This document summarizes a research article that reviewed 30 studies examining perceptions of mental health services among Black Americans of African American, African, and Caribbean descent. The review found:
1) For African Americans, themes around perceptions that influenced service use included the importance of trust and respect from providers, as well as concerns about stigma and discrimination.
2) A lack of literature limited identifying themes for Africans and Caribbean Blacks.
3) The findings highlight the need for more research to better understand nuanced differences in perceptions within the Black American population in order to improve mental health services.
This is a 100,000 word, 200 page, longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to October 2013. This account is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in its 13th edition. In my retirement, the years from 2001 to 2013, I have revised the account each year up-dating the content (i) as new information about the mental health issues I deal with are added to the science, and (ii) as I continue to deal with these mental health issues as I head to the age of 70 in 2014.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Social integration and the mental health needs of lgbtq asylum seekers in nor...TÀI LIỆU NGÀNH MAY
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Research on Sexual Abuse of Humanitarian Workers Thierry Debels
Na het seksschandaal bij OXFAM en Artsen zonder Grenzen (AzG) is de onderzoeksvraag hoe wijdverspreid dit laakbare gedrag is in de wereld van de ngo's.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Mobilizing the House/Ball Community around Preventative and Therapeutic HIV C...Stephaun Wallace
United States Conference on AIDS 2013 Poster Presentation:
A presentation that presents information on knowledge, attitudes and beliefs about HIV clinical research in the House and Ballroom Community (HBC), and efforts to form a national coalition that addresses knowledge gaps,
works to build trust between the HBC and the HIV scientific community, and provides a forum for HBC
members to discuss structural issues that fuel the epidemic in their communities.
This is a 100,000 word, 200 page, longitudinal, retrospective and prospective account of my experience with bipolar disorder and some other mental health problems over 70 years: from October 1943 to October 2013. This account is a personal, clinical, and idiosyncratic study of what some life-study students call a chaos narrative. This study focuses on an aspect of my life involving several mental health issues, but mainly bipolar 1 disorder. This account is now in its 13th edition. In my retirement, the years from 2001 to 2013, I have revised the account each year up-dating the content (i) as new information about the mental health issues I deal with are added to the science, and (ii) as I continue to deal with these mental health issues as I head to the age of 70 in 2014.
Global Medical Cures™ | USA Chartbook on HealthCare for Blacks
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Social integration and the mental health needs of lgbtq asylum seekers in nor...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Research on Sexual Abuse of Humanitarian Workers Thierry Debels
Na het seksschandaal bij OXFAM en Artsen zonder Grenzen (AzG) is de onderzoeksvraag hoe wijdverspreid dit laakbare gedrag is in de wereld van de ngo's.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
Mobilizing the House/Ball Community around Preventative and Therapeutic HIV C...Stephaun Wallace
United States Conference on AIDS 2013 Poster Presentation:
A presentation that presents information on knowledge, attitudes and beliefs about HIV clinical research in the House and Ballroom Community (HBC), and efforts to form a national coalition that addresses knowledge gaps,
works to build trust between the HBC and the HIV scientific community, and provides a forum for HBC
members to discuss structural issues that fuel the epidemic in their communities.
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Running head CULTURALLY RELEVANT RESEARCH APPROACHES1CULTURALL.docxlillie234567
Running head: CULTURALLY RELEVANT RESEARCH APPROACHES 1
CULTURALLY RELEVANT RESEARCH APPROACHES 2
Culturally Relevant Research Approaches
Name
Institutional Affiliation
Culturally Relevant Research Approaches
An analysis and a description of traditional research, addressing the question of its cultural relevance.
Traditional research is described as research done by individuals outside a specific organization. This research is aimed at offering some generalized truth on the investigated question. The basis of this research is a hypothesis where various variables are handled by a researcher in order to ascertain a particular research question through manipulation. This research is assessed from two perspectives; qualitative and quantitative. Qualitative research is the analysis of data obtained through interviews, journals and observations, while quantitative involves data that is numeric. Cultural relevance tends to be critical when the human population is involved. In traditional research, quantitative research does not cater to the cultural factors of the population being researched as qualitative research does. Under the group, I am analysis that is Asian Americans. Their data were collected from interviews and observing their way of living. Understanding their culture as social workers will limit bias when handling individuals from different cultures.
An analysis and a description of what comprises culturally relevant research.
Cultural relevance is significant to social workers because it allows them to maneuver through various multicultural situations whereby they must serve clients from different backgrounds and cultures without offence or bias. Cultural relevance involves social workers working on cases to approach each case in a way that is respectful to cultural differences while showing appreciation for diversity. Therefore, research needs to be culturally relevant. This means that the research conducted should take into consideration the social, cultural and linguistic needs of the population in question. By taking into consideration these aspects, the research will gather more information and will take a shorter period.
An analysis and a description of at least three research studies that have addressed the cultural group you are exploring.
In the United States, Asian Americans are among the fastest-growing ethnic groups. In the census conducted in 2010 in the US, based on Davidson & Smith (2015), the Asian American population was over seventeen million individuals, which translates to over five percent of the population. In terms of ethnic composition, the population has the most diverse composition. Below are three studies that focus on the issues that affect this population.
Research conducted by Cheng (2015) offered a detailed analysis of the stigma levels that affected Asian Americans in terms of social and biological explanations. The population group compared was European Americans. Based on this research, th.
Issues in Multicultural Correctional Assessment and Treatment By.docxchristiandean12115
Issues in Multicultural Correctional Assessment and Treatment
By Corinne N. Ortega
Introduction Increasing diversity in the United States has widened the base populations to whom psychologists provide services. Various divisions of the American Psychological Association (APA) have recognized the importance of multicultural competencies for more than 25 years (notably, Division 17—Counseling Psychology and Division 45—The Society for the Psychological Study of Ethnic Minority Issues). In 2002, APA formally recognized the evolution of the science and practice of psychology in a diverse society by adopting as policy the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2002b). Nowhere is the changing face of the United States reflected more clearly than in its correctional systems. Blacks and Hispanics make up 62% of the incarcerated population, although they comprise only 25% of the national population (Human Rights Watch, 2002). Hispanics represent 40% of all sentenced federal offenders, although they account for only 13% of the total U.S. population (López, 2000). According to the Bureau of Justice Statistics (2007), the lifetime chance of a person going to prison is higher for Blacks (18.6%) and Hispanics (10%) than for Whites (3.4%). Furthermore, Blacks represent approximately 40% of the death row population in the United States (Amnesty International, 2003). The sociopolitical and socioeconomic explanations for this phenomenon are complex and far beyond the scope of this chapter. It is clear, however, that given the disproportionate confinement of minorities in the United States, any meaningful discussion of correctional mental health must necessarily include a discussion of multicultural issues. This chapter will first focus on a general overview of multicultural counseling and its applications in correctional settings. Second, the use of psychological tests and assessments with multicultural correctional populations will be explored with an emphasis on forensic evaluations. Finally, the issue of cultural competence with religious minorities and religious extremists will be addressed.
Multicultural Counseling Jackson (1995) succinctly defines multicultural counseling as counseling that takes place between or among individuals from different cultural backgrounds. Although a simple enough definition, the implications of this in the mental health field are far-reaching. The increased racial, ethnic, and cultural diversity in the United States creates a demand for professional services, including mental health, that meet the needs of people from a wide variety of backgrounds (Barrett & George, 2005). The issues involved in providing culturally competent services are as complex and varied as clients themselves (Sue & Sue, 2007). Cookbook approaches to multicultural counseling cannot be utilized without contradicting the very concept. López (2000) discusses this in terms .
RESPONSE 1 Respond to at least two colleagues who selec.docxronak56
RESPONSE 1
Respond to at least two colleagues who selected a different article from the one
you selected. Share any insights you gained from your colleagues’ posts.
Colleague 1: Whitney
One important article that focuses on mental illness and culture is the article Community
Attitudes Towards Culture-Influenced Mental illness: Scrupulosity vs. Nonreligious OCD among
Orthodox Jews that was found through the Walden library (Pirutinskiy, Rosmarin, & Parament,
2009). The article focuses on how culture can influence a community’s attitude towards mental
illness (Pirutinskiy, Rosmarin, & Parament, 2009). One specific culture the article focuses on is
the Orthodox Jewish Community who has OCD (Pirutinskiy, Rosmarin, & Parament, 2009). This
article also addresses how Orthodox Jews see their up bring through their culture as casual to
their development involving their routines, rituals, and religions (Pirutinskiy, Rosmarin, &
Parament, 2009). This then does not affect them as much as those who are from a different
culture who are not brought up the same way and this would then affect them through the
acculturation process (Pirutinskiy, Rosmarin, & Parament, 2009)
It’s important that social workers take in consideration in using the cultural formulation
interview to apply cultural competence skills in working with the cultures such as the Orthodox
Jews. A cultural formulation interview will focus on a framework that assess for an individual’s
cultural features, mental health, and these relate to the individuals social and cultural context and
history (American Psychiatric Association, 2013).
The scholar will use the cultural formulation interview to assess and apply competence skills
to each client’s case. The scholar would first asses the client with four categories that are
included in a cultural formulation interview (American Psychiatric Association, 2013). The
scholar would first have the client describe their cultural identity such as their as their race,
ethnic, or cultural influences (American Psychiatric Association, 2013). Then continue to follow
the assessment with the other three categories.
Then the scholar would use a set of 16 questions cultural formulation interview to obtain
information of the clients mental health and by using this assessment it will identify the clients
culture and how it has impacted the clients clinical presentations and care (American Psychiatric
Association, 2013).Through this assessment it will assist the social worker and client in
understanding how culture affects the individual.
Acculturation can affect each cultural client different involving their psychological
and sociocultural aspects. Acculturation occurs and affects the individual’s psychological change
when two cultures have contact involving cultural groups or cultural members (Berry, n.d.). An
individuals experiencing acculturation can also experience behavioral repertoire due to the
a ...
Cultural Competence and PovertyExploring Play Therapists’ AOllieShoresna
Cultural Competence and Poverty:
Exploring Play Therapists’ Attitudes
Lauren Chase and Kristie Opiola
Department of Counseling, University of North Carolina at Charlotte
This article reports the findings of a survey that investigated attitudes toward poverty
among play therapists (N � 390) and its relation to demographic information. Multi-
variate analyses of variance (MANOVA) were used to measure the relationship
between play therapists’ demographics and their attitudes toward poverty, specifically
their structural, personal deficiency, and stigma scores. Results indicated that both
region and age resulted in differing views on poverty. Participants living in the
Northeast held stronger structural views of poverty than participants in the South.
Similarly, participants in the 50 –59 and 60 plus age groups disagreed to strongly
disagree with a personal explanation toward poverty than participants in the 30 –39 age
group. The importance of play therapists’ examining their attitudes toward poverty and
the direct impact on their work is discussed. Finally, implications of the results,
including overall findings, are explained.
Keywords: play therapy, attitudes of poverty, cultural competence
Culturally competent training is an element
of credentialing requirements that ensures men-
tal health providers offer adequate and respon-
sive care to diverse populations. Although the
mental health field has embedded cultural com-
petence in their standards and guidelines, there
are discrepancies in the way the profession as-
sesses and measures competence (Sue et al.,
1996). Researchers have investigated attitudes
toward poverty in the helping professions
(Levin & Schwartz-Tayri, 2017; Noone et al.,
2012; van Heerde & Hudson, 2010; & Wit-
tenauer et al., 2015), but no study has focused
on play therapists’ attitudes toward poverty.
The purpose of this study is to fill a gap in the
literature regarding play therapist’s attitudes to-
ward poverty because awareness and knowl-
edge are key elements to implement culturally
responsive services and skills with diverse chil-
dren in a variety of settings.
Cultural Competence
Cultural competence is an important compo-
nent of professional practice, and practitioners
are expected to develop skills and understand-
ing pertaining to diverse clientele. Researchers
define cultural competence as the set of beliefs,
knowledge, and skills mental health providers
possess in order to deliver effective interven-
tions and services to members of various cul-
tures (Gilbert et al., 2007; Sue, 2006). The New
Freedom Commission on Mental Health (2003)
recognized disparities in mental health delivery
and viewed the lack of cultural competence for
minority populations as a persistent problem.
Culturally competent health care is essential to
providing effective care to all populations. To
aid practitioners in their ability to increase their
cultural competence, leading professional men-
tal health associations have published ...
The U.S Healthcare System, African Americans and the Notion of Toughing It Ou...Chelsea Dade, MS
This project presentation will explore whether or not African American adults are less engaged patients, and whether the notion of toughing it out plays a significant role regarding how African Americans interact with their healthcare.
The Tuskegee Experiment was not the first time that African Americans were experimented on for scientific gain. One book that examines this history is titled Medical Apartheid (Washington, 2006). The novel dives into the dark history of medical experiments on Blacks, including, but not limited to inhumane slavery assessments and Marion Sims’ gynecologic obscenities on Black women (Wall, 2006). Though these debacles occurred decades ago, I propose that these events may continue to play a role in the way African Americans interact with the American healthcare system. Today, there are rules in place to prevent such issues with consent. However, after historically being placed in positions marked by humiliation and mistreatment based on skin color, I wanted to obtain a clearer understanding of whether or not African Americans have responded to the effects of these events by limiting their trust of other people, creating gender norms within their communities, and “toughing it out”.
The structure of this power point presentation for my final paper from HLTHCOMM440, Engaging Patients in Care, will begin by defining this demographic by its key cultural attributes. Second, the paper will highlight research on how one health belief, “toughing it out”, effects African American patient engagement levels. Third, the paper will summarize and discuss the methodology and results from a standardized patient engagement survey, and compare them to the existing literature. Finally, this paper will highlight a hypothetical federally funded health care program, titled “Mandating Mental Health First Aid in Chicago Businesses”, which will require all mid-size and large companies in Chicago to train human resources professionals in “Mental Health First Aid”. This intervention not only benefits African American employees in Chicago, but entire staffs in Chicago in general. In this way, the program does not target African Americans, but seeks to offer helpful resources on mental health that due to either a lack of access or stigmatization, some African Americans may or may not have be aware of. Therefore, the point of having this program is to help employees , especially newer employees, feel supported as the manage the many facets of their lives. Whether or not resources are utilized will depend on many individualistic factors that are including in this presentation. However, the first step towards health equity is to offer equal resources, to everyone.
For access to the standardized survey, please contact Chelsea Dade via email (chelseadade2018@u.northwestern.edu).
Defining Mental Health Within a Transcultural Nursing Perspective.docxvickeryr87
Defining Mental Health Within a Transcultural Nursing Perspective
The World Health Organization (WHO) (2007) proposed: “There is no health without mental health” and the influential organization incorporated mental well-being in their definition of health. According to WHO, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (p. 1). WHO further specified that mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (p. 1), and that this understanding of mental health can be interpreted “across cultures” (p. 1). For example, in the Rural Healthy People 2010 Report, survey results of state and local rural leaders indicated that mental health and mental disorders are the fourth most often identified rural health priority (Gamm & Hutchison, 2003). Taking into consideration the WHO definition of mental health, a definition of mental illness would then include one or more of the following: a lack of a sense of well-being in which the individual does not realize his or her own disabilities, is not able to cope with the normal stresses of life, is not able to work productively and fruitfully, and is not able to make a contribution to his or her community. It is important to remember there is a continuum of mental health on one end and mental illness on the extreme other end. An individual can fall on one end of the continuum or the other, or anywhere in between. Individuals’ and communities’ cultural beliefs and values about mental health and mental illness can influence one’s placement on the continuum, as well. It is a daunting task to know all there is to know about each cultural group that mental health nurses care for in their daily practice. Leininger (1991; Leininger & McFarland, 2002) in Culture Care Diversity and Universality: A Theory of Nursing, theorized the importance of identifying what is common and universal among cultures, while at the same time understanding there is individual diversity within cultures. Diversity for transcultural mental health nurses would encompass not only culture and ethnicity, but also gender, sexual orientation, socioeconomic status, age, physical abilities or disabilities, religious beliefs, and political beliefs or other ideologies. Figure 10-1 shows a transcultural nurse working on promoting health and well-being with a patient from a culture different from her own. In this chapter on Transcultural Perspectives in Mental Health Nursing, patterns of values, beliefs, and practices for mental health care are presented and can be used as one “tool” in caring for patients, families, and communities from diverse cultural groups. This is different from simplistic overgeneralizations that can lead to stereotyping a particular culture. Stereotyping can also lead to .
There are 4 peer responses needed and the instructions and posts are.docxsusannr
There are 4 peer responses needed and the instructions and posts are included below:
Guided Response:
Review several of your classmates’ posts. Provide a substantive response (a minimum of 100 words) to at least two of your peers by comparing and/or contrasting your selected three groups to theirs. What similarities or differences do you notice? How did your classmates justify their responses?
Nicole:
Vulnerability varies among people, some are more sensitive to it than others. When looking into various vulnerabilities I found that they can overlap, often vulnerable people are sensitive to risks that originate from economic, physical, social, biological, and genetic factors along with their lifestyle behaviors. Each of these factors plays an important role in vulnerabilities.
After an analysis of statistical data and trends related to different populations, I found that vulnerable mothers and children, abused individuals, and people affected by alcohol and substance abuse overlap in many ways. When considering data it is important to remember “It is difficult to get definitive data on any given population. Variations in how studies are conducted, the communities in which they are conducted, and the type of respondents all contribute to incomplete and inaccurate data compilation.”( Burkholder, D. M., & Nash, N. B. (2013). ). Vulnerable children can be affected by abuse ”Child maltreatment has enormous immediate and long-term repercussions. Beyond death, physical injury and disability, violence can lead to stress that impairs brain development and damages the nervous and immune systems.” (WHO). Many times child abuse can be linked to poverty and the stress of caring for children. Alcohol abuse can also be a cause of abuse of children, spouses or other people in our lives. Substance and alcohol abuse can also lead to health issues as well per the World health organization “Alcohol is a toxic and psychoactive substance with dependence producing propensities. Alcohol consumption contributes to 3 million deaths each year globally as well as to the disabilities and poor health of millions of people. Overall, the harmful use of alcohol is responsible for 5.1% of the global burden of disease” (WHO).
References:
Burkholder, D. M., & Nash, N. B. (2013).
Special populations in health care
[Electronic version]. Retrieved from
https://content.ashford.edu/ (Links to an external site.)
World Health Organization
.
Retrieved from
https://www.who.int/
Qiana:
There are many factors that can affect a person’s vulnerability. These factors can consist of finances, family, and education. (Burkholder & Nash,2013). The three groups that I feel are most vulnerable are people diagnosed with mental conditions, immigrants and refugees, indigent and homeless people.
Studies show that 50% of Americans have had some sort of knowledge of a mental illness in their lifetime. 5% of adults in America have been diagnosed with a serious mental disor.
Running head CULTURAL SENSITVITY1CULTURAL SENSITVITY2.docxsusanschei
Running head: CULTURAL SENSITVITY1
CULTURAL SENSITVITY2
Cultural Sensitivity
Name
Institution
Cultural Sensitivity
Introduction
Cultural sensitivity refers to the awareness as well as the sensitivity to culture and other practices. Cultural sensitivity can encompass examining different cultures and how they should be accurately approached in the health care. It also includes how to communicate according to within the health care setting. Cultural sensitivity is important area because it can impact the way people work in the health care facilities. It also encompasses valuing differences so as harassment and discrimination, either intended or not, do not happen. Culture is a fundamental and complex concept with consist of broad aspects of people in the health care setting (Campinha-Bacote, 2003). It includes the concepts of sexual orientation, gender, faith, age, disability, race, ethnicity, profession and socioeconomic status. Cultural sensitivity stems from this understanding in that; it is must encompass interpersonal skill as well as the knowledge that will allow the providers of health care, appreciate, understand, and work with individuals from different cultures other than theirs. It also consists of acceptance and awareness of the people’s cultural differences, knowledge, self-awareness of the cultures of the patient and adapting to the skills. Many cultural groups, including lesbian and gay people, individuals with disabilities, lower socio-economic groups and ethnic minorities, for example, African-Americans (Campinha-Bacote, 2003). Cultural sensitivity is considered one of the reasons peoples do not access quality health care services because people are not aware as well as understand the effects attached to one’s culture and how it may be perceived by others. An individual's culture should not appear to be dominant in the place of work.
Healthcare Disparities and How they Relate to Cultural Sensitivity in the Healthcare Setting
Health care disparities, by definition, refer to the differences in health as well as healthcare between population groups. It typically involves a higher burden of illness, mortality experienced in the health care setting, disabilities, and injury by one population group about another. Moreover, it refers to the differences between groups in the health care facilities regarding provision of care services, its access, and quality given. This issue are related to the people’s cultural sensitivity in that the issue surrounds this concept are based on socioeconomic status, gender, sexual orientation, age, and disability status. Similarly, cultural insensitivity arises from disparities that in return causes care limit as well as continued improvement in overall quality of cares (Campinha-Bacote, 2003). Health care disparities can be exacerbated by looking at some things that comprise specific health conditions, provider biases, differences in access to care, poor patient-provider comm ...
Depression Treatment 1Running head DEPRESSION TREATMENT IN .docxhallettfaustina
Depression Treatment 1
Running head: DEPRESSION TREATMENT IN AFRICAN AMERICAN BY CLERGY
DEPRESSION TREATMENT IN AFRICAN AMERICAN BY CLERGY 2
Depression Treatment in African American by Clergy
University Of Texas Arlington
Depression Treatment in African American by Clergy
Depression Treatment
The perception of clergy as the bridge to God along with cultural barriers results in the shunning of mental health professionals for the treatment of depression among the African Americans (Smith & Cummins, 2017). Although depression chronicity is higher among African Americans (56.5%) compared to whites (38.6%), 63% of the Black Community believe that depression is a personal weakness with nearly two-thirds agreeing that it can be addressed through prayers. Additionally, studies reveal that nearly 40% of African Americans rely on clergy for mental issues (Taylor, Sullivan, & Kliewer, 2013). Despite the high percentage of severity and high dependency on religious leaders, less than half of the clergy have training in counseling. As an illness, depression is treatable through medication, psychotherapy or a combination of both. Evidently, the clergy has a role to play in reducing the chronicity of depression among the Black Community by drawing a thick line between their religious and counseling duties. The clergy ought to recommend depressed congregants to mental professionals if the symptoms exhibited by individuals are beyond their mandate (Taylor, Sullivan, & Kliewer, 2013). So, how does liaising with health professionals or getting more information on depression help in reducing the chronicity of depression among the African Americans?
After approval by the Institutional Research Review Board of the University of Cincinnati, Anthony, Johnson, & Schafer (2015) conducted research to examine the role of clergy and church in the treatment of depression among the African Americans. The research targeted 18-year-old or older African American clergy with the ability to read and complete the data collection tools. Several notable facts emerged from the research that explores the treatment of depression among the Black Community through clergy services. The interviewed religious leaders spent 50-80% of their time counseling the congregants with the services starting with the children before evolving to the whole family (Anthony, Johnson, & Schafer, 2015). Additionally, educational levels of the clergy had a notable influence on the counseling services i.e. the higher the levels, the more likelihood of having a depressed and anxiety counseling training hence the better the services. Lastly, over 50% of the clergy believe that depression and spiritual counseling are similar hence high chances of employing spiritual services to address depression symptoms in patients. However, nearly all the clergy agreed that additional information on depression is essential in addressing this illness among their congregants.
...
Tangible Needs and External Stressors Faced by Chinese Ameri.docxperryk1
Tangible Needs and External Stressors
Faced by Chinese American Families with
a Member Having Schizophrenia
Winnie Kung
This article examines the tangible needs and external stressors experienced by Chinese
American families with a member living with schizophrenia, in the context of a six-month
pilot study of family psychoeducation. Therapists’ notes from 117 family and group sessions
were analyzed. The families expressed concerns regarding housing, finance, work, study, and
the shortage of bilingual psychosocial services. Interacting with government offices and
social services agencies caused anxiety and frustration, partly due to the high stakes involved
given their low socioeconomic status, and partly due to the bureaucracy. As immigrants,
study participants had needs for language translation, knowledge about resources, and advo-
cacy by case managers. This study also highlights the importance of interventions beyond
the micro individual level to the mezzo and macro levels, where changes in organizations
and policies are necessary.
KEY WORDS: caregivers; Chinese Americans; environmental stressors; ethnic sensitivity;
schizophrenia
This study aims to address the knowledge gap in understanding the challenges faced by Chinese American families with a member
living with schizophrenia in relation to their tangible
needs and external stressors from the environment. I
conducted this research in the context of an interven-
tion study of family psychoeducation that I previously
developed and pilot-tested as an ethnic-sensitive pro-
gram for Chinese Americans ( Kung, Tseng, Wang,
Hsu, & Chen, 2012). Family psychoeducation has
been proven effective in reducing caregiver stress and
the relapse rate of individuals with schizophrenia
( Jewell, Downing, & McFarlane, 2009; Lefley, 2010;
McFarlane, Dixon, Lukens, & Lucksted, 2003). The
intervention protocols focus on educating the fami-
lies about the nature of the illness, promoting better
communication, and helping family members re-
solve conflicts ( Anderson, Reiss, & Hogarty, 1986;
McFarlane, 2002) to reduce “expressed emotions”
such as criticism and overinvolvement, which highly
predict relapses ( Butzlaff & Hooley, 1998; Hooley,
2007; Leff & Vaughn, 1985; Marom, Munitz, Jones,
Weizman, & Hermesh, 2005). Few studies had been
conducted with Chinese American families, many of
whom face unique challenges due to their immigrant
status and cultural values ( Kung, 2003).
To more thoroughly understand the stresses ex-
perienced by these families so as to better meet their
needs and to refine the family psychoeducation pro-
tocol, a qualitative inquiry was conducted using the
clinicians’ session notes from the intervention study.
Whereas the family psychoeducation model in its
original design focused on resolving the psycho-
logical and relational issues within the families, this
investigation noted that these families’ struggles were
closel.
Tangible Needs and External Stressors Faced by Chinese Ameri.docx
Mental Health Stigma pub1
1. Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=wsmh20
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Social Work in Mental Health
ISSN: 1533-2985 (Print) 1533-2993 (Online) Journal homepage: http://www.tandfonline.com/loi/wsmh20
Perception of Mental Health Services among Black
Americans
Gina B. Gaston PhD, LCSW, Tara R. Earl MSW, PhD, Aslihan Nisanci MSW, MA
& Blake Glomb BA
To cite this article: Gina B. Gaston PhD, LCSW, Tara R. Earl MSW, PhD, Aslihan Nisanci MSW, MA
& Blake Glomb BA (2016): Perception of Mental Health Services among Black Americans, Social
Work in Mental Health, DOI: 10.1080/15332985.2015.1137257
To link to this article: http://dx.doi.org/10.1080/15332985.2015.1137257
Accepted author version posted online: 01
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Perception of Mental Health Services among Black
Americans
Corresponding Author:
Gina B. Gaston, PhD, LCSW
Assistant Professor
University of Illinois at Chicago
Jane Addams College of Social Work
1040 West Harrison, (M/C 309)
Chicago, Illinois 60607
ggasto3@uic.edu
Tara R. Earl, MSW, PhD
ICF International, Public Health and Survey Research, 3 Corporate Boulevard Northeast #370,
Atlanta, United States
tara.r.earl@gmail.com
Aslihan Nisanci, MSW, MA
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PhD Student
University of Illinois at Chicago
Jane Addams College of Social Work
1040 West Harrison, (M/C 309)
Chicago, Illinois 60607
anisan2@uic.edu
Blake Glomb, BA
MSW Student
University of Illinois at Chicago
Jane Addams College of Social Work
1040 West Harrison, (M/C 309)
Chicago, Illinois 60607
Abstract
As the Black Americans’ population becomes more diverse, it is important to extrapolate
differences amongst individuals who have historically been grouped as Black or African
American in the literature. This review systematically explores differences in the perceptions of
mental health services among Black Americans of African American, African, and Caribbean
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Black descent. Thirty studies were included in the analysis. The paucity of literature limited the
author’s ability to identify themes substantial themes for Africans and Caribbean Blacks, stigma,
discrimination, and racism mired the perceptions of mental health services for African
Americans. The findings underscored the need for more research to be able to adequately
identify and better understand important and nuanced differences in perceptions of mental health
within the Black American population. Implications for how to better serve Black Americans
through social work practice, intervention and prevention are discussed.
Keywords: African Americans, Africans, Caribbean Blacks, perceptions, mental health services,
stigma, discrimination, racism, Black Americans, Social work
INTRODUCTION
As the American population becomes more diverse, acknowledging important cultural
differences and perceptions of care amongst subgroups of people of African descent becomes
paramount (Lincoln, Chatters, Taylor, & Jackson, 2007; U.S. Census, 2011). Identifying as
“Black” in the United States can include a heritage of Caribbean or West Indian, African, or
another non-American descent. For the purposes of this paper, we focus on African Americans,
Africans and Caribbean Blacks. Collectively, Black Americans alone—not including Blacks of
multiple races—encompass about 13.2% of the U.S. population (U.S. Census 2014). Albeit not
easy to discern, within the Black American population, approximately 1.6 million (4%) identify
as being African (e.g. Ghanaian or Kenyan) and 1.7 million (4.4%) report as being of Caribbean
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Black decent (e.g., Haitian or Jamaican) (American Community Survey; Logan & Deane, 2003;
Migration Policy Institute, 2012).
While significant differences between African Americans and Caribbean Blacks on measures of
physical health have been widely reported (Singh & Siahpush, 2002; Read, Emerson, Taylor,
2005; Read, & Emerson, 2005), considerably less is known about variations in mental health,
despite a small, yet growing, body of evidence (Earl & Williams, 2008; Jackson et al., 2007). In
order to ensure equitable access to adequate care for Black Americans, it is important to
understand the complex role culture and diversity play within race. These factors impact how
symptoms of mental illness are expressed, understood and ultimately diagnosed (Earl, Fortuna,
Gao, Williams, Neighbors, Takeuchi, & Alegría, 2014). Understanding the impact of a person’s
cultural background on their perceptions about mental health treatment is especially important
given that, for some, seeking mental health care may not be something with which they are
familiar (World Health Organization, 2011); Migration Policy Institute, 2012; Miranda et al.,
2005). For example, as a result of the earthquake that crippled Haiti in 2010, the dearth of mental
health services and infrastructure within the country was brought to national attention and in
Africa less than 1% of the total healthcare budget is allocated to mental health (Bird et al., 2010).
Social workers comprise nearly half of the behavioral health care workforce therefore it is
essential for them to be trained in specialized skills to provide evidence-based behavioral health
services (Rosen, 2003; Walrath et al., 2006) that facilitate mental health care among this diverse
population. While there are common experiences across the Black American community, there is
also a great deal of heterogeneity that requires social workers and other mental health service
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providers to understand and be able to provide high quality care that is appropriately tailored to
the unique needs of their patients (Rosen, 2003).
SYSTEMTIC LITERATURE REVIEW APPROACH
In an effort to help the field better understand and disentangle important differences in
perceptions of mental health care within the Black American population We systematically
reviewed the literature using Medline, PsychInfo, Academic Search Complete, PubMed, Ebsco,
and Social Work Abstracts. Our search was guided by a combination of key words that focused
on mental health care, patient perceptions of mental health care and ethnic variations of Black
Americans. We specifically sought to include peer-reviewed articles because these are more
widely reviewed to inform clinical practice and service delivery. We included a broad range of
articles that were published between 2002 and 2014 and emphasized care and perceptions of
American and/or foreign-born Blacks who resided in the states. Examples of key words included,
mental health, perceptions of care and/or treatment, mental health, mental health communication,
patient and provider communication, culture competence, trauma, clinical encounter, and
communication styles. In order to discuss literature that represented the diversity within the
Black American population, we looked for articles that used the terms like, African American,
Black, African, Haitian, Jamaican, Dominican, Trinidad and Tobago, Afro Caribbean, Caribbean
Black, immigrant, and refugee.
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ANALYSIS STRATEGY
We used a three-step process to identify the studies that met our inclusion criteria. The
first step involved examining all studies that were (1) published in peer-reviewed journals, (2)
that were specifically focused on mental health, (3) recruited African Americans, Africans,
and/or Caribbean Black participants, and (4) included African and Caribbean Blacks (foreign- or
U.S.–born) who lived in the United States at the time of the study. Any differences between
foreign-born and U.S.–born Africans and Caribbean Blacks will be identified. Studies were
excluded from the review if results were not reported separately by race and nationality of the
participants. A total of 560 studies were reviewed. See Table 1 for the total number of studies
reviewed by population. Upon further examination, a total of 278 out of 560, met possible
inclusion in the study.
We were interested exclusively in studies that met at least one of two search criteria. Studies
must have examined: (1) the perceptions of mental health services among specific African and
Caribbean Black groups, and/or (2) the perceptions of mental health services among African
Americans. The review was expanded to include peer-reviewed studies published from January
2002 and December 2014.
The second step involved reviewing and employing thematic analysis of the 278 studies. Two
members of the team conducted independent reviews of the literature using the specified key
words as a guided framework. Matrixes were constructed and used by the researchers in order to
allow for study comparison and identification of emergent themes. The matrixes included the
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author(s), date of publication, methodology used, study participants inclusive of racial/ethnic
groups and nationality, location of the study to ensure individuals living in the U.S. were the
subject of the study, results, and study recommendations. The team members met weekly to
review and discuss their independent findings until they reached consensus.
Matrixes were then compiled and categorized according to African American, Caribbean Black,
and African participants. In the end, we found 30 studies that met the inclusion criteria. Twenty-
three of the studies examined African Americans’ perceptions of mental health care. See Table 2
for studies examining African Americans’ perceptions of mental health services. Two studies
examined perceptions of mental health services among Caribbean Blacks. Two studies examined
perceptions of mental health services among Africans living in the United States. Three studies
included mixed populations. See Table 3 for Caribbean Black, African, and mixed population
perceptions. The final step involved using the matrixes to identify emergent themes. Two raters
(the principal author and the PhD student) were used to identify themes. Raters independently
reviewed each study, wrote notes regarding possible themes, and met twice weekly until there
was agreement about emergent themes. The total review process took approximately 6 months to
complete.
EMERGENT THEMES
Two primary themes emerged that seemed to best describe the perceptions of mental health care
within the literature. The themes were: (1) perceptions that influenced service use and (2)
perceptions related to barriers to mental health help-seeking. Subthemes for African American
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participants are also displayed in Table 2. Subthemes and themes could not be identified for
African and Caribbean Blacks due to the paucity of studies found.
RESULTS
Overall, as shown in Tables 2 and 3, of the 30 studies reviewed, 23 focused on African
Americans, 2 focused Africans, 2 focused on Caribbean Blacks, and 3 included a combination of
Black Americans. There were a number of studies that met the inclusion criteria, informed
perceptions about mental health service use, discussed “African Americans” or “Blacks”, but did
not identify or discuss ethnicity or country of origin. Therefore, we present the findings in an
order that aligns with the number of available articles that were reviewed for each of the three
subgroups of Black Americans.
Perceptions of African American
Service Use and Access. African Americans’ negative perception of mental health and the
mental health system was identified as a barrier to service use. Their experiences of societal
discrimination may lead to skepticism and distrust of the mental health system (Copeland &
Snyder, 2010; Earl, Alegría, Mendieta, & Linhart, 2011). We identified three reasons for varying
service use among African Americans. A client’s trust in their provider was one important
reason; a service provider’s competence was a second theme found in the review and a client
feeling that they were respected by their provider were all common themes in service use among
African Americans.
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The importance of trust and comfort with the provider were common reasons across various
studies (Earl et al., 2011; Leis, Mendelson, Perry, & Tandon, 2011; Lindsey & Marcell, 2012;
Thompson, Dancy, Wiley, Perry, & Najdowski, 2011; Ward, 2005). African Americans
identified several dimensions of trust including the need for providers to be nonthreatening and
reassuring. It was important that providers be emotionally and personally accessible. Having
similar spiritual beliefs would also help the client trust their provider. Participants also preferred
their provider to have professional credibility, which was defined as having expertise, fame, and
being the same race (Mishra, Lucksted, Gioia, Barnet, & Baquet, 2009).
Ward (2005) found that clients were constantly evaluating the practitioner’s effectiveness on the
basis of years of education, training, and experience working with African Americans.
Confidentiality-related concerns negatively influenced client-provider relationships (Leis et al.,
2011; Lindsey & Marcell, 2012; Thompson et al., 2011). Findings indicate that clients were
concerned that the information they disclosed in therapy could be used against them in the court,
especially when treatment was court-mandated (Ward, 2005).
The desire to be respected and understood by the provider was a common theme across studies
(Copeland & Snyder, 2010; Earl et al., 2011; Leis et al., 2011; Mulvaney-Day, Earl, Diaz-
Linhart, & Alegria, 2011). For example, African American women were concerned that
clinicians would not understand the unique societal challenges they encountered (Copeland &
Snyder, 2010). In their analysis of African American, Latino and White patients’ preferences for
relational styles in encounters with mental health providers, Mulvaney-Day et al. (2011) found
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that African American clients specifically emphasized the provider’s listening skills. They
wanted to be understood and were appreciated as experts of their lived experiences.
Barriers to Mental Health Help-Seeking. After further examination, four subthemes were
identified as barriers to mental health help seeking: stigma; structural barriers such as poverty,
racism, discrimination; reliance on other coping mechanisms; and fear (Brown et al., 2010;
Barksdale & Molock, 2009; Conner et al., 2010a; Copeland & Snyder, 2011; Lindsey & Marcell,
2012; Leis et al, 2011; Mishra, Lucksted, Gioia, Barnet, & Baquet, 2009; Neighbors et al., 2009;
Richman, Kohn-Wood, & Williams, 2007; Thompson et al., 2011; Ward, Clark, & Heidrich,
2009; Ward & Heidrich, 2009).
Among structural barriers, African American women identified poverty, lack of health insurance,
unemployment, housing issues, and low education as barriers to mental health service use (Ward
et al., 2009). Copeland and Snyder (2010) found that low-income women were not seeking
mental health treatment largely because of economic stressors and stress from conflicting roles in
their lives. Richman et al. (2007) explored the impact of race, discrimination, and racial identity
on mental health service use among African Americans. They found that past discrimination and
identity were more important than education and income in explaining disparities in mental
health service use.
The perception of racism and stigma were also identified as major barriers to seeking mental
health information and services (Conner et al., 2010b; Mishra et al., 2009). Brown et al. (2010)
found that African Americans reported more negative attitudes toward mental health treatment
than Whites. Both African Americans and Whites internalized stigma, which led to negative
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attitudes about mental health. One study found that among African American women,
internalized stigma and not the perception of mental illness by their community was a major
factor influencing help-seeking (Ward & Heidrich, 2009). On the other hand, among young
African American males, negative community beliefs about mental health care were barriers to
seeking treatment (Lindsey & Marcell, 2012). Among African Americans in their late
adolescence, family norms toward mental health treatment were the strongest predictor of help-
seeking intentions (Barksdale & Molock, 2009).
Cultural perceptions that African Americans are “strong” and do need mental health treatment
was another barrier. Lindsey and Marcell (2012) found that young adult African American males
were engaging coping activities in isolation or were engaging in negative coping mechanisms
such as drug use instead of seeking mental health treatment. Ward et al. (2009) found that
African American women were not seeking help because of their belief that Black women “had
to be strong,” or because they believed that they could handle it on their own. Women were
relying on their informal support groups, religious coping, reading, normalizing mental health
problems, and/or denying mental health issues altogether. An analysis of the National Survey of
American Life (NSAL) documented that African American older adults underutilized mental
health services but may be due to a variety of reasons (Neighbors et al., 2009). For example,
cultural perceptions that African Americans are “strong” and do need mental health treatment
was a barrier. Additional contributors were the belief that depression was normal and that
seeking treatment was a sign of weakness (Conner et al., 2010).
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Fear also appeared to hinder access to mental health services for African Americans (Copeland
& Snyder, 2011; Leis et al, 2011; Lindsey & Marcell, 2012; Thompson et al., 2011). The fear of
breached confidentiality emerged as a barrier to treatment-seeking for young adult males in a
study by Lindsey and Marcell (2012). Women may also have unique fears, such as the fear of
losing their children should they seek treatment (Copeland & Snyder, 2011). Another concern
noted across studies was the negative attitude toward psychotropic drugs (Leis et al., 2011);
including fear of overmedication (Copeland & Snyder, 2011) or of side effects (Thompson et al.,
2011).
Perceptions of Caribbean Blacks
Examining a sample of 150 Haitian immigrants living in the United States, Schwartz, Bernal,
Smith, and Nicolas (2012) found that Haitians were more likely to seek help from family rather
than mental health professionals. Jackson et al. (2007) found that Spanish-speaking Haitians
were more likely to report satisfaction with mental health than respondents from the English-
speaking Caribbean.
Perceptions of Africans
Piwowarczyk et al. (2014) examined both concepts of mental illness in addition to attitudes and
beliefs about treatment and potential barriers to seeking mental health treatment among a sample
(n= 296) of Congolese and Somali men and women in the U.S. They found that mental health
concerns were often first dealt within the family. Commonly, faith based coping methods were
used to address mental health issues. Also, the role of formalized mental health was not well
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understood, intact, participants were hesitant to seek services due to issues such as stigma.
Through a phenomenological study by Ezeobel, Malecha, Landrum & Symes, (2010), which
examined perceptions of depression among 19 Nigerian women living in the U.S., stigma was
associated with seeking mental health services. They avoided such stigma by relying more on
religious coping mechanisms. Seeking mental health services was stigmatizing when specifically
being diagnosed with depression. Many participants reported being isolated from family after
being diagnosed with depression due to stigma. DeJesus and Earl (2014) explored the
perceptions of the quality of mental health care among Brazilians and Cape Verdeans. Cape
Verdean is located off the coast of Africa. Focus groups of 24 Brazilians and 24 Cape Verdeans
who received outpatient mental health treatment in the U.S. found that aspects of mental health
care were linked to psychosocial and environmental factors.
DISCUSSION
Given the potential depth and breadth of the ways in which culture can mediate the expression of
what might be considered psychotic-like experiences, the accuracy of diagnosis and efficacy of
treatment for psychotic disorders depends on the recognition of potential racial, ethnic and
cultural variations and influences on symptom presentation. Not attending to socio-cultural
influences, limits diagnostic accuracy and the quality of psychiatric care for those who are most
in need. The systematic review suggests that social workers must be aware of the myriad of
perceptions associated with barriers to mental health care among African Americans, Africans,
and Caribbean Blacks. For African Americans, perceptions about mental health services
appeared to be associated with two major themes—mental health help-seeking and service use.
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Barriers to service use and help-seeking for African Americans were associated with perceived
discrimination and racism in care, distrust, and practitioner factors such as the perception of
practitioner expertise and the perceived quality of their listening skills. The review also revealed
additional perceptions that specifically affected help-seeking among African American women
such as their own stress and the belief that seeking treatment was a reflection of personal
weakness. Limitations to this study include the lack of research exploring the perceptions of
mental health services among Africans and Caribbean Blacks is the significant gap in literature.
The limited amount of studies, which focused on specific groups of Africans and Caribbean
Blacks living in the U.S. coming from different cultural backgrounds are not available and
therefore a limitation to this study. The few studies found that explored the topic of mental health
services perceptions among Africans and Caribbean Blacks revealed some similarities among
African Americans, but also highlight cultural differences that require additional attention. It is
important for additional research to also extrapolate perceptions of mental health among Africans
from various countries
Implications for Social Work Practice, Intervention and Prevention
Diversity, Culture and Practice
Discrimination and racism increase African Americans’ and Caribbean Blacks’ risk for mental
health problems (Clark, Salas-Wright, Vaughn, & Whitfield, 2014) and adversely affect their
access to mental health care (Conner et al., 2010; Mishra et al., 2009; Richman et al., 2007). The
perception of discrimination and racism in mental health services for African Americans
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appeared to be a significant barrier to care. While the relationship between discrimination and
racism was less clear among Africans and Caribbean Blacks, social workers and other mental
health professionals should be cognizant of the experiential and historical differences that may
influence these perceptions.
Research suggests that the perception of discrimination and racism by African Americans stems
from a history of racism and discriminatory health and medical research practices inclusive of
medical experimentation in slavery, involuntary family planning sterilization, and the Tuskegee
Syphilis Study, which revealed unethical medical practices conducted by the United States
Public Health Service (Boulware et al., 2003; Washington, 2006). It is this legacy of
maltreatment that may influence perceptions of distrust, racism, and discrimination about mental
health by some African Americans. African Americans integrate experiences from previous
social or clinical interactions to appraise current clinical encounters (Earl et al., 2011) and
transfer experiences of perceived discrimination and racism to future relationships with
providers.
The relationship between perceived discrimination and satisfaction with mental health is less
clear for Caribbean Blacks. Jackson et al. (2007) found that Spanish-speaking Caribbean Blacks
and Haitian respondents are more satisfied with mental health and medical services than are
respondents from predominantly English-speaking parts of the Caribbean. In a seminal study
conducted by Eaton and Garrison (1992) it found that Haitians reported more discrimination and
less satisfaction with mental health and with life in the U.S. than Cuban refugees. The study
examined differences in psychopathology and use of the mental health system among 952 Cuban
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and Haitian refugees living in Florida. Additional research is needed to explore the possible
impact of discrimination and racisim on mental health services use among Caribbean Blacks and
Africans living in the U.S.
The review revealed one study conducted by Jackson et al. (2007), which found both African
Americans and Caribbean Blacks utilized formal mental health infrequently, but U.S.–born
individuals were more likely to receive care than first-generation immigrants. There is also a
need to explore the phenomenon of “the immigrant paradox” for Caribbean immigrants.
According to the immigrant paradox, the longer the immigrants stay in the U.S., the more mental
health problems they have (Suarez-Orozco, Todorova, & Qin, 2006). The relationship between
the generation status of immigrants on their perceptions and use of mental health status should be
further investigated. Miranda, Siddique, Belin, and Kohn-Wood (2005) found that Black women
born outside the United States (in Africa or the Caribbean) were less likely to screen positive for
depression. However, the longer they lived in the United States, the more likely they were to
screen positive for depression. Social workers should be aware of the impact of immigration on
the mental health risk of Caribbean Blacks. Additionally, more needs to be known about the
impact of immigration on mental risk and access among Africans living in the U.S. as well.
Social workers must pay attention to structural racism, its implications, and underlying
ideologies that foster discrimination against individuals (Viruell-Fuentes, Miranda, &
Abdulrahim, 2012). Social workers are mental health providers and can act as conduits and
facilitators of communication between patients and providers (Gaston, Gutierrez, & Nisanci,
2014). They should actively engage in dialogue with their clients and health care professionals in
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their practice settings about the everyday realities of African, African American, and Caribbean
Black clients that include experiences of racial discrimination and oppression.
The most salient cultural barrier found was stigma attached to mental health problems and
treatment among African Americans, Africans, and Caribbean Blacks. Research suggests that
stigma related to accessing and engaging in mental health treatment often discourages patients
from pursuing care (Hine, Howell, & Yonkers, 2008; Corrigan, 2004). Stigma is a well-
documented barrier for African Americans’ access to mental health care (Brown et al., 2010;
Conner et al., 2010b; Mishra et al., 2009). The pressure to be “strong” may be one factor that
perpetuates mental health stigma among African American women. For example, Ward et al.
(2009) found that the normalization of challenging life conditions and community pressure to be
a “strong Black person” decrease African Americans’ awareness of their need for treatment.
Social workers can challenge such issues related to stigma by educating clients and the
community about mental health (Kohli, 2012; Mishra et al., 2008). Secondly, attempting to
integrate family and other sources of support will aid in the treatment process (Schwartz, Bernal,
Smith, Nicholas, 2014). Educating clients and their support system can also serve to address
potential barriers to treatment (Kohli, 2012). Finally, social workers can also work individually
with clients to deconstruct narratives and reduce self-blame about mental health issues related to
maneuvering significant structural barriers such as poverty, lack of community resources,
unemployment/underemployment, and discrimination (Corrigan, 2004; Kohli, 2012; Misra,
2008; Mulvaney-Day, 2011).”
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It would also be important for scholars to explore whether a similar phenomenon exists among
Caribbean Blacks. To date, there is a paucity of research on Caribbean Blacks’ perceptions of
mental health and U.S.–based mental health services, even though they are the largest Black
immigrant population. We found no information on mental health perceptions among individuals
from Jamaica, the Dominican Republic, Trinidad and Tobago, and only two studies on those
from Haiti. Although it is unclear if this preference is related to stigma, one study on Haitians
residing in the United States shows that they prefer to seek assistance from family versus mental
health professionals, (Schwartz et al., 2012). Nadeem, Lange, Edge, Fongwa, Belin, & Miranda
(2007) found that, among a sample of 15,383 immigrant and U.S.–born Black and Latina
women, African and Caribbean immigrants were more likely to worry about stigma related to
mental health care. This raises concerns of stigma being an issue for Caribbean Blacks.
Some international studies also support this idea and associate stigma with reduced mental health
access among Caribbean’s. Youssef, Bachew, Bodie, Leach, Morris, and Sherma (2012) studied
knowledge and attitudes about mental illness among a sample of 673 individuals from university
campuses in Jamaica, Barbados, and Trinidad and Tobago and found that stigma is associated
with being diagnosed with schizophrenia and substance abuse. These findings suggest that
educational campaigns may be needed to reduce stigma and discrimination for individuals with
certain mental health issues. Similarly, Arthur, Hickling, Hickling-Robertson, Haynes-Robinson,
Abel, and Whitney (2010) in a study of 126 socioeconomically diverse individuals from
Kingston, Jamaica, found that barriers to mental health include perceptions of stigma, negative
associations of mental illness with “madness,” and avoidance. More research needs to explore if
stigma affects mental health use among Caribbean Blacks living in the U.S.
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The literature revealed only two studies on African immigrant perceptions of mental health in the
United States. While themes could not be generated, stigma appeared to influence perceptions of
mental health services (Ezeobele, 2010; Piwowarczyk et al., 2014). Similarly, in an international
study conducted in South Africa, Egbe et al (2014) found among a sample of 77 South African
mental health services users that stigma was perpetuated by family members, friends, employers,
community leaders and health providers. The authors suggested that mental health services
aimed at treating this population should integrate the patient’s support system and teach the
patient how to deal with internalized stigma. It is important for additional research to extrapolate
perceptions of mental health among Africans from various countries. The African continent is
rich in diversity; researchers and social workers need to continue to explore the specific needs of
African immigrants from specific countries.
Conclusion
It is important for social workers to help create an environment where mental health perception
barriers can be addressed by engaging in culturally specific practice. Multilayered and complex
factors appear to affect African Americans,’ Africans, and Caribbean Blacks’ access to and use
of mental health services. Diversity within the Black population calls for additional research that
explores perception barriers about mental health among African Americans, Africans, and
Caribbean Blacks. The increasing recognition of culture as an important factor in public health
and communication has the potential to contribute to the development of new and more effective
strategies to help eliminate health (Kreuter & McClure, 2004) and behavioral health disparities.
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Of concern was the limited number of studies that focused on specific groups of Africans and
Caribbean Blacks living in the U.S. Social workers need to be aware that African and Caribbean
clients might be coming from different cultural backgrounds and may be facing challenges that
stem from immigrant status and history. Behavioral health specialists should be clinically
trained, bi-lingual, and culturally competent social workers or psychologists (Manoleas, 2008).
In the end, the paucity of research that extrapolates intra-group diversity among Black
Americans in the U.S. underscores the need for a deeper understanding of this complex interplay
of attitudes, barriers, and other forces influencing perceptions of mental health services and
subsequent access to care.
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anuscript
28
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Table 1—Total of Number of Studies Reviewed,
Population
Total Number
of Studies
Reviewed
Studies Meeting
Search Criteria
Total included in the
Review
African Americans 345 197 23
Caribbean Blacks 121 42 2
Africans 38 7 2
Mixed Population 56 32 3
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Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2002-2014
Study Research
Focus
Research
Design
Sample
Size
Population Key Findings Subthemes
Alvidrez
et. al.
2010
Examine
whether
stigma and
other
concerns
about
entering
treatment
had an
impact on
engagement
and service
use across 3
months.
Quantitative 42 African
Americans
African
American men
and those with
more education
perceived more
stigma in
mental health
care. However,
perceived
stigma was not
related to
treatment
engagement.
Discrimination
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
Barksdale
and
Examine
whether
Cross-
sectional
219 African
Americans
Individually,
peer and family
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anuscript
32
al. 2010 depressive
symptoms,
stigma and
treatment
related
attitudes
and
behaviors.
survey and
White.
of stigma is key
in the
development of
negative
attitudes
toward mental
health
treatment
among African
Americans.
Conner
et. al.
2010
Explore
attitudes
and beliefs
about
depression
and mental
health
treatment.
Qualitative 42 Older
adult
African
Americans
Barriers to
treatment were
perceptions of
depression
(“this is
normal”, not
recognizing
symptoms), the
African
American
experience
Discrimination
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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anuscript
34
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research
Focus
Research
Design
Sample
Size
Population Key Findings Subthemes
Conner
et al.,
2010
Examine
older adult
African
Americans
with
depression
perceptions
of barriers to
seeking
mental
health
treatment.
Qualitative 37 African
American
older
adults
Participants
reported fear of
stigma, mistrust
of mental health
treatment, lack
of access, sense
of being too old
to seek
treatment, and
the lack of
recognition of
mental health
symptoms due
to persistent
stress in the
community were
barriers to
Discrimination
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
Subthemes
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anuscript
37
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research
Focus
Research
Design
Sample
Size
Population Key Findings Subthemes
Hines-
Martin et.
al. 2003
Examine
the barriers
to mental
health care
service use
among
low-
income
African
Americans.
Qualitative 24 African
Americans
Individual
barriers were
fear, denial,
economic, and
values.
Environmental
barriers were
family issues,
community,
and resources.
Institutional
barriers were
time,
limitations,
gatekeepers
and rules.
Discrimination
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
Subthemes
Discrimination
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anuscript
38
Leis et. al.
2011
Explore
perceptions
of mental
health
services
and its
effect on
service use
among
clients
from a
home
visiting
program.
Qualitative 64 African
Americans
Overall,
perceptions of
mental health
services were
negative.
Negative
perceptions
included
beliefs that
providers gave
medications
without
listening,
concerns about
confidentiality,
suspicion
about
psychotherapy
and
psychotropic
drugs.
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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anuscript
39
Leis, J. A.,
Mendelson,
T., Perry,
D. F., and
Tandon, D.
T., 2011
Explore
perceptions
of mental
health
services as
a barriers
to use
among
perinatal
African
American
women.
Qualitative 38
clients
26
staff
African
American
women
Perceptions of
mental health
were negative
with many
participants
believing that
stigma, lack of
confidentiality,
psychotropic
medication,
and
questionable
effectiveness
of
psychotherapy
was significant
barriers to
mental health
treatment
seeking.
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anuscript
40
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research
Focus
Research
Design
Sample
Size
Population Key
Findings
Subthemes
Lindsey
and
Marcell,
2012
Explore
African
American
males’
perceptions
of help-
seeking for
mental
health.
Qualitative 27 Young
adult
African
American
men
Barriers to
mental
health
seeking were
engaging in
coping
activities in
isolation, at
the social
level (drug
use), and
negative
community
beliefs about
mental
health.
Discrimination
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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anuscript
41
Mishra et.
al. 2009
Better
understand
mental and
illness
information
and service
delivery
preferences.
Qualitative 42 African
Americans
Providers
should be
non-
threatening,
credible,
accessible,
and
incorporate
spirituality in
treatment.
Stigma and
perceptions
of racism as
barriers to
seeking
treatment.
Mulvaney-
Day et. al.
2011
Examine
preferences
for
relational
Qualitative 51 African
American,
Latino,
and White.
No primary
differences
in major
preferences
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anuscript
43
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research
Focus
Research
Design
Sample
Size
Populatio
n
Key Finding Subthemes
Murry,
Heflinger
, Suiter,
and
Brody,
2011
Examine
perception
s about
mental
health and
help-
seeking
among
rural
families of
adolescent
s with
mental
illness
Mixed
method
163
(survey)
21
(qualitativ
e
interviews
)
African
American
mothers
Preferences
for social
support were
family,
religious
institutions,
and school.
Stigma and
cultural
mistrust were
barriers to
help seeking.
Discriminatio
n
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
Subthemes
Neighbor Examine Quantitativ 55 Older Mental health
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anuscript
44
s et. al.
2009
mental
health
services
utilization.
e African
American
s
services were
underutilized.
Those who
were 65 and
older were
less likely to
receive
mental health
or general
medical
treatment
compared to
those under
the age of 65.
Participants
with a high
school
education or
higher were
more likely to
use mental
health
Discriminatio
n
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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anuscript
47
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research Focus Research
Design
Sampl
e Size
Populatio
n
Key Findings Subthemes
Richman
et. al.
2007
Examine the
role of race,
discrimination
and racial
identity in
explaining
mental health
service
utilization.
Quantitativ
e
955 African
American
and
White
adults.
Past
discrimination
and identity
variables are
more
important than
structural
variables such
as education or
income in
explaining
mental health
utilization.
Discriminatio
n
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
Subthemes
Sanders-
Thompso
n, Bazile,
Examine
beliefs
regarding
Qualitative 201 African
American
men and
Participants
associated the
term
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anuscript
48
and
Akbar,
2004
psychotherapist
s,
psychotherapy,
and barriers to
seeking mental
health
treatment.
women psychotherapy
with stigma.
Psychologists
were perceived
to be White
male elitists
who were
unsympathetic,
uncaring, and
unavailable.
They preferred
the term
counseling.
Barriers to
treatment were
stigma,
financial costs,
and the lack of
recognition of
mental health
issues.
Discriminatio
n
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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anuscript
49
Thompso
n et. al.
2011
Explore
participants’
past experience
and satisfaction
with mental
health services.
Qualitative 40 African
American
s mothers
and their
youths.
About half of
the mothers
dissatisfied
with services.
Group and
family therapy
was positively
regarded.
Dissatisfaction
centered on
medication
concerns, lack
of
professionalis
m,
confidentiality,
and poor
quality
treatment.
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anuscript
50
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research
Focus
Research
Design
Sample
Size
Population Key Findings Subthemes
Thurston
and
Phares,
2010
Examine
the
influence of
parents’
gender,
race, and
mental
health on
perceived
barriers and
attitudes
about
treatment.
Quantitative 194 African
American
and White
parents.
White parents
were not
significantly
different in
child-related
attitudes.
White parents
did perceive
fewer barriers
to treatment
utilization for
themselves and
their children
than did
African
American
Discrimination
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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55. Accepted
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anuscript
54
Table 2—Summary of Studies that Explore African American Perceptions of Mental Health,
2003-2013
Study Research
Focus
Research
Design
Sampl
e Size
Population Key Findings Subthemes
Ward et.
al. 2009
Examine
beliefs about
mental
illness,
coping
behaviors,
barriers to
treatment
seeking.
Qualitative 15 African
American
women
Individual
level barriers
were more
prevalent than
systemic
barriers.
Treatment-
seeking
barriers
included poor
access to care
(agency and
socioeconomic
issues),
stigma, and
lack of
awareness of
Discriminatio
n
Stigma
Peer/Family
Support
Mistrust
Racism
Economic
stress
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anuscript
55
mental illness.
Ward,
Wiltshire
, Detry,
and
Brown,
2013
Examine
African
Americans’
beliefs about
mental
illness, help
seeking, and
coping
mechanisms
.
Quantitativ
e
272 African
American
men and
women
Participants
were not very
open to
acknowledgin
g
psychological
problems due
to stigma
concerns.
Participants
were
somewhat
open to
seeking help,
but preferred
religious based
coping
mechanisms.
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anuscript
58
Table 3— African and Caribbean Black Perceptions of Mental Health Services in the United
States, 2002-2014
Study Research
Focus
Research
Design
Sample
Size
Population Key Findings
Jackson et al.,
2007
Examine the
use and
correlates of
formal
psychiatric
services
between U.S
born and
immigrant
Caribbean
Blacks.
Quantitative 3570 Spanish-
speaking
Caribbean’s,
Haitians, and
English-
speaking
Caribbean’s.
Haitian
respondents were
more likely to
report satisfaction
for specialty
mental health and
African
Americans.
Caribbean Blacks
from English-
speaking
countries were
less likely than
those from
Spanish-speaking
Caribbean and
Haiti as less
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anuscript
59
helpful.
Schwartz,
Bernal, Smith,
and Nicolas,
2012
Examines
help-seeking
patterns of
behavior
among
Haitian
immigrants
living in the
U.S.
Quantitative 150 Haitian
immigrants
living in the
U.S.
Participants were
least likely to go
to professionals
for mental health
services.
Participants relied
upon family or
relatives
regardless of the
problem.
Piwowarczky
et al., 2014
Examined
both concepts
of mental
illness in
addition to
attitude and
beliefs about
treatment and
barriers to
Mixed
methods
344 Congolese
and Somali
immigrants
Mental health
concerns were
often dealt with in
the family. Faith
based coping was
used to address
mental health
concerns.
Formalized
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Table 3— African and Caribbean Black Perceptions of Mental Health Services in the United
States, 2002-2014
Study Research Focus Research Design Sample
Size
Population Key Findings
Ezeobele
2010
Examined
perceptions of
depression
among Nigerian
immigrant
women living in
the U.S.
Phenomenological
study
19 Nigerian
immigrant
women
Stigma was a
major barrier to
seeking mental
health services.
Participants
reported being
isolated from
family after
being
diagnosed with
depression.
Religious
coping was
used more than
formalized
mental health
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services.
DeJesus
and Earl
2014
The aim of this
study was to
identify
indicators of
quality of mental
health care that
matter most to
two
underrepresented
immigrant
patient groups:
Brazilians and
Cape Verdeans.
Qualitative; focus
groups
24
Brazilians
and 24
Cape
Verdeans
Brazilians
and Cape
Verdeans
The
effectiveness of
mental health
care treatment
was related to
two categories
inclusive of the
therapeutic
relationship
and treatment
outcomes.
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