Chapter 2. Mental Health in the Hispanic Immigrant Community

Abstract

This chapter addresses the mental health status of Hispanics in the United States. The prevalence and incidence of mental health disorders among different Hispanic ethnic subgroups is examined. Patterns of mental health services utilization and barriers to mental health care are also reviewed. Research specific to best mental health practices with Hispanics is stressed.     

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.     

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 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 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.     

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.     

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.     

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.     

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.     

Impact of the 1996 Welfare Reform and Illegal Immigration Reform and Immigrant Responsibility Acts on Caribbean Immigrants

SUMMARY

This paper examines the impact of the 1996 Welfare Reform and Illegal Immigration and Immigrant Responsibility Acts on Caribbean immigrants in the United States. Drawing from the conceptual framework posited by Dye's (1984) Elite Preference Modelof policy analysis, the author argues that the three laws have created enormous economic and psychological difficulties among families in the United States. Developing countries in the Caribbean region have been severely impacted by the law since they have had to accommodate returning citizens when they are deported under provisions of immigration policies. The question for consideration by this paper is how may the legal and human rights of deportees be balanced against the rights of the U.S. government to secure its borders and ensure the security of its citizens? The paper also addresses issues of immigration, and international relations particularly the north-south dialogue between powerful developed countries such as the United States and small developing states of the Caribbean.     

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.     

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.     

Integrating Behavioral Health Care and Primary Care: Application of a Clinical and Economic Model in Culturally Diverse Communities

Although mental illness treatment protocols exist, the organization and financing of screening and treatment services inhibit access. These challenges are compounded for refugees, immigrants, and other groups vulnerable due to their ethnicity, race, or culture. By creating a system-wide, collaborative, integrated model that recognizes and addresses critical clinical and economic aspects in the delivery of services, high quality, evidence-based care can be made available to groups susceptible to the burdens of mental illness. Clinically and financially aligning primary and specialty care offers a viable alternative for improving access and quality of mental health services to vulnerable populations.     

The New Public Management Theory and the Reform of European Health Care Systems: An International Comparative Perspective

The New Public Management (NPM) Theory is a rhetorical construction with diverse intellectual roots. That diversity means that it is open to reinterpretation and shifts in implementation across countries (Sahlin-Andersson, 2001 Sahlin-Andersson, K. 2001. “National, international and transnational constructions of New Public Management”. In New Public Management—The transformation of ideas and practice, Edited by: Christensen, T. and ægreid, P. L. 43–72. Aldershot, , UK: Ashgate.  [Google Scholar]; Smullen, 2007 Smullen, A. 2007. Translating agency reform: Rhetoric and culture in comparative perspective, Rotterdam, , The Netherlands: PhD Dissertation, Erasmus University.  [Google Scholar]). This overview article critically investigates NPM application in various EU health care systems. NPM led to a greater focus on market forces and competition and improved information sharing and cooperation among health care networks, and changed the way care is delivered. This article also identifies significant misfits between policy announcements and NPM implementation. NPM has taken root much more substantially in the United Kingdom (UK) than in France and Germany. The variety of capitalism and institutional systems provides an explanation for divergences in NPM implementation.     

Health Care Versus Border Care: Justification and Hypocrisy in the Multilevel Negotiation of Irregular Migrants’ Access to Fundamental Rights and Services

Abstract

Providing—and also not providing—public services to unlawful residents implies a certain cost for host societies, and both inclusion and exclusion involve localized renegotiations of fundamental rights, legitimate needs, and social membership. Based on original qualitative research data, this article compares how, why, and under which conditions irregular migrants are granted or denied access to healthcare services provided in London and Barcelona. From a multi-level perspective and by drawing on organization theory, I highlight key differences in how the responsible governments deal with the underlying contradictions and thereby either help or hinder effective policy implementation.