CULTURAL CONSIDERATIONS IN MENTAL HEALTHCARE
there were 1.2 million Hispanic or Latinos who are US military veterans (U.S. Census Bureau QuickFacts: United States). ● The rates of substance use disorders are slightly lower in Hispanic women and slightly higher in Hispanic men. Hispanics are approximately twice as likely as Whites to die from liver disease, which could be associated with substance use (Hispanic Health | VitalSigns | CDC). There are few Hispanic children in the child welfare system, but Hispanics are twice as likely as Whites to be incarcerated at some point in their lifetime (Sakala, 2014). The lack of Spanish- speaking mental healthcare providers has been a problem, likely causing fewer than 1 in 11 Hispanic individuals with a psychiatric disorder to seek treatment (Mental and Behavioral Health - Hispanics - The Office of Minority Health (hhs.gov)). Misdiagnosis is common and is often related to language barriers. Among Hispanics living in the United States, one in three do not speak English well (Hispanic Health | VitalSigns | CDC). Hispanic Americans are more likely to use folk remedies solely or as a complement to traditional care, and some may consult church leaders or healers for more traditional care (Hispanic/Latinx | NAMI: National Alliance on Mental Illness). Asian Americans and Pacific Islanders comprise just over 20 million of the US population and are considered one of the fastest growing racial/ethnic groups within the United States (U.S. Census Bureau, 2020; Wyatt, Ung, Park, Kwon, & Trinh- Shevrin, 2015). By 2060, it is projected that 1 in 10 children in the United States will be Asian (Wyatt et al., 2015). There are numerous ethnic subgroups included in the Asian American/ Pacific Islander demographic, with over 100 languages and dialects (Asian American/Pacific Islander Communities and Mental Health | Mental Health America (mhanational.org)). Thirty-two percent of Asian Americans have difficulty accessing mental healthcare services because they do not speak fluent English (Asian American/Pacific Islander Communities and Mental Health | Mental Health America (mhanational.org)). For example, older Asian Americans may not understand questions or the intent of a medical interview, and they may give affirmative answers to avoid confrontation. Asian Americans and Pacific Islanders are the least likely of any group to seek help with mental health issues (Hernandez, Nesman, Mowery, Acevedo-Polakovich, & Callejas, 2015). Although fewer mental health concerns are reported in this group, few epidemiological studies have included this population (Asian American/Pacific Islander Communities and Mental Health | Mental Health America (mhanational.org)). Asian Americans tend to exhibit somatic (physical) symptoms of depression more frequently than emotional symptoms (Boyd, 2018; Kalibatseva & Leong, 2011). The focus on physical symptoms and misdiagnosis serves as a barrier to mental healthcare for this population. Suicide rates within this population should be monitored closely by examining risk factors such as acculturation, family discrimination, social acculturalization, and discrimination (Boyd, 2018; Wyatt et al., 2015).
Culture influences various aspects of mental health, including the recognition and expression of psychiatric symptoms, coping styles, community support, and the willingness to seek treatment. Cultural concepts of distress are recurrent, locality- specific patterns of aberrant behavior that are not linked to a specific diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders , fifth edition (American Psychiatric Association, 2013). More impoverished communities have environmental risks such as a lack of access to healthy nutritious foods, clean soil, and clean air in urban areas. This may impact mental health via physiological/neurological impact and deficits, especially in vulnerable populations. As of 2021, the percentage of the US population that self- identified as African American had grown to 13.4% (U.S. Census Bureau QuickFacts: United States). Although anyone can develop a mental health problem, African Americans may experience barriers to appropriate mental healthcare(National Alliance on Mental Illness, n.d.a). For example, the poverty rate among African Americans in 2020 was 19.4%, with 11.4 million people of all races living in poverty (Income and Poverty in the United States: 2020 [census.gov]). Poverty directly relates to mental healthcare access. The poverty rates in the African American community combined with provider bias and patient distrust of the health system can result in subpar mental health care for African Americans (NAMI: National Alliance on Mental Illness. In addition, the African American community has experienced increasing diversity because of immigration from Africa, the Caribbean, and Latin America. Mental healthcare providers need to understand this diversity and develop cultural competence (Boyd, 2018). Contributing to this cultural consideration is the estimation that over half of the prison population has a mental illness and that African Americans are five times more likely to be incarcerated than Whites (Mental Health America, n.d.; Sakala, 2014). The Latin/Hispanic American population is rapidly growing, currently comprising 18.6% of the nation’s total population (U.S. Census Bureau QuickFacts: United States). In 2020, 17.0% of Latin/Hispanic Americans were living in poverty. Rates of mental health disorders in this population are similar to those of non- Hispanic Caucasians, with some exceptions: ● Older Hispanic adults and Hispanic youths are more vulnerable to the stress associated with immigration and acculturation’ and experience more anxiety, depression, and drug use than non-Hispanic youths. ● Depression in older Hispanic adults is closely correlated with physical illness; and suicide rates were about 50% that of non-Hispanic Whites, although suicide ideation and unsuccessful attempts were higher (State of Mental Health in America - 2020_0.pdf (mhanational.org). ● There is a higher incidence of post-traumatic stress disorder (PTSD) in Hispanic men, some of which may be attributable to social disorder experienced before immigration. As of 2020,
NURSING CARE IN MENTAL HEALTH
Standards of practice The American Nurses Association’s scope and standards of practice of psychiatric-mental health nursing (Psychiatric-Mental Health Nursing Scope and Standards of Practice) provides the foundation for the application of the nursing process to patients with psychiatric disorders (American Nurses Association, 2014). The PMHNP Scope and Standards of Practice also serves as a reference document for the National Council Nursing Licensure Examination (NCLEX) and many state nurse practice acts. The PMHNP Scope and Standards of Practice includes each step of the nursing process: assessment, diagnosis, planning, implementation, and evaluation. When using the PMHNP Scope and Standards of Practice , the nurse should consider the individual’s age, language, and culture. The nurse should also address each patient’s
developmental level. Note that the age and the developmental level may be incongruent in certain mental illnesses. Use age-appropriate communication techniques to establish a therapeutic alliance with both the patient and the family. Additionally, observations of behaviors and reactions are just as important as the conversation. Parents are often present during a child assessment. However, if abuse or neglect is suspected, it may be prudent to talk to the child or adolescent alone. In cases involving child sexual abuse or other uncomfortable issues, the nurse may need the assistance of a healthcare provider with advanced training to interview the child. When working with adolescents, the therapeutic alliance may be hindered by concerns of confidentiality. Reassure the adolescent that conversations are confidential, and information is only
Book Code: ANCCUS3023
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