THE ROLE OF CULTURE IN INTEGRATING SCHOOLS AND MENTAL HEALTH

Mario Hernandez, Ph.D. and Teresa Nesman, Ph.D. Department of Child and Family StudiesLouis de la Parte Florida Mental Health Studies

School of Mental Health Studies

Presented to the Department of Student Support Services, Hillsborough County Public Schools Paul R. Wharton High School, 20150 Bruce B Downs Boulevard, Tampa, FL. 33647October 17, 2008

Purpose

Why is culture important?

Identify issues/challenges faced in serving diverse children and their families

Increase awareness of how recommendations made by school personnel might be perceived by diverse families

Assumption Underlying

Culture plays a pivotal role in child development,

parenting, learning approaches as well as in

mental health and mental illness

What Is Culture?

Culture has been defined in various ways by different disciplines and for numerous purposes (Kao, Hsu, & Clark, 2004)

It is often invisible to people until they find themselves in a cross-cultural situation

(Cross, Bazron, Dennis, & Isaacs, 1989)

Self

Actualization

Esteem and Identity

Love and Belonging

Safety and Security

Physiologic (e.g., Food, Water)

Maslow’s Hierarchy Of Needs: Humanistic Theory

Culture:

The way w

e go about meeting our needs

Why Is Culture Important To Mental Health?

Life trajectories of diverse children and youth

are impacted when disproportionate numbers

end up in systems such as child welfare,

juvenile justice, and alternative education, etc.

Sadly, relatively high levels of severity of a mental health problem are required in order for culturally-diverse individuals to overcome their reluctance to seek help from a professional

This is likely true for all people

In The US….

Emergency rooms are swamped with people with mental health problems with nowhere to go; and the failure to treat those with serious mental health problems has resulted in incalculable cost, in terms of real dollars and human suffering, to the community and individuals (Gruskin & Dickens, 2006, p. 1904).

Schools have born the burden of unmet mental health needs of both children and their families.

Gaul, C. E, & Farkas, C. (2007). Public Health and Mental Health: A model for Success. Perspectives in Psychiatric Care. Oct.

Global Conditions Experienced By Many Of Our Children And Their Familes

World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France.

Unfortunately, in most parts of

the world, mental health and

mental disorders are not

regarded with anything like the

same importance as physical

health, instead, they have been

largely ignored or neglected.

Global Conditions Experienced By Many Of Our Children And Their Familes

Most individuals with severe mental disorders and their families are left to cope as best they can with their private burdens such as depression, dementia, schizophrenia, and substance dependence.

Many are victimized for their illness and become the targets of stigma and discrimination.

World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France.

Examples Of Disparities In Mental Health

African Americans Less likely to seek treatment and when

they do seek treatment, they are more likely to use the emergency room for mental health care, and they are more likely than whites to receive inpatient care.

For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for African Americans. Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact1.asp

Latinos/Hispanic Americans In a national survey of high school

students, Hispanic adolescents reported more suicidal ideation and attempts than whites and blacks.

For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for Latinos/Hispanic Americans. Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact3.asp

Examples Of Disparities In Mental Health

Asian American/Pacific Islanders When they do seek care, they are

more likely to be misdiagnosed as "problem-free“.

For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for Asian American/Pacific Islanders. Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact2.asp

Examples Of Disparities In Mental Health

The Challenges We Face Integrating Mental Health And The Schools

Stigma

Lack of trust

System bias (managed care, Medicaid, etc.) and institutional racism

Navigating unfamiliar systems

Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children’s mental health services. Tampa, FL: USF, Louis de la Parte Florida

Mental Health Institute, Research & Training Center for Children’s Mental Health. Online at: http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/services/CultCompServices.pdf

Cultural Competence

Definition Of Cultural Competence

“Cultural Competence” is a set of behaviors and attitudes that come together in a person that enable him or her to work effectively in cross-cultural situations.

The word “cultural” is used because it implies an integrated pattern of human behavior that includes thoughts, language, actions, customs, beliefs, and values shared by a social group, including service providers or school personnel.

The word “competence” is used because it implies having the capacity to learn and function effectively in cross-cultural interactions.

(Cross, Bazron, Dennis, & Isaacs, 1989)

Essential Elements Of Cultural Competence

Value diversity;

Have the capacity for cultural self-assessment;

Institutionalize cultural knowledge;

Develop adaptations to diversity; and

Be conscious of the dynamics inherent when cultures interact

(Cross, Bazron, Dennis, & Isaacs, 1989)

Summary Of Cultural Competence Continuum

Cultural Destructiveness

Cultural Incapacity

Cultural Blindness

Cultural Pre-Competence

Cultural Competence

Advanced Cultural Competence

(Cross, Bazron, Dennis, & Isaacs, 1989)

Consequence Of Well-Meaning Cultural Blindness

Compatibility With Our Community Populations

Compatibility withCommunity Populations

An organization’s combined policies, structures and processes that support

compatibility

Cultural/Linguistic characteristics of a

community’s population

Compatibility

Hernandez, M., & Nesman, T. (2006)

Cultural

Competence

means developing

compatibility

Between schools and

populations

Between mental

health providers and

populations

Understanding The Racial, Ethnic And Cultural History Of Your School’s Community

Who lives in the community?

What are population characteristics such as: Cultural view of mental health

History

Language

Resources

Strengths

Needs

What are the accepted racial and ethnic stereotypes in the community?

Creating a Front Porch: Strategies for Improving Access to Mental Health Services

Responsive to both child & family Supportive family focus Simplified intake process Address stigma & adapt mental health terminology Outreach to community organizations &

providers Broad network of services and supports System navigation Flexible, individualized, culturally specific interventions

Consequences Of Untreated Mental Health Issues….

"While mental disorders may touch all Americans either directly or indirectly, all do not have equal access to treatment and services. The failure to address these inequities is being played out in human and economic terms across the nation – on our streets, in homeless shelters, public health institutions, prisons and jails.“

For our country’s children and youth, the schools are front lines for connecting to, and at times, providing formal mental health services

United States Surgeon General Press Release: Sunday, August 26, 2001 http://mentalhealth.samhsa.gov/cre/release.asp

Additional Resources

http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/porch/default.cfm

http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/services/default.cfm

http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/protocol/default.cfm

References