Seeking Psychotherapy

You’re extremely exhausted, you can’t control your outburst and now your world feels like it’s no longer belongs to you. These could be signs of something more serious than just being “tired”. You like 4.4 million Americans could be struggling with a mental illness, which unlike the common cold, getting treatment is not easy. While therapists, psychologists, psychiatrists and counselors are all Mental Health Care professionals, they all play many roles in getting adequate treatment.

Psychotherapy, a term used within the Mental Health field, simply means “talk therapy”. Known to be the most effective key treatment option, talk therapy has been around since 1879 and is constantly being integrated with many other forms of therapy. While there are various key techniques that contribute to the success of talk therapy, open ended questioning provides the consumer with an opportunity to be heard and the professional a chance to observe body language and tone.

If you are still hesitant about seeking therapy, here are a few tips to help ease some of your dismay.

Awareness of Your Mental State

When you have a mental illness one behavior/ symptom is the thought that you are perfectly A Okay. Persistent Depressive Disorder is a type of depression in which symptoms last for a minimum of 2 years. While many consumers express that they experience symptoms of despair for at least 10 years, they don’t seek treatment due to the thought that they are truly ok. Being aware of a change in your behavior may be difficult to do in the beginning. Changes such as an inability to sleep, irritability or decrease in appetite that continuously occur may not indicate a mental illness; however, uncontrollable crying, delusions and hallucinations indicate a serious internal alarm that you are experiencing an episode.

TIP: Start a daily journal, take notes or voice record patterns, moods or even things that you normally enjoy doing. This will be awesome for a visit to your mental health care provider because it will provide a consistent behavior pattern.

Understand Your CoPay and Insurance Plan

Although having medical insurance is a huge financial help, most insurance companies do not ensure full coverage. It is important to pull your coverage or call your insurance company to get all of the facts before you attend your first session.

TIP: Some tests are not covered by your insurance company, find out the exact terms of your coverage.

Research Mental Health Care Professionals

This step is very crucial and vital to a successful relationship between consumer and professional. You can find out their professional background, disbarment, primary focus and much more on many websites. Each mental health care professional plays a specific role in managing your illness.

TIP: Find one close to your home, work or a friend for an easy option for cooling down.

You Can Always Change Doctors

Finding a doctor is not as easy as it may seem. Every doctor has a different approach and sometimes you may not feel comfortable with their approach. If you are not meshing well or feel as though their diagnosis does not seem accurate, feel free to get a second opinion. Once you have a positive connection with a doctor of your choice the better your experience will be.

TIP: You know your body best, if you are experiencing unusual side effects or feel over medicated express your concerns to your doctor.

Have a Support Team

You may be exhausted after all of the searching and attending sessions so make sure that you have a strong support group for those difficult times. Some sessions will be intense and trigger some unwanted symptoms or feelings. You may need a friend to just be there for extra comfort.

TIP: You don’t have to share your sessions with friends unless you absolutely want too.

Try to Be Open, Honest and Consistent

Last but not least remain transparent. This will be the only way your Mental Health care professional can adequately treat your illness. The better insight on your symptoms, behaviors and experiences the real managing can begin.

TIP: Let your doctor know how difficult the topic may be before you begin to discuss your feelings. They can ease into the subject and ultimately be there for you.

SPIRIT | SOUL| then BODY

In today’s world, when it comes to being, there is so much emphasis placed upon the outer appearance, that the essentials of soundness of being are lost in the mix.

What we are spiritually, and how we are emotionally, must be attended to MORE THAN, how we appear physically.

HOW YOU ARE IS MORE IMPORTANT THAN WHO YOU ARE, AND HOW YOU LOOK!

The truest self is SPIRIT. As such, that true self must be in touch with the Spirit that created it. Everything that is living must be nourished, this means that the spirit part of who we are must be fed in order to maintain spiritual health and vibrancy.

The perceived self is SOUL. As such, how we see ourselves and others must constantly be examined to see which emotional choices are most conducive to our goal of emotional health, and sense of well being.

The least of who we are is the BODY. The body is merely the earthly expression of our spirit selves. As such, the body is the slave of the emotions, and will depict whatever we think we are.

Endeavor to create a holistic focus on overall well being. It is not wise to place too much emphasis on the outer appearance, while suffering from the lack of identity and healthy sense of value and well being on the inside.

 

Dr. Mark T. Jones Sr.

Thinking holistically.

Budget Increases for Mental Health and What It Means For Our Community

By: Lindsay Anderson

A new year means a new budget for America. The HR2029 budget bill of 2016 has been given and Mental Health has seen an increase of $400 Million Dollars. That sounds like a huge amount of money when America is in a financial deficit that seems to be increasing every second. And even with this increase for Mental Health many question what and where does the money go?

First, let’s talk about the National Institute of Mental Health (NIMH). If you have ever wondered where the bulk of the funds go it is to this institute.  The NIMH is the lead federal agency that administers research on mental disorders. There are 27 Institutes and Center that play a part in the National Institutes of Health (NIH) which is the nation’s medical research agency. NIMH does research on major diseases like Anxiety, Bipolar Disorder, Depression and many other disorders. The test examine everything from cellular, molecular, behavioral, brain function and clinical investigations.

So knowing what they do, how does all of the research and testing weigh to actually getting treatment out to consumers? Well that goes hand and hand with each state. Each state also receives a funds and they can disperse the funds as they see fit. The problem is most states don’t see Mental Health research as a valuable piece of information. With the rise in Suicide( 12.9 per 100,000) and now the 10th leading cause of death prevention and treatment should be a top priority.

There are also other programs that receive money underneath this increase, programs like new Project AWARE with $49.9 million ( +$10 million ) or the Mental Health Block Grant program which receive a $50 million increase. And with the newly additional funds there is also some new requirements to ensure that research and data findings are concentrated on evidence-based plans that are geared to serious mental illnesses.

Hopefully with new programs and increased cash there will a larger focus on advocacy from consumers and non consumers alike. It doesn’t matter how much money is being used to gather resourceful information to treat these illness if we don’t begin to seek the help that is needed. There are so many programs and initiatives that are cut every year and if we don’t voice the severity of mental wellness, I am fearful that millions will continue to decline in the future.

To find out more information on the 2016 FY Budget <—- CLICK HERE

Lindsay Anderson is the Editor-In-Chief and Founder of ConsciouslyCoping.org, a Mental Wellness social media site that primarily focuses on educating minorities, underprivileged and lower income based families on healthy approaches of managing Mental Illnesses.

President Barack Obama on Mental Health and Dropping the Stigma

 

Pass the Pain: Epigenetics of Black Health

By: Natasha Duggan, MSPH

Minorities and African Americans in particular are disproportionately affected by various chronic diseases in comparison to their white counterparts. Diseases including obesity, diabetes, cancer and asthma are much more prevalent in the black community. The question is …why?

It is in part due to genetics. Some illnesses like diabetes have a genetic component, meaning risk of disease is passed down in your family through your DNA. However, genetics alone does not account for the disproportion of some diseases found only in certain populations or neighborhoods. These findings can be explained by epigenetics.

Epigenetics refers to the changes that occur in gene expression-turning genes on and off- without changing the actual DNA sequence.¹ Epigenetic changes happen naturally but can be influenced by things like age, environmental exposures, and disease. In many instances epigenetic changes are reversible, but they are sometimes irreversible and affect a person for life.¹ Exposure to different environmental factors can cause epigenetic changes which result in diseases like cancer, obesity, diabetes, and asthma. Increased and prolonged exposure to adverse environmental factors increases the likelihood of epigenetic changes being irreversible.¹

Epigenetic changes go beyond effecting the person being exposed to adverse environmental factors. Epigenetic changes can be hereditary. If a pregnant woman is exposed to certain environmental factors, the epigenetics of her child may be permanently altered, resulting in an increased risk of chronic disease.^1,2 One of the most famous and well-studied examples of this is the Dutch Famine. In the later years of World War II, pregnant women who experienced famine gave birth to children with increased incidences of both heart disease and obesity due to the epigenetic changes which occurred while they were still in the womb.¹

So why is epigenetics so important to minority communities? Epigenetics partially explain why minority populations are disproportionately affected by some chronic diseases. An example of this includes the effects antibiotics have on infants before they are even born. Antibiotics are the most common drugs prescribed to pregnant women. Scientists have found that when pregnant women take antibiotics they are more likely to have a child with low birth weight². In turn, these children often under-go catch-up growth in early childhood, which often results in obesity². Although this phenomena occurs across all races, it is much more common in black women.²

So what is going on to make this happen? The taking of antibiotics while pregnant creates a stressful environment for the fetus, so to ensure its survival epigenetic changes occur.  Once the child is born and is no longer in a harsh environment they tend to become obese due to the fact that the epigenetic changes which occurred when they were still in the womb are still in effect.²  However, it is not just antibiotics that can cause these epigenetic changes. Many pharmaceutical drugs also cause epigenetic changes, increasing the risk of heart disease, cancer, neurological and cognitive disorders, obesity, diabetes, infertility, and sexual dysfunction³. Because of this it is very important to be careful what goes into your body.³

Stress is a major contributor of epigenetic changes. Unfortunately being black in America causes a lot of everyday stress. Although being of a lower socioeconomic class is correlated with higher stress and worse health outcomes, across all socioeconomic classes Black and Latino people were found to be more likely to have high levels of the stress hormone cortisol.^4,5,6  Stress can cause a variety of epigenetic changes. Firstly, high stress levels during pregnancy can cause epigenetically induced asthma in infants.⁴ This is exacerbated by the mother also being obese while pregnant.⁴ High stress levels (marked by high cortisol levels) have also been shown to result in premature childbirth.⁶ This is thought to be a possible reason why black women have more premature births than white women.

The scary part about epigenetics is the fact that epigenetic changes can be inherited and can affect your children’s and even your grandchildren’s likelihood of having a disease. With epigenetics being a fairly new field, there is still a lot more research that needs to be done to see the role epigenetics plays in many chronic illnesses. Even though a lot of epigenetics  cannot be changed, it is still important to educate ourselves on what may be responsible for our illnesses and to try to avoid the exposures that we can. Don’t take drugs (pharmaceutical or antibiotics) unless necessary, and adopt effective stress relieving behaviors. The more you know, the more likely you are to make better, healthier decisions.

Natasha Duggan received a B.A. in Psychology from the University of San Francisco and M.S.P.H. with a focus in Tropical Medicine from Tulane University. She is currently working on her Ph.D. looking for potential vaccines against HIV at the University of Miami. She plans to use the knowledge and skills acquired from these different disciplines to work on a vaccine and/or treatments against HIV and make sure that they get to the people that need them the most in countries hardest hit by the pandemic in Sub-Saharan Africa.

 

Resources

1.http://www.whatisepigenetics.com

2.AC Vidal et al. “Association between antibiotic exposure during pregnancy, birth weight and aberrant methylation at imprinted genes among offspring.” International Journal of Obesity 2013; 37,907-913.

3.AB Csoka & M Szyf. “Epigenetic side-effects of common pharmaceuticals: A potential new field in medicine and pharmacology.” Medical Hypotheses 2009; 73, 770-780.

4.RJ Wright et al. “Disrupted prenatal maternal cortisol, maternal obesity, and childhood wheeze.” American Journal of Respiratory and Critical Care Medicine 2013; 187(11), 1186-1193.

5.RJ Wright. “Epidemiology of stress and asthma: From constricting communities and fragile families to epigenetics.” Immunol Allergy Clin North Am. 2011; 31 (1), 19-39.

6.Janell Ross “Epigenetics: The Controversial Science Behind Racial and Ethnic Health Disparities.” The Atlantic March 20, 2014. http://www.theatlantic.com/politics/archive/2014/03/epigenetics-the-controversial-science-behind-racial-and-ethnic-health-disparities/430749/

Toxins in the Hood

By: Cassandra Bazile

When we hear of racial injustice, we tend to think of police brutality or the criminal justice system’s war against minorities; but what about the air and water we consume? “Environmental racism”, a term coined in the 1980s, plagues the United States as many illegal dumps, chemical plants and sewage treatment plants reside in the backyards of people of color and the poor. Polices and practices are implemented to discriminate against people based on race and social class by forcing them live in areas near facilities that are major causes of pollution. These waste facilities contain toxins and carcinogens such as lead, cobalt and Styrene. People who live in these areas are inhaling and consuming toxins that can cause generational defects. Research has shown that middle class African Americans who make between $50,000-60,000 a year are more likely to live in a polluted neighborhood than white Americans who make just $10,000 a year.  Don’t believe me? Let’s talk about some cases of environmental racism.

Along the Mississippi River between New Orleans and Baton Rouge there are over 150 industrial factories that produce a quarter of the nation’s petrochemicals. The 85-mile stretch, infamously known as “Cancer Alley”, has been known for the unusual cases of cancer and mysterious illness that happen in its vicinity. How do these chemicals ultimately lead to cancer?  Well, it first started with the residents awaking to mysterious ash on their cars every morning. The ash soon caused putrid smells which, eventually, the residents became accustomed to. After a while the residents became used to the pollution, unaware of their diminishing health.

With the decline of industries such coal mining and petroleum, many white Americans suffer from environmental bias as well. The decline of industry also brought the decline of the livelihood of those that depended on those jobs.

Flint, Michigan recently made headlines for a water crisis in which Flint changed its water source from Lake Hurton to Flint River, which had major lead contamination. Exposure to lead causes developmental problems in children including impaired cognition, delayed puberty and a variety of behavioral problems. Between 6,000 and 12,000 children where exposed to lead and are now haunted by  life-long impending health problems. Coverage of this crisis raised the debate of whether the race and social status of Flint’s residents had to do with this situation.

Flint was once an industrial powerhouse and housed General Motors’ largest plant. The plant downsized in the 1980s, taking the jobs from residents and negatively impacting the livelihood of the city. Many of Flint’s residents live below the national poverty line and over 40% are African American. The state’s actions following the exposure of the contaminated water being pumped into Flint were questionable to say the least, leaving questions about whether the situation’s handling had to do with the racial and socioeconomic demographics of Flint.

So what now?

Laws to protect Americans against environmental bias have long existed. In 1994, President Bill Clinton signed a bill to ensure the goal of achieving environmental protection for all communities.  It has been shown that areas of impoverished people have not reaped the benefits since the bill was never enforced. Over 20 years later, we are still battling to enforce these laws in areas where the people aren’t heard. The environmental protection agency (EPA) has a department that is specifically concerned with civil rights and in its 22-year history the office has not found a case of discrimination. Surprised?Environmental racism doesn’t just affect the generation of people living there. Environmental toxins can cause generational damage. The cycle of bias when it comes to the environment in which we are born and raised, or where we play, live, and work perpetuates the oppression of minorities and low-income communities.

Cassandra Bazile is a Graduate Student at the University of Miami, currently pursing a PhD in Microbiology and Immunology. She graduated from Morgan State University in 2012 with a bachelor’s degree in Biology and then moved to Boston where she worked at MIT for 3 years. Cassandra has a deep rooted love for science and research. Her Interest Include Women’s Health, Fitness, and Community Outreach.  

Bibliography

1. Huffington Post, (2016) “EPA to Weaken Civil Rights Protections Under Obama”. New York, New York.

http://www.huffingtonpost.com/keith-rushing/epa-to-weaken-civil-right_b_9069362.html

2. The New York Times. (2016) “A Question of Environmental Racism in Flint”. NEW YORK, NEW YORK. http://www.nytimes.com/2016/01/22/us/a-question-of-environmental-racism-in-flint.html?_r=0

3. Pollution Issues. “Cancer Alley, Louisiana”.  http://www.pollutionissues.com/Br-Co/Cancer-Alley-Louisiana.html

4. Lee, Trymaine. MSNBC. .(2014) “Cance Alley: Big Industry, Big Problems”. http://www.msnbc.com/interactives/geography-of-poverty/se.html

5. (2013) “Mapping the Cancer Corridor along Louisiana’s Gulf Coast”. https://dabrownstein.com/category/cancer-alley/

Internet Resources

1.https://en.wikipedia.org/wiki/Environmental_racism

2.https://en.wikipedia.org/wiki/Cancer_Alley

3.“Environmental Racism explained”. Online Video clip. Youtube, 29, Jan 2016.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Make It Relevant: A Cultural Approach to Healthcare

By: Daphney Dorcius, MPH

The United States is an increasingly global society; currently, immigrants make up 30% of the nation’s population, and this percentage is projected to increase to 50% by 2050 (7). The U.S. Census Bureau reports that Florida has the largest immigrant population in the country, making it one of the contributing the most to the diversity of the nation. Minority populations including African Americans, Asian Americans, Native Americans, and Latinos have a higher prevalence of chronic disease, higher mortality rates, and poorer health outcomes, compared to the White population. In order to make improvements in health equity, disparities-focused interventions in health care delivery will be necessary (1).

Although health disparities have been documented across minority populations, each subpopulation faces specific challenges and risks. There are nearly 53 million Hispanics living in the United States, making up about 20% of the population (9). Poorer health outcomes among Hispanics can be largely attributed to linguistic and cultural barriers as well as the lack of access to preventive care. Heart disease, stroke, and diabetes are the main causes of death within this population, with the rate of obesity being higher than non-Hispanic Whites. African Americans make up the second largest minority group in the U.S., with a population of approximately 43 million in 2012 (1,9). Similarly to Hispanics, African Americans face a higher mortality rate than Whites. Causes of death, chief among being stroke, cancer, asthma, diabetes, HIV/AIDS, and homicide, can be largely attributed to socioeconomic and cultural forces. Similarly to African Americans, American Indians/Alaska Natives face barriers such as geographic location and culture, that prevents them from receiving quality medical care. As a result, some of the leading causes of death seen within this ethnic group include heart disease, diabetes, and stroke. Although Asian Americans have the highest life expectancy than any other group in the US, it is worth noting that due to factors such as fear of deportation and language/cultural barriers, a high prevalence of chronic obstructive pulmonary disease and liver disease has been reported within this population, together with an increased risk for heart disease, stroke, and diabetes (US Department of Health and Human Services) (9). Significant health disparities faced by minority populations indicate that cultural factors present a unifying barrier to quality health care in the U.S., and are largely responsible for the disproportionate burden of negative health outcomes among non-Whites.

The consideration of cultural factors in dialogue surrounding health care and patient- centered care has been absent for too long. Health care providers are now facing the reality of having to adapt their current methods of health care delivery to become more culturally responsive. Such an approach requires providers to think differently when addressing the physical and behavioral health needs of patients. Consequently, National CLAS standards were put into place as a form of Blueprint for the acquisition of Cultural Competency within the health sector (10). Critics questioned CLAS’s applicability due to the underlying notion that competency necessitates measurement scales that could not be applied to assess cultural awareness. In the effort to resolve this issue, Cultural Responsiveness was proposed. Many prefer this term “Responsiveness” because it places an emphasis on one’s ability to respond to the diversity of communities by focusing on social and cultural factors impacting patients’ lives (8).

A clear understanding of culture is crucial in health care delivery because culture has the ability to influence the decisions, attitudes and beliefs of patients in relation to their access and engagement in healthcare, and can exponentially impact health outcomes. Culture plays a critical role in the patient’s perception of health care delivery, their experiences in relation to health and illness, and their ability to reject, accept, and commit to proposed treatment options (6). The literature acknowledges the importance of cultural awareness within the health sector because of the impact it has on prevention and health promotion initiatives, but emphasizes the necessity for responsiveness to enhance of patient-provider relationship and improvement in health outcomes within minority communities (4,5,6).

Dr. Erin Kobetz, whose research into the cultural barriers that prevent Haitian women from accessing breast cancer screening methods in Miami, Florida, exemplifies cultural responsiveness to healthcare in minority communities. Although mammography screening has been recognized as the screening method of choice to decrease morbidity and mortality from breast cancer in women in the U.S., women from minority ethnic groups, especially those who are foreign born, have not used these resources adequately. Consequently, a disproportionate number of women from these groups die of late-stage breast cancer, which, if caught at a treatable stage, could have been prevented (3). The findings of the research showed that Haitian women in Miami did not receive routine mammograms due to barriers including language and communication problems, citizenship and immigration, and social-cultural customs. Her work emphasizes that these barriers should be considered within the social context of patients’ lives in order to develop and implement effective interventions (3).

More than half (57%) of Haitian women are monolingual Kreyol speakers (3). Therefore, these women would be less likely to access care because of the discomfort and fear caused by their inability to understand the language their being spoken to. As a result, poor quality of communication and a lack of trust between Haitian women and health care providers are likely to impact diagnostic reliability and decrease treatment adherence. Furthermore, the cultural depiction of health differs across cultures. Haitian women describe health as absence of obvious physical or psychological symptoms (3). For diseases that are asymptomatic and can be prevented via screening, it is highly likely that these women will have a higher morbidity and mortality rate than women of other groups because they will not access health care on a timely manner. Being able to understand this aspect of the culture of a population will therefore allow health care providers to respond in the appropriate manner via education, screening intervention, and counseling, all of which can be tailored to their beliefs. For example, plant based remedies are highly valued within the Haitian culture. Understanding that the usage of oil and plant based mixtures for cleansing of the body inside and outside is important for appropriate response, prevention of Drug-Drug interactions, and even for preventative methods. Finally, diagnostic is associated with death within the Haitian community. As a result, the people will be less likely to go to health care facilities out of fear. Being able to understand that can strongly affect the deliver of messages regarding diagnostic in a manner that would promote continue of care by the patient.

Skin color should not be used as an indicator of similarity of cultural beliefs and practices because of differences in heritage (1,4). For instance, many similarities exist between the African American culture (people of African descent) and Caribbean, but there are key cultural differences that have the capacity of impacting health outcomes. For example, African American families tend not to be restricted to blood related members to often include non-related individuals (5). Therefore, when acquiring information on family history, and when counseling patients on inheritable conditions, it is important to be mindful of the formulation of the questions. Beyond this, older generations tend to be more conservative and traditional. They tend to have a strong voice in the decision making within families while also holding housekeeping task within their households (2,5). Because of the strong families ties and their cultural norms, institutionalization of the Elders has been historically avoided.

Minority populations face an array of interconnected social factors that ultimately determine health outcomes at the population level. The literature has shown that living in disadvantaged neighborhoods increase the risk of negative health outcomes such as obesity, and the prevalence of chronic illnesses increase because of limited access to healthy affordable food (4,6). The relationship between faith and health outcomes plays a crucial role in addressing health disparities. People within the African American ethnic group have a strong affiliation to their parish. A good understanding on this aspect of their culture allows for better management of health related behavior that could be linked to their faith. Finally, understanding the type of diet that a person consumes based on their culture, and being able to link this information with convenience and cost is another avenue to influence the dietary habits of individuals from minority groups impacted by economical barriers.

Health equity has become the main topic of interest within our heath care system because of the common goal among health care providers, policy makers, and the community at large. In addition to contributing to better health outcomes and improvement of diagnostic accuracy, cultural responsiveness in health care has the capacity to increase adherence to recommended treatment by allowing health care providers to obtain complete health information from the patient due to better communication between health care provider and patient. Because the provider is much more informed, he/she is able to make more accurate assessment mindful of the patients’ cultural background. Because social-cultural barriers are understood when this type of care is applied, there a decrease in the delay in health care seeking and therefore, increase the quality of life and care. The patient is much more comfortable in seeking care because they feel that their culture is respected, and therefore, they, themselves feel respected. It is widely accepted that quality of care is a right for all regardless of cultural norms present witting a certain group. Thus, culturally responsive health care delivery has emerged as the new blueprint of health care practices.

Daphney Dorcius earned her Masters in Public Health from University of Miami is now a first-year medical student at Florida International University. She has a strong interest in the field of community health and an intense desire to fight against health disparities.

Works Cited

1. Anyanya Mandal, M. (2014, October 8). What are Health Disparities? Retrieved 2016, from News Medical: http://www.news-medical.net/health/What-are-Health- Disparities.aspx

2. Carteret, M. (2011, Summer). Health Care for African American Patients/Families. Dimensions of Culture Newsletter .

3. Erin Kobetz, J. M. (2010). Barriers to Breast Cancer Screening Among Haitian Immigrant Women in Little Haiti, Miami. Journal of Immigrant Minority Health , 12, 520-526. 4. Maria, C. (2008). Cross-Cultural communications of health care professionals . Retrieved 2016, from Dimensions of culture : http://www.dimensionsofculture.com/2010/10/576/

5. McMillan, F. (2013, April 29). Culturally Responsive Health Care. Indigenous Allied Health Australia.

6. The Partnership Connection . (2015, May). Providing Culturally Responsive Health Care. News for the Pediatric Community .

7. U S Census Bureau. (2014). Projections of the size and composition of the US population: 2014 to 2060. Current population reports , 25-1143.

8. UCare. (n.d.). Culturally Competent Care. Retrieved 2016, from UCare: Health care that starts with you : https://www.ucare.org/providers/Resources-Training/Provider- Manual/Pages/ProviderManual_19.aspx

9. US Department of Health and Human Services. (2014, March 1). Minority Health HHS. Retrieved 2016, from OMH: http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlID=26

10. US Department of Health and Human Services. (n.d.). ClAS and CLAS Standards. Retrieved from Think Cultural Health: https://www.thinkculturalhealth.hhs.gov/content/clas.asp

Black & White: Death & Dying by Race & Ethnicity

Is health black and white?

Before you answer… Did you know that there are differences in death rates based on race? On average, at birth a white person may expect to live 5 years longer than a black person in the United States. This gap grows to a 10 year difference when comparing life expectancy of white women (81 years) to black men (71 years) [1, 2].

Why is this the case?

Well for starters, the leading causes of death differ down both race/ethnicity and gender lines. For instance, homicide makes the list as one of the top five killers of black men, but does not make the list for white men (nor either group of women). Diabetes makes the list as one of the top five killers of black women, but does not make the list for white women (nor either group of men) [3]. However, when comparing death rates between blacks and whites for the same disease, blacks still tend to have worse health outcomes. In fact, according to 2012 data, the U.S. Department of Health and Human Services Office of Minority Heath states “the death rate for African Americans was generally higher than Whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide” [4].

But really, why is this the case?

It comes down to what researchers refer to as ‘social determinants of health’. This term translates into how where you live, work, and play shapes your health. Moreover, these differences may in part be explained by health inequity, “difference or disparity in health outcomes that is systematic, avoidable, and unjust” [5]. For instance, it is common knowledge that many black people in America are living in poverty. This fact is tied to societal oppression dating back to slavery. Poverty manifests in predominately black neighborhoods, leading to limited access to resources such as healthy food, safe environments for physical activity, and quality health care services. As declared by Dr. Martin Luther King Jr., “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” BUT, poverty does not explain it all. Even when a 2015 study compared breast cancer survival rates between low socioeconomic status white women with high socioeconomic status black women, black women still suffered from worse health outcomes [6]. Thus, factors beyond poverty, such as racial discrimination (e.g. subconscious differences in treatment by health care professionals) must be considered.

What can be done?

First and foremost, health education and health inequity awareness must become common knowledge. Children and adults, men and women, black and white must all understand what constitutes health, so that health is not only seen as the physical absence of a pathogen, but more holistic and inclusive of mental, emotional, environmental, and social health. Professionals and patients must work together to actively address gaps in sociocultural competence/humility through being open and honest with each other. Particularly, physicians have a responsibility to treat “humanity as [their] patients” [7]. Thus, systematic discrimination must be deconstructed for the assurance of ‘justice for all’. While health policy should be at the forefront of the conversation to combat these issues of social justice, communities must also consider their power in determining their destiny. Black communities, as they have done in the past, must begin to gather, organize, and mobilize to persevere.

Now, with all of this in mind… you tell me, how long should health continue to be black and white?

Rhoda Moise is a graduate of Pennsylvania State University with a B.S. in Biobehavioral Health and a passion for health promotion. She has been trained to approach health from an interdisciplinary perspective from proteins to people. Through her doctoral studies as a PhD student at The University of Miami, she intends to combat health disparities by conducting research which provides empirical evidence that demands alteration in standing policy.

References

1 http://www.cdc.gov/nchs/nvss/mortality_tables.htm

2 http://www.cdc.gov/nchs/data/dvs/LEWK3_2009.pdf

3 http://www.cdc.gov/nchs/nvss/mortality_tables.htm#lcod

4 http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

5 http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html

6 Keegan, T. H., Kurian, A. W., Gali, K., Tao, L., Lichtensztajn, D. Y., Hershman, D. L., … & Gomez, S. L. (2015). Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. American journal of public health, 105(5), 938-946.

7 http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/declaration-professional-responsibility.page

Health Isn’t One-Size-Fits-All

By: Delphine Gervais, LCSW

This May will mark five years since my mom was “officially” diagnosed with stage 4 breast cancer and two years since she transitioned.  There were plenty of days that I replayed the rush to the hospital, the exposure of her upper body to the doctors, the shock at what I saw. I remember the doctor questioning my mother, “When did you feel the first lump?”  I remember hearing my mother respond, “four years ago”. (hence my reference to the word “official”).  My mother was a resourceful Haitian woman, who never missed a doctor’s appointment and who never missed out on an opportunity to eat healthy.  Olive oil was a staple in our home.  Processed food was not.  She did everything she knew how to live a fit life.  In her mind, that lump negated every effort,  and it was then that her life completely changed.

For the purpose of conversation, I opt to turn my lense to black women and what their attitudes towards receiving services imply for their ultimate well being.  The stats are not favorable for communities of color.  Heart disease, cancer, hypertension, mental health–people of color lag behind in prevention and are dying at faster rates for lack of both prevention and intervention services.  In the case of breast cancer, although screenings among black women tend to be on level with those of their white counterparts, follow-ups for negative results were much lower.  Death rates among black women are 42% higher than their white counterparts.  It is one thing to schedule and conduct one’s mammogram every year.  Everyone can do that.  It’s another thing to follow up after receiving some not so favorable results.

I didn’t believe my mother loved me and my brother less because she didn’t seek the help she needed.  It couldn’t have been an easy pill to swallow to suffer in silence. Help seeking behaviors among African-American and Afro-Caribbean women have historically been a point of concern among those in the health profession.  The cultural construct surrounding help seeking behavior for physical or mental health concerns boils down to “it’s nobody’s business but mine.” If you couple that with the religious and spiritual impact on decision-making and you likely have a woman who will keep secrets from her loved ones and bear the entire emotional burden of disease.  To say that women of color reject the notion of prevention or intervention services is a fallacy.  It is best to first understand that normalizing health seeking behavior is the first order of business.

Imagine walking into a space where medical jargon is thrown at you left and right.  Machines are beeping.  People hurry about their work day, some stay long enough to inquire as to your well-being, while others just come long enough to poke and prod and leave with nary a word.  A person who speaks the king’s English would have a hard time navigating the health system.  A person who speaks limited or no English would drown in fear and embarrassment.  There is also the matter of inequitable access to services in the communities of color.  Are clinics within walking distance or near a bus stop? Do those who provide services understand the complexities of a person of color coming to their spaces in search for help?  Are they immediately placed at ease?  Are there people present in these spaces who can walk among the emotional minefields of their patient’s mind?

I remembered offering to take my mother to a cancer support group comprised of Haitian women.  The social worker in me thought it would be best for her to be among others who were grappling with similar issues.  She gave me a blank stare and a firm “No”.  I never brought it up again.  At times, we professionals believe we know what’s best for those who need help.   Imposing our norms and expectations lessens the opportunity for the person to establish personal ownership of their circumstances.  They’ve heard about the church member who became ill, went to the hospital and never came back home.  Walking into foreign spaces and experiencing a new normal is difficult for the average human being.  Being a woman of color compounds those feelings of helplessness.  When the strong black woman mystique had been challenged and the figurative “S” was off her chest, my mother didn’t want a support group.  Attendance at weekly church services was support enough.

There cannot be a one size fits all approach to healthcare.  My mother’s doctor knew well enough not to say the big “C” word in sessions.  She was delicate and respectful in her approach, she maintained deference in her tone and she left the hard discussions during one-on-ones with me.  At times she would practice her Creole on my mom.  This would make my mom smile.  The feeble attempts at seeking commonality met with ultimate respect.  For my mom that was enough to keep her committed to returning every month.  Even when the blood work started coming back with less than positive news, she kept her appointments without fail. Being seen by doctors and nurses who knew her name and smiled with their eyes made the trips that much bearable.  Half the battle is won when communities of color are provided with opportunities to maintain their personal dignity while seeking the help they so very much deserve and need.

This is not a mandate to learn a new language or join Doctors Without Borders.  It is however a call to action for professionals in the healing arts to take stock of how they approach their patients of color.  What works for Jane Doe may not work for Marie Pierre and Mary Johnson.  Cultural norms play a big part in how they each approach seeking help.  Knowing Jane’s cultural constructs and not Marie/Mary’s should cause one to pause and assess their effectiveness in providing service.  As the Haitian daughter of a Haitian woman I thought I knew all there was to making sure my mom received the services she needed.  My westernized approach to therapeutic intervention failed miserably.  I should have known that my mother cared less about support groups than ensuring she had a nurse aid to provide meals.  She cared less about the blood work coming back negative and more about when the bus would come to take her to her prayer service.  It didn’t take me long to stop hitting my head against the proverbial wall.  It was less of what I wanted and more about what she needed.  Once I made peace with that, it was smooth sailing.

Delphine is a licensed clinical social worker with experience in education, health, social welfare, community development, and individual/family/group intervention services. Her professional background emphasizes a special focus on community involvement and service; utilizing social networking for the purpose of bridging the gap between those with established needs and those with access to the resources to meet those needs. Read more on her blog.

Source:  American Cancer Society http://www.cancer.org/

 

Suffering In Silence: Mental Health Conversations in Communities of Color

As a person of color, the topic of mental health is avoided like the plague in our community. We all have that family member or friend who, at the mere mention of going to counseling, shouts back “I’m not crazy”; “You should pray about it”; “Tough it out”; “Therapy’s for White people”. These answers are further distractions from the real problem. I’m not saying there’s anything wrong with seeking counseling services from your religious leaders, of which is a great support system for those who believe. However, there are some things that require a different outlook. There’s just something about a fresh perspective that can bring about change. I’ll admit to being a novice in the field, but I can say that I do have some African American clients. However, amid the few, a substantial portion fails to receive continuous care (Snowden & Yamada, 2005). High levels of untrustworthiness and the stigma drenched with the word therapy/counseling may influence this lack of commitment. A part of the problem lies in the lack of public discussion and recognition of these disparities in our community and what can be done about them. Something needs to change ASAP because I, for one, am tired of hearing about the behavior of members of another race being dismissed as a result of mental health difficulties, but my own people who are struggling mentally, just as much in some areas and more in others, being publicly ridiculed, never even given the chance to defend themselves, while struggling to stay afloat in a society that was built on our backs and which is working hard to keep us that way.

The key word here is suffering because that’s exactly what we’re doing. While many people from all different backgrounds find the topic of mental health a difficult one to discuss, African Americans especially have created such a negative association with the term that discussion is actively avoided. According to the U.S. Department of Health and Human Services Office of Minority Services, African Americans are 20% more likely to report having serious psychological distress than non-Hispanic Whites. Unfortunately for us, this stress is often coupled with higher levels of poverty, with those living below the poverty line being 3 times more likely to report psychological distress, when compared to those living twice the poverty level. Yet and still, White people are receiving nearly double the amount of mental health services than African Americans. A more common practice in the African American culture is to seek help from family and friends, not from “out-group members” as therapists may be viewed (Vogul et al., 2007).

To go back to the earlier misconception of being “crazy” as a reason to seek counseling, I for one do not like to use the “c” word with anyone. EVERYBODY has struggles at one point or another in their life. Therapy helps you work through them and helps you find the most effective and productive resolution. Everyone in therapy doesn’t have a diagnosis of Bipolar or Schizophrenia. Therapy can also help you work through grief, trauma due to things such as natural disasters, relationship stress, among countless other things. Yes, you can lean on friends and family for support during these times. In fact, minority groups who value close networks have been found to use family and friends rather than counselors when seeking help (Vogul et al., 2007). African American youth tend to use a family member more often than White American youth when experiencing a problem (Vogul et al., 2007). I hear you when you wonder why someone would want to pay a person to listen to his or her problems, but I promise we have a lot more to offer than our ears. Although each client is unique and each culture has its differences, through research and experience, providers have and will gain the knowledge necessary to assist minorities if you let us.
One thing we don’t see enough of is our own people offering these services. As a member of a non-dominant population, it can be hard to relate to, or expect to be related to, a person of the dominant population, especially when some of their actions have contributed to your suffering. I remember expressing my despondency regarding my relocation to a predominantly White area. Nothing wrong with White friends, I just missed my people. Speaking with a White male, he compared it to his relocation and having to adjust to fishing for a different type of fish than he was used to. I get the analogy, but c’mon now, I’m a person not a fish. Insensitivity has a huge impact on the needs of minorities seeking services and may in fact contribute to why we tend to run the other direction. However, there are issues much bigger than this that are causing us so much pain that it’s worth the exploration to find someone who you can relate to. As much as this profession is growing and expanding, the rate of ethnically diverse providers is struggling to keep up. With this in mind, it’s important for all practitioners to be culturally sensitive to the problems brought to therapy. This is important for clients to know too that they may need to provide a more in depth explanation of their struggles, and it may take some time to find someone they’re comfortable with. Cultural sensitivity can have many interpretations, but here it’s referring to awareness of unique differences that impact treatment. For instance, some symptoms may be misinterpreted in certain cultures as something other than a mental health issue. As an example, the National Alliance on Mental Illness notes that numerous African Americans struggle to identify symptoms, underestimating the impact that it may be having on a person’s life. Take depression, it may be written off and referred to as “the blues” when in reality it is a common mental health disorder experienced among African Americans more often than White Americans.

Anybody out there familiar with the TV series A Different World? I recently began binge watching it again on Netflix, and there was an episode where Whitley attended one therapy session when her feelings for Dwayne and Julian were conflictual. Her one take away was “relax, relate, release”, and I’ve noticed in future episodes that she repeats that same phrase in times of stress. Though comically expressed through Jasmine Guy’s overly dramatic character, it was a great example of one of the many benefits therapy has to offer: the things you learn can be applied to different areas of your life and used over and over again. This is especially true due to the fact that the likelihood of African Americans currently receiving services decreases if there was past service (Broman, 2012). I was pleasantly surprised at even the slightest mention of the subject of therapy in the late 80’s/early 90’s. Psychological distress doesn’t necessarily mean a diagnosable disorder; it simply refers to your mind feeling overloaded with what life has thrown at you.

There has also been a lot of discussion around medication that is offered in conjunction to therapy. True, it can be helpful, but it’s also costly in the long run of continuously having to refill prescriptions. Therapy is about activating tools that you already have within yourself to work through troubling situations. Let me tell you something, the old me was against this ‘hoopla’, as it’s often referred to, at one point too. I’ve experienced things in my life where therapy crossed my mind, and just as swiftly I kicked it out. I won’t sugar coat it, it’s a very vulnerable process; sharing your personal story with a stranger, anticipating judgment and backlash for what you have to say, expecting to be misheard and misunderstood. But for your own good, sometimes you have to take that chance. Speaking from personal experience, it’s a necessity. Just like your doctors and dentists appointments, hair appointments, even the popular need for retail therapy and other personal care appointments, this mental health check-up is just as, if not more, important.

Cost is something that can also contribute to this suffering. Many people think that all these services are offered at an unreasonable price, and that just isn’t true. There are numerous community health clinics that offer these services to individuals with or without insurance and on a sliding scale fee. Sometimes these places also have interns, who are training in the field under the supervision of a licensed professional, and offer these services free of charge. This can also be found on college campus’ that again, offer services on a sliding scale fee and sometimes free of charge. All this requires is a little research, whether it’s through the Internet, word of mouth, or asking other health care providers for referrals.

With all of the discrimination and injustice present in society, because unfortunately it doesn’t seem to be going anywhere, why not strengthen your mind so that we can continue to fight back. When will the media talk about the possibility of a black mans actions being attributed to mental health issues? When we find the motivation in ourselves to take control of our lives and stop being afraid to acknowledge that we need help. Suffering in silence is more detrimental than allowing someone who is qualified to return you to your most empowered state.

Alysha Thomas is a native of Newton, MA and a current resident of Hattiesburg, MS. In the fall she is relocating to California to obtain a Doctorate degree in Marriage and Family Therapy and is looking forward to serving in an urban community to increase the level of ethnic participation in mental health care. Alysha enjoys cooking, being outdoors, and almost everything social.

Sources:

Broman, C. L. 2012. Race differences in the receipt of mental health services among young adults. Psychological Services, 9(1), 38-48.

Snowden, L. R. & Yamada, A. 2005. Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143-166.

Vogul, D. L., Wester, S. R., & Larson, L. M. 2007. Avoiding counseling: Psychological factors that inhibit seeking help. Journal of Counseling & Development, 85, 410-422.

http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

https://www.nami.org/Find-Support/Diverse-Communities/African-Americans

Sometimes It Is Just Black & White | The Color Wheel

Let’s talk straight no chaser! When it comes to being a black woman in America a mental illness is the last thing that you would also like to have associated with your name. Take myself for instance, I have dealt with Depression for most of my life and it wasn’t until I was 27 years old that I realized how much I needed help. I never thought about telling anyone in my family about my struggles or even my experiences. So when I decided to create a mental health blog showcasing my life, I knew it was going to be seen as an attention seeking affair. Little did I know how much therapy this blog was going to be not only for me, but for other people who looked like me.

In the mental health community there are very few African Americans. From support groups, rallies, speaking engagements and even research centers we are lacking representation. From my experience alone I have always been the only black person and black woman in many support groups, I have never encountered a black mental health professional and I have never met someone who was open and as honest as I am about their illness. Until recently, I thought that it didn’t even matter.

When I began talking to young, black girls about their daily lives, I was shocked to hear that they were open and honest about their emotions, but felt like no one wanted to listen to them. How is that? How can it be that way when you are born to a mother and father? Shouldn’t they want to listen? Aren’t they asking fact finding questions? How are we not showing compassion to our own children?

Let’s get to the facts…

“Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after experiencing a traumatic event, such as a war, hurricane, sexual assault, physical abuse, or a bad accident. Although you are no longer in danger, PTSD makes you feel stressed and afraid. It affects you and the people around you.

Consumers with PTSD can experience a range of emotions such as flashbacks, hallucinations, “going blank”, detachment from events and others, trouble sleeping, nervousness, or being over aware. PTSD can also be accompanied by other mental illnesses such as depression, anxiety, bipolar and schizophrenia.

PTSD does not only effect one age group or race; however, it is proven to be more prevalent in “urban communities”, veterans and patients with other mental disorders. Anyone who has faced a traumatic event like sexual assault, combat, life threatening events  or witnessed others, survivors of natural disasters, unexpected loss of someone or illness that caused severe pain or procedures can develop PTSD”(1).

With adequate treatment including psychotherapy, medications and support from family and friends, PTSD can be managed successfully. However, if left untreated, PTSD can last for months and even years depending on the severity.

In the summer of 2005, I was diagnosed with three different mental illnesses (yes it’s possible). The one I had always heard of was PTSD. Growing up I heard the term being used for survivors of rape, bank robberies and really bad car accidents. The term ” I put it in the back of my mind” was always used to describe what PTSD was and how it can come back to haunt you in the future.

I didn’t even feel like I had been involved in something traumatic enough to be considered a mental illness. So when I got the results from my evaluation, I was shocked. I never told the doctors that I was molested, I used to get bullied and threatened at school or I was in an abusive relationship in high school. So how could they have known about the things I locked away?

As I began thinking about it, I had never been asked how I was feeling or what I was feeling when I was at home. It wasn’t a topic of discussion at the dinner table. It wasn’t even a concern anywhere in my home. And I am sure in any black home we have all heard the ” Shut up. I don’t want to hear anything you have to say. Why are you crying?” Those negative statements which some of us have heard, mold us and begin to create other issues.

If a child has gone through something traumatic like maybe being bullied or threatened at school and has not had an outlet to voice their feelings and experience PTSD can begin to develop. So if you can’t feel safe and supported at home, then where else can you feel comfortable when there is no one that looks like you and shares your experiences in your Insurance Coverage Network?

We don’t see black health advocates on television, we don’t even see black people in medication ads or television shows (other than Andre on Empire). It’s as if black people are Immune to mental illness. The characters are superhuman and forever fearless. They don’t have any duality or vulnerability. When I think about segregation and slavery I always think about the long term psychological effects that it had and is still having on black people. With the current racial situations on the rise, PTSD still has a presence in our community.

I don’t think television is the key to representation or the hear all see all as well. If we don’t have prominent medical professionals, qualified programs and black advocates in our communities, we will continue to sweep mental illness under the rug. Yes it is a black or white thing because let’s be real we all choose what’s comfortable for us. And if you feel as though someone will understand your experience, then you would think they will understand what kind of treatment you need.

My question is who will step up?

Lindsay Anderson is the Editor-In-Chief and Founder of ConsciouslyCoping.org, a Mental Wellness social media site that primarily focuses on educating minorities, underprivileged and lower income based families on healthy approaches of managing Mental Illnesses.

(1) https://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html