Eastern Beliefs and Mental Wellness: A Common Ground of Understandings AN ASIAN AMERICAN MENTAL WEALTH FORUM October 20th, 2009

Demographics Virginia is one of "ten states with the largest Asian populations in 2000 There are 309,886 APAs - 4.2%--in Virginia (2003 Census Estimates) 47% Asians holding Bachelor's degree or higher (2000 Census)

Forein Born Population 48% of foreign-born population from Asia are naturalized U.S. citizens vs 37% of foreign-born population as a whole From 1990 to 2000, the Asian population grew 72% compared to total population growth of 13%. APAs are the fastest growing racial/ethnic group in the United States, and are expected to reach 8 percent of the population by the year 2050. (Census)

Barriers Faced By Asian Pacific Americans Language barriers: 11% of Virginia residents over age of 5 speaks a primary language other than English (2000 Census) Lack of health care: 33% of foreign born APAs are not covered by health insurance compared to 13% of native-born residents (Census CPS March 2002) Poverty: the poverty rate of APA families (14 percent) is higher than that of non-Hispanic White families (8 percent)

Risks Health insurance: More APAs are lack health insurance than the total U.S. population, with Korean Americans being the most likely racial/ethnic group to be uninsured. An estimated 2 million APAs are uninsured. Cultural & linguistic barriers: APAs face tremendous cultural and linguistic barriers that impede access to health and social services. Health Risk: APAs suffer disproportionately higher rates of hepatitis B, diabetes, cancer and tuberculosis than the general population.

What Virginia Needs to do to Help APA Communities The APA community is one of the most economically productive communities in the Commonwealth. By helping APA families in need, we ensure that the APA community remains a strong contributing part of the state. Need for development of state policy and program services for APA communities Increase number of state translators to help APA constituents Conduct research on the service needs of APA communities

Cultural and linguistic barriers Percentage of APAs who do not speak English “well” (or at all) Hmong (76%) Cambodian (70%) Laotian (68%) Vietnamese (61%) Taiwanese (54%) Korean (52%) Chinese, except Taiwanese (50%) Thai (46%) Indonesian (40%) Togan (39%) Pakistani (30%) Japanese (25%) Filipino (24%) Asian Indian (24%)

Percentage of linguistically isolated APAs Hmong (60%) Cambodian (55%) Laotian (52%) Vietnamese (42%) Taiwanese (37%) Korean (35%) Chinese, except Taiwanese (34%) Thai (27%) Indonesian (26%) Pakistani (15%) Japanese (14%) Filipino (11%) Asian Indian (10%)

Conclusion Asian Americans are the 2nd fastest growing racial group in Virginia. They are also one of the most diverse, including at least 43 different ethnic groups who speak more than 100 languages and dialects. A large number of this diverse group needs linguistically appropriate care and services.

Cultural Influence Culture influences the Asian health belief system and has an effect on the diagnosis and treatment of mental disorders. Several key cultural factors that are relevant to this process are There is a great cultural variability among groups and heterogeneity within groups. These factors will have differing effects, depending on the individual's degree of acculturation, socioeconomic status, and immigration status. Most vulnerable population is the new immigrants, who comprise 1% of the US population, and are those who are more traditionally oriented. This population see patients who experience the greatest barriers to receiving mental health care.

Key Cultural Factors Language Knowledge of English is one of the most important factors influencing access to care. Asian languages and dialects usually are not widely spoken outside the individual's ethnic group and, depending on degree of acculturation, even within it. 42% of Vietnamese American, 41% of Korean American, and 40% of Chinese American households are “linguistically isolated.” This designation means that no one in the household age 14 years or older speaks English “very well.

Key Cultural Factors Level of acculturation Typically, it takes three generations for immigrants to fully adopt the lifestyle of the dominant culture. This intervals about the amount of time it takes to accept Western medical care more readily than traditional care.

Key Cultural Factors Age In general, the younger people are when they migrate, the more readily they adapt to living in a country in the West.

Key Cultural Factors Gender Historically, men have acculturated more rapidly than women. This standard may be changing, however, as women enter the work force.

Key Cultural Factors Occupational issues Especially among undocumented immigrants, professionals and highly skilled technicians often cannot regain previous careers - language or license verification issues. Some are forced to accept low level jobs - minimum wage or less. Sometimes, women earn more than men - disrupting family expectations and traditional values.

Key Cultural Factors Religious beliefs and spirituality The predominant religions of Asians who do not practice some form of Christianity or Muslim religion are: Buddhism Confucianism Taoism Animism

Key Cultural Factors Asian Philosophy & Belief Systems Values: social harmony and deference to the elders and teachers - Cultures deciding to put a certain set of priorities above others. China: Social harmony – Social stability - most distinctive characteristic of Chinese culture vs chaos and general disruption of social structure. Social harmony – vs Avoid open conflicts and disagreements Chinese culture actually chose not to go along the path taken by the Europeans. (Case of adoption of Confucian beliefs over more Taoism) India: Adoption of mystical doctrine emphasizing the role of meditation and private insights rather than publicly demonstrable methods of knowing.

Asian-American Mental Health National Latino and Asian American Study (NLAAS) -2,095 participants- Chinese, Filipino and Vietnamese- Japanese, Koreans and Asian Indians. Second generation - More likely than their immigrant parents to have emotional disorders. Asian Americans - Less likely to seek help for their emotional or mental health problems than whites Asian Americans - Have lower rates of mental illness than whites but seek treatment less often. Disparity in cultural values – religious beliefs immigration status Birthplace Age

Asian-American Mental Health Asian Americans - Born in the Unites States or who immigrated at a young age: Higher rates of mental illness. Prejudice and mental health – Social status Income level, profession and familial respect–A perceived or real sense of success. Findings: Do not perceive as important- or may expect different treatment because of their accents or limited English and unfamiliar customs. In contrast, Asian Americans who grew up in the United States - may be more attuned to suggestions that challenge their rights and identity as Americans.

Asian-American Mental Health Family matters Second generation's embrace of mainstream culture - Lead to confusion or conflict in the family Parents expectations – education level-pressure of success Cause of deep conflict between child and parent- increases risk for experiencing mental health problems. Conflict – leads to violence. Unpublished research: Over 30 percent of Asian-American parents reported minor parent-to-child assault, and 2 percent reported major assault. Families with issues over personal goals – success idea- family unity – personal priorities – Most likely to report severe abuse

Asian-American Mental Health APAs have lower rates of child abuse than other ethnic groups Abuse goes largely undetected APAs reluctant to talk about personal issues – denial of family problems exist. Parents from Asian cultures – View the use of physical discipline as part of being an involved and concerned parent -way to teach children concept of duty. The children themselves may not even perceive it as abuse-Still show increased stress levels.

Asian-American Mental Health Cultural stress Cultural adjustment and changes in gender roles - Domestic or interpersonal violence- taboo to discuss - private family issue. Cultural clash - Root of domestic violence cases among recent immigrants, Traditional risk factors: Alcohol use, poverty, cultural conflicts, family or couple goals – Increase the risk for intimate partner violence. Work and career- upsetting traditional gender roles. Struggles over household duties Friends and family – Urge women to keep quiet. Language - may also keep a woman silent –there may literally be no one to talk to.

APAs Getting Help Getting help Barriers: Language, culture and little access to care – Barriers to access to get help for mental illness. APAs as a group are unlikely to seek help for mental illness from any source When they do they report low levels of satisfaction. When Asian Americans seek help from a mental health professional rather than a medical provider, the rates of satisfaction go up.

How to Help the APA Mental Health Patients? How can the psychological community reach out to this group? Education Immigrants aren't aware of resources. Working with medical providers – Crucial as its the first or only professional seen by most immigrants Interpretation services should be used whenever possible.

How to Help the APA Mental Health Patients? Providers – Many immigrants have no concept of what a psychologist is - or what they do. Health professionals need to educate themselves about a patient's culture and how that might affect symptoms or treatment. Since many Asian Americans don't seek medical help, the public health and psychological communities need to be creative.

Question for Mental Health Care Providers How do people from different racial and ethnic groups find a "place" or a sense of belonging in their neighborhoods, schools or workplaces? HOW CAN WE HELP THEM FIT IN?

Thank you My Lan Tran Foundation Administrator Virginia Asian Foundation Email: aabac@aabac.org Tel: 804-798-3975 www.va-asianfoundation.org