0 Diversity Mental Health Month: Why It is Needed and How It Came to Be

By Steve Koh, MD, MPH, MBA

July of 2014 is the very first APA Diversity Mental Health Month. This
emphasis on mental health needs of diverse populations is much needed. While we
have diversity oriented month observances for specific population groups like
the Black History Month (February), National Women’s History Month (March),
Asian Pacific American Heritage Month (May), Gay and Lesbian Pride Month
(June), American Indian Heritage Month (August), and Hispanic Heritage Month
(September), we have not had a dedicated month more broadly addressing diverse
populations and mental health issues.

I cannot overemphasize the importance of this month. For the first
time, together, we will bring attention to the unique and challenging needs of
the diverse populations with mental illness and substance use disorders, work
to decrease mental health disparities, and engage with diverse populations to
help promote and grow future mental health champions in the communities.

The concept for Diversity Mental Health Month came from a group of
participants in APA’s Minority Fellowship program.  The program’s goal is to eliminate racial and
ethnic disparities in mental health and substance abuse care by providing
specialized training and mentorship. The fellowship fosters those with diverse
backgrounds who have chosen to become physicians specializing in mental health
and to do this work with the diverse populations.  



But what happens when we go home? What then? We felt that it was easy to get
lost when we left our APA meetings in Washington DC. How do we galvanize our
colleagues at home to look at the importance of minority mental health issues?
To recognize the stigma of being an ethnic and cultural minority and also
suffering mental illness? To understand that many minority students do not
consider going into field of medicine let alone mental health profession? To
appreciate the importance of cultural competency and humility in working with
diverse patient population?

Without
involvement a coordinated effort by the APA, it was our belief that while we
personally benefited from the fellowship experience, our impact would be
limited. There needed to be a designated time for all of APA to bring attention
to this important patient population.  So
the idea was born to create a Diversity Mental Health Month. The APA Assembly asked
APA staff to help create a month designated to minority mental health issues
and for the APA to actively promote the month.

I hope that others are excited about this new endeavor of the APA as I
am. The challenges are great but together we can bring the needed attention to
this area of our profession.

Many resources, including an infographic with basic data on mental
health disparities, and brochures and fact sheets on specific populations,
suggested activities, video messages, and more, are available at www.psychiatry.org/diversity-month.

Detail: Diversity Mental Health Month: Why It is Needed and How It Came to Be

0 Suicide Prevention for Seniors and African Americans

By Gina N. Duncan, M.D.

Don Cornelius’s death shocked many of us. The report that his death was a suicide has made it all the more tragic. Best known as the founder of Soul Train, Don was an icon in American music history. Unfortunately, as noted by others commenting on his death, the “Love, Peace, and Soul” he promoted as a public figure may have eluded Don in his personal life, particularly in his later years.

Now we are further shocked by the untimely death of Whitney Houston. Her battle with drug abuse was well known, though the cause of her death has not yet been determined. In our sensational, media-driven culture, the very personal details of celebrities’ mental, emotional, and family struggles are often on display for public entertainment, sympathy, judgment, and criticism. In recent years, with the tragic losses of Michael Jackson, Amy Winehouse, Heath Ledger, and others, the dangers of illegal and prescription drug abuse have been given an increasing spotlight in the media.

 

Don Cornelius’s death, however, highlights two mental health issues that are significantly under-discussed in the public: suicide in African Americans and in seniors.

Depression is under-diagnosed in older adults. It often co-occurs with medical illnesses such as heart disease, diabetes, stroke, and cancer, and can be associated with the social difficulties and financial strain many older adults experience. Because of this, we tend to accept depression as a natural consequence of aging, but this is not so. When depression is present, it not only diminishes a person’s quality of life but also increases his / her risk of death by delaying or worsening recovery from the medical illness or by suicide. Depression is also under-recognized and under-treated among African Americans and other minorities. 

I recently spoke at a National Alliance on Mental Illness (NAMI) program called "Sharing Hope: Understanding Mental Health" in Augusta, GA. “Sharing Hope” is an educational program designed to raise awareness of mental health issues in African American church congregations. One woman there told us that her brother had died from suicide not long ago. She explained that he had been troubled for some time and had made threats before but not acted on them. She asked: Were there signs she and her family missed? Was there some way they could have prevented it? She expressed feelings of guilt and shared that she and her family blamed themselves for not having done more, yet at the same time, they didn’t know what more they could have done. 

My heart goes out to her and to anyone who has been affected by the suicide of a loved one. Feelings of guilt, self-blame, and shame are common. Perhaps some consolation can be found in the recognition that it’s impossible to fully control the decisions and actions of another adult. There are support groups for survivors of suicide that provide a place to express these complex emotions. Seek support from your faith if that is relevant to you, and tune out those who would make negative remarks about your loved one's fate after death, as none of us have the final say in that matter. 

The best suicide prevention is early recognition and treatment of depression. Depression may be masked by factors such as medical illness, dementia, personality style, and other mental illnesses, so understand the symptoms. 

If you are concerned about a loved one, please follow these suggestions:

1)  Do not be afraid to ask if they are considering suicide--you will not plant the thought in their mind by asking.

2)   Stage an intervention if necessary, where you can express your concerns and encourage them to get treatment.

3)  Take any and all threats or gestures seriously--seek help from their doctor immediately or call 911.

We should celebrate the achievements of Whitney Houston, Don Cornelius, and the other amazing talents we’ve recently lost; our lives are richer for their contributions. I hope that by raising awareness of these critical mental health issues, their untimely deaths will cause others to seek help and to heal. 

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Detail: Suicide Prevention for Seniors and African Americans

0 Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.

The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:

• mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;


• community mental health centers;


• hospital psychiatry departments, outpatient clinics and/or inpatient units;


• family services, social agencies, or clergy;


• peer support groups;


• private clinics and facilities;


• employee assistance program; or


• the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on Healthyminds.org,

Detail: Getting Help: How to Start the Conversation and Find Professional Services

0 Faith & Mental Wellness in the African American Community

By Gina N. Duncan, M.D.



For many in the African American community, faith is an integral part of life.  In one study, approximately 85 percent of African American respondents described themselves as “fairly religious” or “religious” and considered prayer a common way of coping with stress.   

My training as a psychiatrist coupled with my background enables me to have a unique perspective on the field of psychiatry as it relates to the African American community.  I come from a Southern, deeply religious African American family of educators.  My grandfather, a gifted musician, suffered from depression for most of his adult life.  While it did not prevent him from having a successful career as a school principal, civic leader, and church member, it did prevent him from enjoying his blessings more fully.  This has had a ripple effect in my family, which continues to be felt even three generations out.  Fortunately, because of the struggles we observed in our grandfather, the younger members of my family have become much more vocal about our own stresses, and are determined to not let history repeat itself.

For many of us, emotional issues and mental illness are inextricably linked to issues of faith.  Some may view depression as a punishment for sin, psychotic illness as the presence of demons, or anxiety as a lack of faith in God’s ability to provide.  As a person of faith myself, I can say that faith provides a holistic view of life and of the meaning behind our individual experiences and struggles.  However, that does not mean that we cannot make use of all the resources available to us.  After all, if we have a headache we take Tylenol, right?  And if your doctor tells you to take medicine for your diabetes and high blood pressure, you listen.

Some emotional problems can be fully resolved with talk therapy and support.  However, more serious problems such as recurrent depression, thoughts of suicide, schizophrenia, or bipolar disorder often require medication in addition to other forms of treatment.  This is an exciting time in the field of psychiatry and brain science, as we learn more and more about the biological basis of many mental illnesses.  And the good news is that there are many proven, effective treatments.

African Americans are a resilient people.  In honor of Black History Month, let’s make a commitment to living our best lives.  That means getting the help you need.  If you think you are suffering from depression, anxiety, or another mental illness, please know that it does not affect you alone.  It impacts your spouse, your children, and your community.  There are a lot of resources on HealthyMinds.org to help you get started.

Let your light shine—don’t let it be diminished by a treatable condition!

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Detail: Faith & Mental Wellness in the African American Community

0 Are Depression Symptoms the Same Across Cultures?

By Gabriella Corá , M.D., MBA



Although, as psychiatrists, we make a diagnosis of depression given a specific set of signs and symptoms, the way in which depression manifests may be different across cultures.



In addition to stigma, many Latinos struggle with acculturation issues, lack of insurance coverage and difficulty communicating with healthcare professionals who are not culturally proficient.



Barriers to care also affect African American communities. The diversity of the Latino, African American as well as the Asian communities is often minimized. Many believe that because someone has the same skin color or speaks the same language they have a similar set of needs. In fact, Spanish-speaking African Americans need tailored interventions to address Latino as well as African American cultural needs in order to effectively treat depression or other mental health disorders.



What to do?



1. Learn about depression: look for good sources of information.



2. Seek for help: Tell your doctor you or your loved one may be experiencing depression. If you don’t have a doctor, go to a community mental health clinic and let staff know you need help.



3. Become familiar with cultural differences in the diagnosis and treatment of depression: ask your doctor if his/her office has culturally-competent or culturally-proficient staff to help you. Cultural proficiency goes beyond speaking the language.



4. Be open to staff: Although the doctor’s office may not have culturally-competent staff, healthcare professionals may be very familiar with working across cultures. The “I can only be treated by someone who looks or talks like me” is a myth. Although this may help in the beginning, we know caring and empathic staff will be able to help you beyond gender, color, ethnicity or language.

Detail: Are Depression Symptoms the Same Across Cultures?