University of Phoenix Cultural Diversity BSHS 421 Special People/Special Needs Mental illness is a special need within itself; couple that with being a minority, specifically an African American, and the problem increases. The following paper will display examples and data portraying the difficulty that African Americans face when seeking mental health services, particularly for schizophrenia. Also included will be assessment techniques, intervention strategies and treatment planning.
According to the NAMI Multicultural Action Center (Medline Plus, 2004), “African Americans in the United States are less likely to receive diagnoses and treatment for their mental illnesses than Caucasian Americans. ” This can be due to many factors, including strong family and religious bonds that do not persuade outside resources, even when called for. Also barring treatment is the bias that many African Americans hold towards mental health professionals.
This is due to a history of misdiagnoses, inadequate treatment, and a general lack of cultural understanding on behalf of the mental health professional. In fact, data shows that as of 2004 only “2% of psychiatrists, 2% of psychologists, and 4% of social workers in the United States are African American. ”(Medline Plus) To complicate this, many African Americans are stigmatized in their own community and mental illness remains vastly misunderstood.
Those with insurance, often do not seek treatment for fear of being ostracized. Those that do seek treatment often struggle with misdiagnoses. Unlike specific diseases like cancer or diabetes which can be diagnosed from specific blood or other laboratory testing, mental illness or disorders are defined by signs, symptoms, and/or functional impairments that are much more difficult to diagnose.
Mental health practitioners and counselors are governed by the American Psychological Association (APA): “Diagnostic and Statistical Manual of Disorder DSSM-IV-TR,” the American Counseling Association (ACA) and the International Statistical Classification of Diseases and Related Health Problems (ICD). In 1987 the APA established the Society of Psychological Study of Ethnic Minority Issues (Division 45), which later went on to publish the “Guidelines for Provider of Psychological Service to Ethnic, Linguistic, and Culturally Diverse Populations. This publication led to the acceptance to policy the “Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists” (Atkinson, 2004, p. 57) These guidelines list different mental disorders and the criteria and diagnostic codes for diagnosis, which are used worldwide by clinicians and researchers. Unfortunately, these guiding principles are just that, guiding principles. In the end it still depends on the accessibility, delivery, and level of competency of the professional(s) whom diagnose and treat the patient(s).
This leads us to schizophrenia. Schizophrenia is on of the most challenging disorders to diagnose, because many of the symptoms can be found in other mental disorders which can lead to misdiagnosis. As stated by the National Women’s Health Resource Center (National Women’s Health Resource Center [NWHRC], 2002) “Some individuals with schizophrenia have prolonged periods of elation or depression, which can be confused with bipolar disorder (also called manic depression) or major depressive disorder.
People with bipolar disorder and major depression can also experience psychotic symptoms” Unfortunately, minority groups have taken an even bigger toll on misdiagnoses, due to clinicians systematic testing use of standard assessment tools such as the; Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Calgary Depression Scale for Schizophrenia (CDSS), Global Assessment Functioning (GAF), Hamilton Depression Rating (HAM-D) Scale, Montgomery-Asberg Depression Rating Scale (MADRS).
These scales and rating work for detection and diagnosis, but do not take into account the clinicians, whom may be bias or prejudice, language barriers or cultural incompetence. These scales also leave out the significant affect of a client’s socioeconomic status, cultural variance, social class, character traits developed in response to their particular environment, demographics, and differences in genetic and biological vulnerability or genetic-intermingling. There are a number of interventions that may help an individual with schizophrenia. There are three main components that aide in the intervention of individuals with schizophrenia.
The three components are medication, education and psychosocial intervention, and rehabilitation. Some other interventions that can be helpful with having schizophrenia are social skills training, group therapy, cognitive training, and pursuing the interests of the individual. Medications help in the recovery of the functioning of the brain and help to relieve stress and prevent relapse. The medications that are used to help schizophrenia are also called antipsychotic or neuroleptics. Once an individual is on a medication they should continue as long as the doctor permits.
Ending the medication without approval can cause relapse and the disease can progress, which causes the symptoms to either come back or become more intense. Also important to remember is that “some studies suggest African Americans metabolize medications more slowly than Caucasian Americans, yet they often receive higher doses of psychiatric medications, which may result in increased side effects and decreased medication compliance. ” (Medline Plus, 2004) Psychosocial intervention can also help individuals affected by schizophrenia. Psychosocial intervention uses behavioral modification, coaching, and modeling among others.
When performing psychosocial intervention there are other interventions used such as group therapy, vocational training, social skills training and leisure management skills. Social skills training involve the individual learning the symptoms of the disease. Learning the symptoms is important because this can help with a relapse and a checklist is usually given to the individual and their family members. Daily living skills are also learned during this time. Daily living skills consist of bathing, cleaning, and decision making of important matters.
Vocational training is important and there are steps that need to be taken. The steps are deciding what kind of work is suitable for the individual, having and help them apply for the job, and having and helping them follow up on the job. The development of intellectual skills such as lapse of attention, concentration, reason and problem solving can affect the individual’s performance of the job. The setting the individual lives can help then with intervention and therapy. There are many different living settings that are used based on the level of functioning and capability.
Day-care is where the individuals go during working hours to get vocational training and intervention strategies. Residential rehabilitation consists of a short stay. Some factors of having to live in a residential program are non-compliance of medication, hostility and relapse. Home-based and community-based rehabilitation are two other programs that allow the individual to live in their home and have help at the same time. Home-based rehabilitation is for individuals whom are confined to their home and do not want to move out. Community-based rehabilitation is for individual s with chronic disabilities along with mental illness.
Community-based rehabilitation should be run with minimal professionals and should focus more on community involvement. The primary result is to have medication compliance, regain self-esteem, and continue counseling. Along with interventions, specific treatment methods are called for with schizophrenia. Schizophrenia may not be a single condition and its causes are not yet known, current treatment methods are based on both clinical research and experience. These approaches are chosen on the basis of their ability to reduce the symptoms of schizophrenia and to lessen the chances that symptoms will return. Schizophrenia. com) African-Americans are more likely to be diagnosed with paranoid schizophrenia and they exhibit more negative symptoms then non-African Americans. It appears to be that treatment for this illness as in other illness the medications used for African Americans may be different but treatment planning is still individualized. Medications have been available since 1950’s and reduce the psychotic symptoms of schizophrenia have allowed some people function more effectively and appropriately. The large majority of people with schizophrenia show improvement when treated with antipsychotic drugs.
People vary in their need of medication and the choice and dosage of medication should be made by qualified physicians who are trained in the treatment of mental disorders. When persons with schizophrenia are fairly free of psychotic symptoms, they still have difficulty with communicating, motivation, taking care of themselves, establishing and maintaining relationships and employment. They not only have thinking and emotional difficulties, but lack social and work skills. When looking at treatment goals for this population some areas to look at are: •Individual Psychotherapy Family Education •Self-Help Groups •Rehabilitation •Vocational Therapy •Social •Medications •Education Although it is said that schizophrenia is not curable some studies show that about a third of people may make a full recovery. Even though this illness does not have a cure, the systems and effects can be lessoned for most people with the careful use of medications and professional, social, family and society’s support. As previously stated, untreated mental illness among minority populations presents itself as a major problem of significance. Even though minorities are just as likely to experience mental disorders as non-minorities, minorities are far less likely to receive treatment. ” (Satcher, 2001). Perhaps some reasons for this dilemma among minorities are due to some existing barriers such as that of accessibility, and utilization. A lack of access to mental health services has been well associated with an individual’s socioeconomic status, such as that of income and the lack of existing medical insurance (HealthyPlace. com, 2000). According to the U.
S Surgeon General, David Satcher (Satcher, 2001) suggested that “minorities are seen as having the most cases of disabilities and greater burdens due to mental illness than their European counterparts. In addition, their greater incidences do not exist because of the severity of their illness, but rather due to their lack of accessibility to care. ” Ethnic minorities are at increased rates of poverty and stand a greater chance of being uninsured by health care coverage, leaving minorities at an over half percentage rate of being uninsured than compared to whites.
Furthermore, “8% of whites are living in poverty compared to 22% African Americans” (HealthyPlace. com) Recent statistics about African Americans proves the mental health needs that they are faced with. According to Satcher (Satcher) “12% of the population is made up of African Americans. One in four African Americans is uninsured and one-third receive care for mental disorders” In addition to other factors, the lack of culture diversity has also contributed to low utilization rates among minorities. Insensitivity about other minority cultures has well worked its way into the system of mental health.
According to Zane (Zane, 2004, p. 61), “The single most important exploration for the problems in service delivery for ethnic minorities involves the inability of therapists to provide culturally responsive forms of treatment. ” Astonishing evidence has proven that when culture diversity is utilized in mental health setting among minorities, they continue treatment beyond that of only one session. Since treatment outcomes are greatly affected by the length of treatment, treatment outcomes were also improved when ethnicity formed programs were implemented.
More utilization to mental health services among minorities increased with ethnicity programs rather than clients actually being matched ethnically with their practitioner (Racial/Ethnic Minorities and Cross-Cultural Counseling, 2004). According to Satcher (Satcher, 2001) “Culture in mental health can influence how mental illness is diagnosed and perceived. ” According to an article on mental illness and minorities, culture is also important because it affects the way in how clients describe their symptoms. In summary, mental health affects all races and cultures.
It is how the individual is perceived and treated that makes the difference. The African American community should not be ashamed to seek treatment, just as Caucasian Americans should treat them as equals, yet as individuals. By observing culture differences and physical characteristics a balanced approach to mental health care can be achieved. References Atkinson, D. R. (2004). Counseling American minorities (6th ed. ). : The McGraw-Hill Companies. Curtis, J. (n. d. ). Schizophrenia Treatment Overview. Retrieved July 17, 2008, from http://health. yahoo. om/other-other/schizophrenia-treatment-overview/healthwise–aa47103. html HealthyPlace. com (2000). Mental illness and minorities. Retrieved July 17, 2008, from http://www. healthyplace. com/communities/depression/minorites_2. asp Medline Plus (2004). African American Community Mental Health Fact Sheet. Retrieved July 19, 2008, from http://www. nlm. nih. gov/medlineplus/africanamericanhealth. html#cat22 National Women’s Health Resource Center (2002, January 2). Diagnosis Schizophrenia. Retrieved July 16, 2008, from http://www. healthywomen. org/healthtopics/schizophrenia/diagnosis Satcher, D.