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How different cultures approach mental health
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Aurora Mental Health Center conducted a cultural immersion program in Costa Rica in March 2010. |
For the last couple of decades, Latinos have made up the fastest growing population segment in the United States, and this trend shows no signs of slowing down. This growth includes families of existing residents, as well as an influx of immigrants, some of who come as refugees or oppressed people seeking asylum.
Those who relocate here are forced to make life-altering adjustments as they immerse themselves in a new language and environment. As some of these immigrants find a home in Aurora and our surrounding communities, we have come to realize that many have endured traumatic experiences in their homelands or arrive with other psychiatric concerns and are in need of mental health services.
As a primary mental health provider, we have found ourselves treating clients with mental health issues that may be compounded by the traumatic events they have experienced and complicated by cultural conflicts. That cultural gap is further compromised by our society that lumps all “Latinos” together.
Yet we know that cultural differences exist within the Latino population depending on their country of origin. Latinos from Cuba, Puerto Rico, Argentina, Mexico, Peru, Brazil and Central America all have unique cultural influences that impact their attitude toward seeking help and in the ways that they may or may not recognize mental illness in their families.
These intra-group cultural differences include a variety of factors, including as language and differences in styles of social interaction. For example, the experience of the Aurora Mental Health Center (AuMHC) in Aurora, Colo. (combined with the research consensus) clearly demonstrates that better outcomes can be achieved if clients are treated in their primary language-especially those who have experienced trauma. There remains a heavy stigma around mental illness in many Latin American countries, and the concept of mental illness can be quite different than it is in the United States.
Access to treatment can be more difficult and resources are often scarce. In many Latin American cultures, the role of the family in caring for those with mental illness is much larger. Large, extended family units are common in Latino cultures, and they tend to devote substantial energy and resources to those that are not functioning well due to mental illness. This sometimes means that problems are handled within the family rather than in the healthcare system.
To become more effective as a mental health provider, more needs to be learned about the cultures that make up the population of the United States. Important question need to be asked, such as:
How do family relationships impact treatment?
How can we in the dominant “American” culture better incorporate families and communities into treatment?
How do we better communicate about mental illness to various cultural groups?
To begin the process of cultural education, and to better understand the role that cultural differences play in mental health issues, AuMHC chose to start in Costa Rica-due in large part to the number of high-level contacts that already existed between members of the AuMHC staff and officials in that country.
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The exchange involved living with a Costa Rican family and a variety of cultural activities |
With the aid of funds provided by a grant, AuMHC was able to give 12 providers and an Aurora police officer the opportunity to participate in a cultural immersion experience in Costa Rica in March 2010. This cultural exchange included living with a Costa Rican family, 30 hours of Spanish classes designed for mental health professionals, participation in cultural activities, excursions throughout the country as well as tours of many of the mental health facilities in Costa Rica.
It soon became clear that this program was as professionally valuable to the mental health workers in Costa Rica as it was to our providers. While Costa Rica provides its citizens with universal healthcare, funding for mental health is not always adequate and they were eager to incorporate innovations from the United States into their healthcare delivery system.
This exchange program that started last March, was the beginning of an ongoing partnership between AuMHC and the Costa Rican government. Shortly after our visit, AuMHC invited members from the Costa Rican National Mental Health Commission and Costa Rican government officials to come to Aurora and learn about the community-based mental health programs at AuMHC.
The Costa Rican government provided the funds for their representatives to participate in this exchange program. The Costa Rican delegation was hosted in the homes of the Aurora delegation that had previously visited Costa Rica.
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Valuable partnerships were formed during the program, with representatives maintaining contact online and in person |
The Costa Rican delegation consisted of ten participants who visited the center in July 2010. Aurora Mental Health employees and board members hosted members of the delegation in their homes. These delegates had the opportunity to learn, first-hand, about U.S. delivery systems for community mental health and specifically in a community that serves a large population of Latino clients. This group visited most of the programs of Aurora Mental Health as well as many of the community partners and other local service providers.
The delegation identified several projects they were interested in implementing in Costa Rica as pilot programs. A partnership developed out of this cultural exchange and representatives of both partners continue to meet through the Internet and in-person to develop initial pilot programs. With ongoing support and consultation from AuMHC, the delegation plans to use what they have leaned to launch a pilot program in the local health clinic of Naranjo, Costa Rica for their clients, in 2011.
Lessons learned in Costa Rica, as they deal with universal health care at the community level, are particularly useful to the provision of community mental health services in our changing health care environment at home.
With an ever-increasing number of Latino clients using our center, it is imperative that we continue to find new and innovative ways to provide culturally sensitive services-ones that recognize cultural differences even among the group we call “Latinos.”
Our objective is to eventually give our professionals an opportunity to have the Costa Rican experience in other Latin American countries so that we can better understand the nuances amongst our population of Spanish-speakers.
Randy Stith, PhD, is CEO and Executive Director of Aurora Mental Health Center, Aurora, Colo.
