Mental Health: the hidden face of the model minority

1. Mental Health: the hidden face of the model minority Howard Liu, M.D. Resident Psychiatrist University of Michigan January 2007

2. Why should you listen to this talk? • Mental illness is common • APA community has specific needs • You will be in a position to help

3. What does it mean to be a model minority?

4. SAT scores?

5. Precocious musical skills?

6. Medical breakthroughs? Dr David Ho - Times Man of the Year 1996

7. Model minority myth • Highlights the superlatives • Propagated not just by media, but by APA community itself • Narrow definition

8. Headlines which did not make the cut …

9. Published May 8, 2001

10. BBC News April 2, 2004

11. BBC News November 22, 2004

12. Overview • Mental Health needs • Barriers to care • Solutions

13. I. Mental illness is not exotic • National Latino and Asian American Study (Takeuchi) • 2095 Asian Americans nationwide • Overall lifetime rate of any disorder = 17.3% • 12 month rate = 9.19% • Men – poor English proficiency had higher rates • Women – native born had higher rates than immigrants of most disorders • Source: Takeuchi, DT et al. Immigration-related factors and mental disorders among asian americans. Am J Public Health; Jan 2007; 97, 1.

14. Depression • CAPES Study – 1993-1994 • 1700 Chinese Americans LA • 6.9% lifetime prevalence dep. • 16.9% in national sample adults Source: Mental Health: Culture, Race, and Ethnicity US Dept Health Human Services 2001.

15. Suicide • Lester 1994: suicide rates per 100,000 • Caucasian 12.8 • Asian Americans overall 7.0 • Japanese American 9.1 • Chinese American 8.3 • Filipino American 3.5 • 1999 DHHS - APA women > 65 have highest suicide mortality rate of all groups • Young women from southern India? Source: Mental Health: Culture, Race, and Ethnicity US Dept Health Human Services 2001.

17. Suicides in young people in rural southern India • Worldwide suicide rate in 2000: 14.5 per 100,000 • Vellore India– population 108,000 • 10 year mortality rates 1992-2001 for age group10-19 • Female suicides: 152 per 100,000 • Male suicides: 69 per 100,000 Source: Aaron et al. Suicides in young people in rural southern India. Lancet 2004. 363:1117-18.

18. PTSD • Southeast Asia • Cambodia Khmer Rouge • > 1.5 million deaths • 1975-1979 • Vietnam War 1965-1973 • US soldiers: > 58,000 killed • ~5 million dead – all sides • 50% population homeless • 1/5 farmland & forests devastated Source: Beiser, Psychological Medicine, 2004

19. PTSD in SE Asian Refugees • Blair 2000 – Cambodian American community sample N = 124 • 45% PTSD • Kroll et al. 1989: 404 SE Asian refugees initial psych eval • 73% major depression • 14% PTSD • 6% anxiety & somatoform disorder

20. December 26, 2004 Tsunami 150,000

21. New PTSD generation? • Indonesia • Thailand • Sri Lanka • Maldives • India

22. Intimate Partner Violence • China – 13% of new moms had experienced IPV • Boston Chinese Am. Women • 181 women survey 1996-1997 • 42% knew an abused Chinese woman • 14% had experienced IPV themselves • Conflicts with relatives, alcohol Source: Hicks, Madelyn Hsiao-Rei. Prevalence and characteristics of intimate partner violence in a community study of Chinese American women. J Interpersonal Violence Vol 21 No 10, October 2006, 1249-1269.

23. IPV: South Asian Women • How common? • 2 in 5 ever had sexual/physical IPV • 208 Boston S.A. women (91% immigrant) • 21% reported IPV in current relationship • Victims at higher risk of: • Poor physical health • Depression & suicidal ideation • Anxiety Source: Himelfarb Hurwitz, EJ et al. Intimate partner violence associated with poor health outcomes in US South Asian Women. J of Immigrant & Minority Health, Vol. 8, No. 3, July 2006.

24. II. Underutilization • Underrepresented in mental health clinics • Seattle 1977 – 1st documented • LA County 1991 – similar results • Treatment delay? Controversial • 1982 study longer treatment delay than African Americans & Caucasians • 2000 study by Okazaki in LA – average delay 17.34 months

25. III. Barriers to Care • Language • Lack of culturally competent practitioners • Stigma

26. A. Language Barriers • 61.9% of APA are foreign born • APA population speaks over 100 languages and dialects • Linguistically isolated households • Definition • Breakdown: 35% Asian Americans • 61% Hmong, 56% Cambodian, 52% Laotian, 44% Vietnamese, 41% Korean, 40% Chinese

27. B. Culturally competent practitioners • 1998 study: 70 APA mental health providers available per 100,000 Asian Americans in US (1/2 ratio caucasians) • Utilization rates increased in outpatient centers tailored to Asian Americans

28. C. Stigma • Stigma against mental illness in APA community • Leads to lower utilization • May delay treatment

29. IV. Solutions • Language – CLAS guidelines • 1964 Civil Rights Act Title VI • CLAS standards 2000 • Free • Written & verbal rights • No minors • Stigma – Education • More culturally competent mental health practitioners

30. V. What you can do • Remain culturally sensitive • Attitude • Knowledge • Skill • Advocate in your family and your community • Use the model minority • Educate others • Refer

31. In conclusion • Confucius says: • “I hear and I forget • I see and I believe • I do and I understand”