Despite showing signs of mental illness, Asian immigrant adults (ages 20-60) with disorders like schizophrenia and ADHD living in the United States are often undiagnosed and therefore untreated by doctors.
The intervention I most recommend would be asking community leaders to recommend utilization of mental health services and decrease stigma regarding mental illness within the community.
I would begin implementing this intervention by sending public health officials to various known community leaders, such as pastors and respected elders. I would try to send public health officials of the same race as the specific Asian community that I try to target using this intervention. I believe doing so would help with the next step which is to cultivate a relationship between the public health official and community leaders that will encourage utilization of mental health services and ending cultural stigma. If the public health official is not of the same race as the community leader, I don't think it will be a cultural barrier as long as there is no language barrier. If there is a language barrier, a translator would have to be found but I believe this can easily be done, possibly without cost if a member of the community volunteers to help communication between leaders and public health officials.
Public health officials would first explain the problem to leaders and ask them to encourage their followers to get help and refrain from ostracizing those with mental illnesses. I doubt that any community leaders will refuse to direct their followers to get professional help, but they may refuse for unforseen reasons. Public health officials and community leaders might work together to create an informative talk on mental health or a pamplet with information about mental health. These may cost some money but if the community leaders are willing to help, the community will most likely cover these costs. There are little infrastructure and monetary costs associated with this intervention because ideally, public health officials working with community leaders would utilize the community's existing tools to help spread the message.
The most important stakeholders in this intervention are the community leaders who are easy to identify and contact. I think all that is necessary to "get them on board" is to explain the long and short term benefits of encouraging mental health services and discouraging stigma against mental illness. Asian immigrants with mental illnesses will often turn to their community leaders instead of seeking professional help. Encouraging utilization of mental health services would decrease the burden that community leaders bear in taking care of these mentally ill constituents as well as the burden of conscience that they might feel when they cannot effectively help them. Though this intervention would take some effort on their part, in the end, they would gain more time to help other members of their community as well as a better conscience knowing that ill members are getting the help they need. The next group of stakeholders would be members who suffer from mental illnesses. They would benefit not only from getting medical help they need from professional mental health services, but they would also feel more comfortable in their social circles if stigma could be decreased. To gain these benefits they would have to listen to the community leaders' advice and utilize mental health services and maybe serve as examples that mentally ill people are not "crazy" to decrease stigma.
To evaluate the effectiveness of my intervention, I would have to do both a quantitative and qualitative study. I would need to quantitatively check measures of mental illness diagnoses in Asian immigrants such as whether the rates of utilization of mental health services are at sufficient levels. I would need to qualitatively check if Asian immigrant communities who have been subjected to the intervention feel less stigma regarding mental illnesses. If the measure of mental illness diagnoses are equal or nearing equal to that of comparable races and if studies show that there is less stigma regarding mental illness in Asian immigrant communities, then the intervention can be deemed successful.
Saturday, April 27, 2013
Saturday, April 20, 2013
Assignment 10: Intervention
Despite showing signs of mental illness, Asian American adults (age 20-60) with disorders like schizophrenia and ADHD living in the United States are often undiagnosed and therefore untreated by doctors.
I have found that currently, only one strategies is in place to address this problem. The current strategy is very indirect as it addresses the much larger problem of uninsured Asian Americans, under which this problem would be specified. The indirect strategy is to improve access and affordability of insurance for Asian Americans so that it will be easier to access mental health services, which makes it more likely that they will seek diagnosis and treatment for mental illness. This strategy has been put into place through various policy changes, a fight that continues today at a time when so many still remain uninsured. This first strategy addresses the influence of economic and environmental key determinants by addressing the cost and presence or absence of health insurance. One possible reason why there is only one current strategy could be that the problem I have defined is a relatively small, specific population which has received little individual attention.
For my first intervention, I would recommend working with community leaders of Asian American adults to encourage their followers who sound like they are suffering from symptoms of mental illness to seek professional help. This can be primary, secondary, and tertiary depending on when the community leaders intervene. Ideally it would be primary and the community leaders would advise their followers to seek professional help before they feel symptoms of mental illness. This primary prevention could help eliminate the stigma surrounding seeking it by talking about it, preventing Asian Americans from feeling too stigmatized to get diagnosed. This intervention can be secondary prevention as Asian American adults who suffer from mental illnesses are likely to go to their community leaders like their pastors and priests for help first. Second prevention would happen with this strategy if community leaders directed their followers to mental health services immediately after followers went to them for symptoms. This intervention can be tertiary prevention as Asian American adults who have been suffering from mental illnesses for a long time are likely seeking counselling from community leaders. Tertiary prevention would happen if community leaders directed those followers who have been suffering for a long time already, to mental health services. This would address the key determinant of social and cultural stigma which prevents them from seeking help.
For my second intervention, I would recommend setting up a mental health counseling center within popular and respected Asian American community, such as church organizations. This could be staffed and run entirely by the community as a simple information center about various symptoms of mental illness and what they can mean. This deals with the environmental key determinant of Asian Americans who are so far removed from mental health services that they do not even consider it an option.
For my third intervention, I would recommend a media campaign together with community leaders of Asian Americans that distributes general information like the typical symptoms of most common mental illnesses, where the nearest mental health services are located, and etc. This would address both social/cultural and environmental key determinants. The media can also target stigma regarding mental illnesses.
I have found that currently, only one strategies is in place to address this problem. The current strategy is very indirect as it addresses the much larger problem of uninsured Asian Americans, under which this problem would be specified. The indirect strategy is to improve access and affordability of insurance for Asian Americans so that it will be easier to access mental health services, which makes it more likely that they will seek diagnosis and treatment for mental illness. This strategy has been put into place through various policy changes, a fight that continues today at a time when so many still remain uninsured. This first strategy addresses the influence of economic and environmental key determinants by addressing the cost and presence or absence of health insurance. One possible reason why there is only one current strategy could be that the problem I have defined is a relatively small, specific population which has received little individual attention.
For my first intervention, I would recommend working with community leaders of Asian American adults to encourage their followers who sound like they are suffering from symptoms of mental illness to seek professional help. This can be primary, secondary, and tertiary depending on when the community leaders intervene. Ideally it would be primary and the community leaders would advise their followers to seek professional help before they feel symptoms of mental illness. This primary prevention could help eliminate the stigma surrounding seeking it by talking about it, preventing Asian Americans from feeling too stigmatized to get diagnosed. This intervention can be secondary prevention as Asian American adults who suffer from mental illnesses are likely to go to their community leaders like their pastors and priests for help first. Second prevention would happen with this strategy if community leaders directed their followers to mental health services immediately after followers went to them for symptoms. This intervention can be tertiary prevention as Asian American adults who have been suffering from mental illnesses for a long time are likely seeking counselling from community leaders. Tertiary prevention would happen if community leaders directed those followers who have been suffering for a long time already, to mental health services. This would address the key determinant of social and cultural stigma which prevents them from seeking help.
For my second intervention, I would recommend setting up a mental health counseling center within popular and respected Asian American community, such as church organizations. This could be staffed and run entirely by the community as a simple information center about various symptoms of mental illness and what they can mean. This deals with the environmental key determinant of Asian Americans who are so far removed from mental health services that they do not even consider it an option.
For my third intervention, I would recommend a media campaign together with community leaders of Asian Americans that distributes general information like the typical symptoms of most common mental illnesses, where the nearest mental health services are located, and etc. This would address both social/cultural and environmental key determinants. The media can also target stigma regarding mental illnesses.
Decision Matrix: (3 – best, 1 – worst)
Options
Decision
Criteria |
Intervention 1:
Talking to Community Leaders
|
Intervention 2:
Setting Up Mental Health Counseling
|
Intervention 3:
Media Campaign
|
Effectiveness
|
3
|
3
|
2
|
Feasibility
|
3
|
1
|
2
|
Sustainability
|
2
|
1
|
3
|
Cost
|
3
|
1
|
3
|
Cost effectiveness
|
3
|
3
|
2
|
Political acceptability
|
2
|
2
|
3
|
Social will
|
2
|
2
|
2
|
Potential for unintended risks
|
1
|
1
|
1
|
Potential for unintended benefits |
3
|
3
|
1
|
Total/conclusion
|
22
|
17
|
19
|
I recommend talking to community leaders. This is the best use of resources and also the most effective way to get through to a population that may otherwise be difficult to get to. There may also be unintended benefits if a relationship is established between public health officials and community leaders. It will not be costly to just send a representative to these communities. It will be very feasible as it is not hard to find Asian American communities and extensive research has been done on the social institutions. Sustainability might be an issue but if both parties are devoted, which they probably will be because both are concerned for the safety of the same population, tools like the internet can help maintain the relationship.
Saturday, April 13, 2013
Assignment 9: Stakeholders
Despite showing signs of mental illness, disorders such as schizophrenia and ADHD in Asian American adults (age 20-60) living in the United States are rarely diagnosed or treated by a doctor.
I would say that because of the specific nature of my problem and the minority it affects, there are relatively few stakeholders compared to perhaps bigger issues. However, there are still stakeholders to consider when considering possible intervention.
There are several possible ways to encourage Asian American adults who show symptoms of mental illness to visit mental health experts. One possible concern I will address before discussing the different ways is the question of whether Asian American adults can identify symptoms of mental illness enough to even think about getting treatment. Though the concern is a valid question and certainly needs more research to verify my opinion, I believe that identifying symptoms is not an issue because mental illnesses have rather distinct symptoms. For example, hallucinations are unlikely to be attributed to a physical illness. Even those who, like many Asian Americans, believe that the mind and body are not separate (Yuasa) will realize that the mind has something to do with the ailment. So I believe I can reasonably conclude that Asian American adults can recognize when they have symptoms of mental illness. The issue is that they are not going to the doctor to get diagnosed and therefore go untreated, not that they do not recognize symptoms of illness.
One suggestion for encouraging them to visit mental health experts is making access to health insurance easier, a much larger problem in and of itself. The stakeholders of this intervention suggestion would be insurance companies who would need to better reach out and communicate to the Asian American community and/or make their insurance more affordable. Many Asian Americans go without insurance because they are small business owners and do not receive it from their jobs nor can afford private insurance. (Carrasquillo) By making health insurance more accessible and affordable, the number of people who utilize mental health services and therefore get diagnosed and treated, will increase. The insurance companies who are the stakeholders would lose the money they gain by refusing to make insurance more accessible and affordable but may gain more money in the future by preventing more costly medical issues caused by untreated mental illness. In this intervention suggestion, my problem becomes part of the bigger, broader problem of lacking health insurance and considers the stakeholders that are part of that larger problem.
A more specific intervention suggestion for encouraging Asian American adults to visit mental health experts is to urge them through valued community leaders. This will address the social stigma that seems to be the main reason why there is underdiagnosis and therefore undertreatment of mental illnesses in Asian American adults. The stakeholders would be the community leaders and environments who would need to agree that mental health services should be utilized and agree to encourage the people they serve to utilize them. An example of this would be for Korean Americans. Many Korean Americans have strong social and cultural connections with their churches, making pastors and other church officials powerful community leaders. (Lee) If pastors agree to encourage their constituents to seek help for mental illness symptoms, it could drastically change the social stigma surrounding mental health services and lead to appropriate diagnosis and treatment of mental illnesses.
Of course, the stakeholders who have the most to gain are Asian American adults themselves. Mental illnesses affect not only the afflicted, but also everyone the afflicted associate with. The symptoms of mental illness are not only privately suffered, but also bear negatively on the emotional wellbeing of others. Solving the problem of underdiagnosis and undertreatment of mental illnesses will improve the lives of many Asian Americans, not only an unlucky few. However, as stakeholders, they too have to make sacrifices. They will need to put the time, effort, and money into getting help and utilizing the services offered. They will need to change their attitude on receiving mental health help as something only for the "crazies".
The most important stakeholders for my problem are the community leaders. They will have the highest impact on a real solution but with a fair amount of sacrifice on their part. I believe my intervention suggest about using the community leaders and organizations to encourage Asian American adults to use mental health services has great promise, especially as the strong ties between community leaders and Asian American adults makes the community leaders invested in their constituents wellbeing.
Works Cited
I would say that because of the specific nature of my problem and the minority it affects, there are relatively few stakeholders compared to perhaps bigger issues. However, there are still stakeholders to consider when considering possible intervention.
There are several possible ways to encourage Asian American adults who show symptoms of mental illness to visit mental health experts. One possible concern I will address before discussing the different ways is the question of whether Asian American adults can identify symptoms of mental illness enough to even think about getting treatment. Though the concern is a valid question and certainly needs more research to verify my opinion, I believe that identifying symptoms is not an issue because mental illnesses have rather distinct symptoms. For example, hallucinations are unlikely to be attributed to a physical illness. Even those who, like many Asian Americans, believe that the mind and body are not separate (Yuasa) will realize that the mind has something to do with the ailment. So I believe I can reasonably conclude that Asian American adults can recognize when they have symptoms of mental illness. The issue is that they are not going to the doctor to get diagnosed and therefore go untreated, not that they do not recognize symptoms of illness.
One suggestion for encouraging them to visit mental health experts is making access to health insurance easier, a much larger problem in and of itself. The stakeholders of this intervention suggestion would be insurance companies who would need to better reach out and communicate to the Asian American community and/or make their insurance more affordable. Many Asian Americans go without insurance because they are small business owners and do not receive it from their jobs nor can afford private insurance. (Carrasquillo) By making health insurance more accessible and affordable, the number of people who utilize mental health services and therefore get diagnosed and treated, will increase. The insurance companies who are the stakeholders would lose the money they gain by refusing to make insurance more accessible and affordable but may gain more money in the future by preventing more costly medical issues caused by untreated mental illness. In this intervention suggestion, my problem becomes part of the bigger, broader problem of lacking health insurance and considers the stakeholders that are part of that larger problem.
A more specific intervention suggestion for encouraging Asian American adults to visit mental health experts is to urge them through valued community leaders. This will address the social stigma that seems to be the main reason why there is underdiagnosis and therefore undertreatment of mental illnesses in Asian American adults. The stakeholders would be the community leaders and environments who would need to agree that mental health services should be utilized and agree to encourage the people they serve to utilize them. An example of this would be for Korean Americans. Many Korean Americans have strong social and cultural connections with their churches, making pastors and other church officials powerful community leaders. (Lee) If pastors agree to encourage their constituents to seek help for mental illness symptoms, it could drastically change the social stigma surrounding mental health services and lead to appropriate diagnosis and treatment of mental illnesses.
Of course, the stakeholders who have the most to gain are Asian American adults themselves. Mental illnesses affect not only the afflicted, but also everyone the afflicted associate with. The symptoms of mental illness are not only privately suffered, but also bear negatively on the emotional wellbeing of others. Solving the problem of underdiagnosis and undertreatment of mental illnesses will improve the lives of many Asian Americans, not only an unlucky few. However, as stakeholders, they too have to make sacrifices. They will need to put the time, effort, and money into getting help and utilizing the services offered. They will need to change their attitude on receiving mental health help as something only for the "crazies".
The most important stakeholders for my problem are the community leaders. They will have the highest impact on a real solution but with a fair amount of sacrifice on their part. I believe my intervention suggest about using the community leaders and organizations to encourage Asian American adults to use mental health services has great promise, especially as the strong ties between community leaders and Asian American adults makes the community leaders invested in their constituents wellbeing.
Works Cited
Carrasquillo, Olveen, and Steven Shea. "Health Insurance Coverage of Immigrants Living in the United States: Differences by Citizenship Status and Country of Origin." American Journal of Public Health, n.d. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446276/pdf/10846509.pdf>.
Lee, Hochang B., Jennifer A. Hanner, Seong-Jin Cho, Hae-Ra Han, and Miyong T. Kim. "KoreaMed Synapse." Http://dx.doi.org/10.4306/pi.2008.5.1.14. Official Journal of Korean Neuropsychiatric Association, 31 Mar. 2008. Web. 06 Apr. 2013. <http://synapse.koreamed.org/DOIx.php?id=10.4306/pi.2008.5.1.14>.
Sue, Stanley, Derald W. Sue, Leslie Sue, and David T. Takeuchi. "Psychopathology among Asian Americans: A Model Minority?" US: John Wiley & Sons, Inc., n.d. Web. <http://ehis.ebscohost.com/ehost/detail?sid=45d5e36d-ffcf-4896-aa50-64a736eaa8d4%40sessionmgr4&vid=1&hid=6&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=1999-00182-004>.
Yuasa, Yasuo, and Thomas P. Kasulis. "Editor's Introduction." The Body: Toward an Eastern Mind-body Theory. Albany: State University of New York, 1987. N. pag. Web. 6 Apr. 2013.
Saturday, April 6, 2013
Assignment 8: Key Determinants
Despite showing signs of mental illness, disorders such as schizophrenia and ADHD in Asian American adults (age 20-60) living in the United States are rarely diagnosed or treated by a doctor.
Works Cited
A key determinant for my problem definition is a factor that is the influence or cause of the lack of diagnosis or treatment of mental illnesses in Asian American adults. There are several possible key determinants from various social, environmental, economic, and etc. sources. This post is limited by the relatively small amount of literature available on the subject. However, several determinants can be deduced from the available literature. Though the determinants are categorized into various groups, it is important to note that every problem, including this one, is the influenced or caused by many different determinants, not just one.
There is no biological determinant that could cause the lack of diagnosis and therefore treatment of mental illness in Asian American adults. However, there are biological factors to consider when looking at the credibility of my problem. Some say that the problem I have put forward does not exist, but rather that Asian American adults simply have lower rates of mental illness. Biologically speaking, there are no indications that Asian Americans have physical compositions that have fewer rates of mental illness. (Sue 1) Therefore it is likely that my problem of lack of diagnosis and treatment does indeed exist.
The biggest determinants of my problem are social and cultural. To understand the direct social and cultural influences that have caused the low rates of diagnosis and treatment, first requires an understanding of the difference in cultural views between Asians and the rest of the American population. In many Asian cultures, the mind and the body are not seen as separate as it is in Western culture. Illnesses of the mind are traditionally, and to some extent even today, treated by treatment of the body. (Yuasa 1) My problem definition specifies my focus as on Asian Americans, so the possible argument could be made that Asian Americans do not share this belief that the mind and body are one entity. However, many studies show that most Asian Americans retain close ties with their ethnic values, which would include this idea. (Carrasquillo 1) The idea that the mind and body are one itself contributes directly to the lack of diagnosis and treatment for mental illnesses in Asian American adults. They may not seek mental health doctors or disregard suggested treatment because they believe that mental illnesses must be treated completely or at least partially with physical, external treatment. This cultural difference also contributes indirectly to the problem. This ancient, long-standing belief in the unity of mind and body combined with negative media portrayals of those deemed mentally ill has caused serious stigma against receiving mental health help. (Lee 1) It is seen as treatment only for the true "psychos" who are completely deranged both mentally and physically. In Asian cultures where honor and how one is perceived by others is very important, this cultural stigma is probably the leading cause of the lack of diagnosis and treatment of mental illness in Asian Americans. When others in the Asian American community learn that a member is receiving mental health treatment, the stigma affects not only the affected member, but also his/her family and friends.
Another determinant might be the environmental affect of living in an area with few mental health resources. Asian Americans are less likely to use mental health resources, especially considering the other determinants, if the resources are far and hard to access.
One major economic determinant to consider is the generally low rate of health insurance in Asian Americans. Many Asian Americans own small independent businesses and cannot get health insurance from their workplace. And because private health insurance is expensive, many choose to live uninsured. (Carrasquillo 1) With low rates of insurance, Asian Americans are unlikely to utilize health resources in general, let alone mental health resources.
There are no political determinants that might cause low rates of diagnosis or treatment in Asian American adults.
Works Cited
Carrasquillo, Olveen, and Steven Shea. "Health Insurance Coverage of Immigrants Living in the United States: Differences by Citizenship Status and Country of Origin." American Journal of Public Health, n.d. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446276/pdf/10846509.pdf>.
Lee, Hochang B., Jennifer A. Hanner, Seong-Jin Cho, Hae-Ra Han, and Miyong T. Kim. "KoreaMed Synapse." Http://dx.doi.org/10.4306/pi.2008.5.1.14. Official Journal of Korean Neuropsychiatric Association, 31 Mar. 2008. Web. 06 Apr. 2013. <http://synapse.koreamed.org/DOIx.php?id=10.4306/pi.2008.5.1.14>.
Sue, Stanley, Derald W. Sue, Leslie Sue, and David T. Takeuchi. "Psychopathology among Asian Americans: A Model Minority?" US: John Wiley & Sons, Inc., n.d. Web. <http://ehis.ebscohost.com/ehost/detail?sid=45d5e36d-ffcf-4896-aa50-64a736eaa8d4%40sessionmgr4&vid=1&hid=6&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=pdh&AN=1999-00182-004>.
Yuasa, Yasuo, and Thomas P. Kasulis. "Editor's Introduction." The Body: Toward an Eastern Mind-body Theory. Albany: State University of New York, 1987. N. pag. Web. 6 Apr. 2013.
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