behind Bars: Predictors of Mental Health Issues Among Geriatric Prisoners

Mental illness in older inmates remains an underexplored topic of interest for prison research. The present study addresses gaps in extant literature, using a nationally representative sample of 1,907 male and female geriatric inmates in the United States (age range 50–84 years; M = 56) to analyze the association between mental health and predictors, such as gender, victimization, physical illnesses, and protective/ameliorative factors. The authors discuss their findings in relation to a theoretical framework that integrates the importation and deprivation models, as well as provide discourse on policy implications and future directions for research on older prison inmates.     

Trade Liberalization in Indonesian Health Services: Prospects and Policies

The worldwide increase in demand for health services offers developing countries, like Indonesia, significant opportunities to expand international trade in this area. However, policy aimed at achieving this objective must carefully consider the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). For signatory nations and those considering becoming signatory nations, the procedural, structural, and other effects of the GATS make it a formidable challenge for national health policy alongside its impact on trade liberalization. Invoking the four GATS health care trade modes, this article develops possible approaches to Indonesian health services in the context of trade liberalization.     

Refugees Who Have Experienced Extreme Cruelty: A Qualitative Study of Mental Health and Wellbeing after Being Granted Leave to Remain in the UK

Abstract

This study explores how vulnerable refugees’ experiences in the first year after being granted leave to remain in the UK impact on mental health and wellbeing. Nine semi-structured interviews were conducted with refugee survivors of extreme cruelty. Data were analyzed using thematic analysis with a narrative influence. Reported challenges included requirements to organize housing, finances and welfare benefits rapidly. Most respondents reported low mood, worry, exacerbated PTSD symptoms, physical ailments and isolation, but valued stable housing, meaningful activities, emotional support and service provider sensitivity in managing this transition. Policy and service recommendations are made, to assist integration and improve wellbeing.     

Psychological Distress,Formal Help-Seeking Behavior,and the Role of Victim Services Among Violent Crime Victims

Using data from the 2015 National Crime Victimization Survey, this research explores the characteristics related to psychological distress and formal help-seeking behavior among victims of violent crime. Logistic regression analyses indicate that psychological distress symptoms vary by victim and offense characteristics. As anticipated, for example, the odds of a victim of sexual assault reporting the highest level of psychological distress are 5.88 times higher than are the odds of simple assault victims. However, when looking at subsequent formal help-seeking behavior for psychological distress, sexual assault victims do not seek formal help for their distress more than victims of other violent crimes. The analyses reveal that only gender and disability consistently predict high psychological distress and formal help-seeking behavior. Contact with a victim service agency was shown to be a powerful predictor of formal help-seeking behavior, though the analyses illustrated that victims most in need of intervention are not always the ones who receive it. In fact, only 23% of victims sought formal help for their psychological distress. This study sheds additional light on the issue of psychological distress and the limited formal help-seeking behavior of violent crime victims, while illustrating characteristics predictive of formal help-seeking, such as intervention through victim services.     

Traumatic Events and Symptoms Among Mexican Deportees in a Border Community

Research on traumatic events experienced among Mexicans deported from the United States is scant. Using clinical interviews, this study assessed the frequency of traumatic events and symptoms of post-traumatic stress disorder (PTSD) among 47 Mexican deportees in a U.S.-Mexico border community. The majority of participants (98%) reported having experienced one or more traumatic events (M = 9, SD = 5) and nearly half met DSM-IV-TR criteria for PTSD. Meeting criteria for PTSD was associated with a higher number of traumatic events. Results suggest that prevention, intervention, and policy efforts are necessary to improve the well-being of this understudied immigrant subgroup.     

Ethnicity,Language Capacity,and Perception of Ethnic-Specific Services Agencies in Asian American and Pacific Islander Communities

Abstract

This study examined (1) the ethnicity and language similarity between professional staff and service users, and (2) client satisfaction in ethnic-specific services (ESS) agencies serving Asian Americans and Pacific Islanders (AAPI). A combined method of agency survey and focus groups was used to collect the data. Findings indicate that ESS served a diverse AAPI population, although some ethnic and language sub-groups remain to be under served. Service users clearly prefer ESS, which is associated with a higher level of trust than mainstream services. However, staff simply sharing similar language or ethnic background does not automatically warrant trust. Trust is developed through a sense of respect that staff demonstrates within a cultural context. The feeling of trust is likely to determine AAPI clients' commitment to remain in treatment, a prior condition for achieving any desirable outcome.