Vol. 10 Issue 7
Far From Over
Ethnic minority patients coping with trauma need culturally competent mental health RNs
Possessing more than clinical skills and empathy, J. Karen Martin, BScN, RN, has a solid understanding of her patients' backgrounds. As a nurse in the Asian Behavioral Health program at Hall-Mercer Community Mental Health Centers, part of Pennsylvania Hospital, Philadelphia, Martin says understanding the cultures of the countries from where patients emigrated is integral to the mental health assessment.
Today, Martin helps Asian-American patients manage mental illness at the outpatient center. But she used to work in an inpatient unit where she would see these patients in crisis, and learning about their native countries during nursing assessments "would be a huge part of the whole overall treatment plan," Martin told ADVANCE.
Why? Because these patients could have been face to face with genocide, human trafficking, starvation and abuse, among other tragedies, she said, and the crisis at hand could be the result of an exacerbation of post-traumatic stress disorder.
In Philadelphia, the Asian Behavioral Health program started in the 1980s in response to a wave of immigrants arriving from Southeast Asia. Many were Cambodian refugees fleeing the Khmer Rouge genocide, in which an estimated 3 million of the country's 7 million people were murdered. Those who survived faced multiple traumas, according to the National Institute of Mental Health.
The majority of them remain traumatized 2 decades later; 62 percent of these refugees exhibited PTSD and half have depression. The study was published in the Aug. 3, 2005 issue of JAMA.
Knowing the external sociopolitical stressors and traumas a patient faced helps the mental health professional sculpt their diagnosis and prognosis. Just as important is recognizing cultural methods to healing. In some Asian cultures, for example, herbs are used to manage symptoms of mental illness, said Helen Luu, director of the Asian Behavioral Health program. As a result, the underlying cause of the mental illness goes undiagnosed and unmanaged.
"Mental health and behavioral issues are not recognized as medical problems in many Asian cultures. Medications and hospitalizations are the last resort, if available," Luu said. Health professionals have to tie in cultural competency to break through the stigma.
Helping Minority Children
In Boston, Carol Glod, PhD, APRN, has heard similar tales of sociopolitical trauma. "It is not just about taking into account they have moved here from another country," said Glod, professor of nursing, Northeastern University, Boston. "Their language, religion and morals all get woven into their actual care."
Glod and her graduate students work in community-based mental health centers throughout the Boston area where they serve patients from a variety of backgrounds.
"Many have been involved in human trafficking or horrible circumstances in their country," she added. In terms of cultural competency in nursing, "it's a matter of being aware of how all of the issues fit together the social, lingual, ethnicity, race and socioeconomic status and all the different ways illness can express itself, as well as the meaning, to these families."
Just as many Asian cultures use herbs to heal, other cultures have different interpretations for what might signal a mental illness. A child who says the spirit of a dead aunt came to her, for instance, might raise questions about whether the vision was a dream, an hallucination or an interpretation. But it could be this is how the family operates when someone dies. "We're deciphering it based on their background and understanding their culture.
"We're trying to figure out all the different layers to understand where the child and family are literally coming from and the meaning based on their background."
Calling for More Nurses
But there are not enough nurses like Glod and Martin to help families figure it out. The need for highly skilled culturally competent mental health nurses is growing, said Glod, who is using a HRSA grant to expand the child psychiatric nursing program at Northeastern.
Glod's state, Massachusetts, has 12 counties designated as medically underserved areas and nine counties deemed health-profession shortage areas. According to Glod, about 20 percent of children and adolescents will have a major mental illness in their lifetime. The problem is worsened with the shortage of qualified mental health professionals equipped to assess and treat children and adolescents with psych disorders.
In a study presented in November at the American Public Health Association meeting in Washington, DC, researchers reported a lack of mental health services for suicidal youth, particularly among minorities. About 50 percent of whites reported receiving services, but the rates dropped for minority groups: about 31 percent of African-Americans, 37 percent of Hispanics and 39 percent of other ethnic groups.
"The demand for mental health services far outweighs available clinicians," Glod said. "There are only about 1,000 APRNs who are trained to work with children and adolescents and only about 5,000 child psychiatrists. When you think about the layers of problems the cultural and language barriers, some of the trauma they had in their lives we simply need more providers trained in this area, and trained in cultural sensitivity."
Erin James is senior associate editor at ADVANCE.