Minorities Face Health Disparities in Mental Health and Addictions
September 24, 2013 – In Oregon, planning for diversity is like parsley on the plate, said April Johnson, behavioral health policy analyst for the state office of Addictions and Mental Health, at a gathering of about 40 people, mostly women, for the Oregon Women's Health Network's lecture series.
Multicultural issues, have traditionally been “the last part of the conversation,” said Johnson, who began her talk with a story about how, in the 1990s, her job for the Department of Human Services was to work with families of color on keeping their families intact, after a state study found African-Americans were disproportionately represented in the foster care system.
“It's always been about teaching the minority community how to work with a system that doesn't favor them,” instead of teaching people in power how to treat minorities respectfully, Johnson said, but her work emphasized teaching respectful communication as a two-way street.
“I think we do a fantastic job around our intent to provide healthcare,” Johnson said, but the state also has some work to do in achieving health equity. “We're also one of the whitest states in America.” She cited a 2003 report called Facing Race in Oregon, which chronicled multiple failed attempts to improve the state's record on racial equity.
But Johnson said she was not ashamed to acknowledge those issues, because things are rapidly changing. Her office is diverse, including staff who identify themselves as sexual minorities, speak languages other than English as their first language and have disabilities, she said. There are also initiatives including increased funding for drug and alcohol treatment programs for women with children, and uniform data collection on health equity, which was passed by the Legislature this year.
“Racism, as I experience it, as an African-American, is more institutional than anything else,” said Johnson, who likened diversity planning to getting ready for a Thanksgiving dinner, ending her talk with a story about how last Thanksgiving, her teenage son brought the girl he was then dating, a vegan, to dinner. “We eat a lot of meat,” Johnson said of her family, but she wants to make all her guests feel loved and welcome at her home, so she spent an extra $20 buying extra food she knew her son's friend would be able to eat. “When she sat down, her plate was full. It was different from everyone else's, but it was full, and later she called me, and she thanked me.”
Riffing off that analogy, near the beginning of her talk, Christine Lau, chief operating officer for the Asian Health Services Center, said Asian-Americans, who recently passed Hispanics as the largest immigrant group in Oregon – are still clamoring for a seat at the table when it comes to discussing mental health.
That's because there is little data on mental health outcomes of Asian-Americans in Oregon, and the “model minority” stereotype, along with cultural barriers to seeking treatment, means that mental health issues largely go unaddressed in many Asian communities. The stereotype also ignores the heterogeneity of Asian communities, she said, noting that Asian cultures have very different norms for interacting with mental health professionals.
Class, gender, age and culture also play important roles in the way Lau interacts with her clients. Often, people who have recently immigrated to this country will involve their families in counseling, or their families will decide to get involved, and Lau works with them to make certain the patient is willing to be receive help.
Some other common ways of treating mental health patients aren't necessarily culturally appropriate for Asian-American immigrants, Lau said. For instance, when she trained for addiction and drug counseling, she was taught that when clients refuse eye contact with their counselor, that's a sign they're lying and have probably relapsed. But in some Asian cultures, it's considered appropriate to look at the floor when being talked to by an authority figure, and many clients – particularly those who have been referred to addiction counseling due to an alcohol-related criminal conviction – consider their counselors authority figures. Clients who are professionals and see Lau as a peer, though, are more likely to focus their conversation on small talk, rather than mentioning the more significant emotional events until the session is nearly over.
Also, standard screening tools may not work for traditionally-minded Asian-American communities. Where it's common to screen for suicidal or homicidal thoughts during a first mental health counseling session, that's not culturally appropriate for people whose backgrounds place a heavy stigma on seeking help in the first place, Lau said.
“There's no way I can speak 100 Asian languages or understand all those cultures,” Lau said. “What I can do is try to keep an open mind.”
Christen McCurdy can be reached at firstname.lastname@example.org.
Update: This article has been edited from an earlier version to more accurately reflect Johnson's comments.