Mental Health: the hidden face of the model minority Howard Liu, M.D. Resident Psychiatrist University of Michigan January 2007

Why should you listen to this talk? Mental illness is common APA community has specific needs You will be in a position to help

What does it mean to be a model minority?

SAT scores?

Precocious musical skills?

Dr David Ho - Times Man of the Year 1996 Medical breakthroughs?

Model minority myth Highlights the superlatives Propagated not just by media, but by APA community itself Narrow definition

Headlines which did not make the cut …

Published May 8, 2001

BBC News April 2, 2004

BBC News November 22, 2004

Overview Mental Health needs Barriers to care Solutions

I. Mental illness is not exotic National Latino and Asian American Study (Takeuchi)  2095 Asian Americans nationwide  Overall lifetime rate of any disorder = 17.3%  12 month rate = 9.19%  Men – poor English proficiency had higher rates  Women – native born had higher rates than immigrants of most disorders Source: Takeuchi, DT et al. Immigration-related factors and mental disorders among asian americans. Am J Public Health; Jan 2007; 97, 1.

Depression CAPES Study –  1700 Chinese Americans LA  6.9% lifetime prevalence dep.  16.9% in national sample adults Source: Mental Health: Culture, Race, and Ethnicity US Dept Health Human Services 2001.

Suicide Lester 1994: suicide rates per 100,000  Caucasian 12.8  Asian Americans overall 7.0  Japanese American 9.1  Chinese American 8.3  Filipino American DHHS - APA women > 65 have highest suicide mortality rate of all groups Young women from southern India? Source: Mental Health: Culture, Race, and Ethnicity US Dept Health Human Services 2001.

Suicides in young people in rural southern India Worldwide suicide rate in 2000: 14.5 per 100,000 Vellore India– population 108,000  10 year mortality rates for age group10-19  Female suicides: 152 per 100,000  Male suicides: 69 per 100,000 Source: Aaron et al. Suicides in young people in rural southern India. Lancet :

PTSD Southeast Asia  Cambodia Khmer Rouge  > 1.5 million deaths   Vietnam War  US soldiers: > 58,000 killed  ~5 million dead – all sides  50% population homeless  1/5 farmland & forests devastated Source: Beiser, Psychological Medicine, 2004

PTSD in SE Asian Refugees Blair 2000 – Cambodian American community sample N = 124  45% PTSD Kroll et al. 1989: 404 SE Asian refugees initial psych eval  73% major depression  14% PTSD  6% anxiety & somatoform disorder

December 26, 2004 Tsunami 150,000

New PTSD generation? Indonesia Thailand Sri Lanka Maldives India

Intimate Partner Violence China – 13% of new moms had experienced IPV Boston Chinese Am. Women  181 women survey  42% knew an abused Chinese woman  14% had experienced IPV themselves  Conflicts with relatives, alcohol Source: Hicks, Madelyn Hsiao-Rei. Prevalence and characteristics of intimate partner violence in a community study of Chinese American women. J Interpersonal Violence Vol 21 No 10, October 2006,

IPV: South Asian Women How common?  2 in 5 ever had sexual/physical IPV  208 Boston S.A. women (91% immigrant)  21% reported IPV in current relationship Victims at higher risk of:  Poor physical health  Depression & suicidal ideation  Anxiety Source: Himelfarb Hurwitz, EJ et al. Intimate partner violence associated with poor health outcomes in US South Asian Women. J of Immigrant & Minority Health, Vol. 8, No. 3, July 2006.

II. Underutilization Underrepresented in mental health clinics  Seattle 1977 – 1 st documented  LA County 1991 – similar results Treatment delay? Controversial  1982 study longer treatment delay than African Americans & Caucasians  2000 study by Okazaki in LA – average delay months

III. Barriers to Care Language Lack of culturally competent practitioners Stigma

A. Language Barriers 61.9% of APA are foreign born APA population speaks over 100 languages and dialects Linguistically isolated households  Definition  Breakdown: 35% Asian Americans  61% Hmong, 56% Cambodian, 52% Laotian, 44% Vietnamese, 41% Korean, 40% Chinese

B. Culturally competent practitioners 1998 study: 70 APA mental health providers available per 100,000 Asian Americans in US (1/2 ratio caucasians) Utilization rates increased in outpatient centers tailored to Asian Americans

C. Stigma Stigma against mental illness in APA community  Leads to lower utilization  May delay treatment

IV. Solutions Language – CLAS guidelines  1964 Civil Rights Act Title VI  CLAS standards 2000  Free  Written & verbal rights  No minors Stigma – Education More culturally competent mental health practitioners

V. What you can do Remain culturally sensitive  Attitude  Knowledge  Skill Advocate in your family and your community  Use the model minority  Educate others  Refer

In conclusion Confucius says:  “I hear and I forget  I see and I believe  I do and I understand”