Creating a New Dialogue Anaheim, CA September 30, 2010 Leticia Villarreal Sosa, Dominican University Rebeca Davila, St. Augustine College
Introductions Current Paradigm of Care Latinos and Mental Health La Familia/Social Justice/Cultural Competency Complementary and Alternative Medicine (CAM) CAM and Latinos Where do we go from here? Open for Questions and Dialogue
Increase in Use of Psychiatric Medications and a Decrease in use of Psychotherapy from 1987 1997 (Olfson et al., 2002) Children on Medicaid are FOUR times more likely to receive an anti-psychotic (Rutgers, Columbia study) Increase in adults using multiple psychiatric medications (Mojtabai, 2010) Shorter life expectancy of those with severe and persistent mental illness (Piatt, 2010).
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise Mental Illness in America (2010) Why, if psychiatric drug treatments are so efficacious, has the number of people on disability for mental illness more than tripled in the last 25 years? Is it possible that psychiatric drugs are actually making people much worse? Could it be that far from fixing broken brains the drugs being offered actually are worsening, and even causing, the very illnesses they claim to heal?
At the start of the psychopharmacological revolution when it became popular to blame all illness on imbalanced brain chemistry the percentage of bipolar patients who could return to work was 85 percent. Now it is less than thirty percent. In 1987 there were less than 20,000 severely mentally disabled children, now there are almost 600,000. That is a 30 fold increase. Part of that is due to the diagnosis of autism, while more is due to the even newer diagnosis of bipolar disorder in children which has increased 40 fold in the last 10 years!
Focus of literature on access to mental health & disparities in access. Access to which services? Do we really want access those services? Current paradigm of care may be worsening outcomes Process of medication & multiple side effects Case Examples
Medication for social conditions Increased use of drug cocktails Disempowering Model with a focus on a broken brain Increase use of medication only as An intervention Illness viewed as a life long condition
Source: Current Population Survey, March 2000, PGP-4
Latinos are a multi-racial, multi-ethnic, population self identifying roots in over 26 different countries in the Caribbean, Latin America, and Spain. U.S. foreign and immigration policies continue to play an integral role in shaping the patterns of immigration from these regions which directly affect the composition of the Latino population.
Latino married-couple families with minor children have had a poverty rate that has remained substantially higher than any other racial/ethnic group: 4.5 times (16.2% vs. 3.6%) than their non- Hispanic white counterparts, almost twice as high as their African American (8.7%) equivalents.
Very difficult social conditions (violence and trauma in urban communities, immigration and anti-immigrant rhetoric, etc.) Demographic changes increases in areas that traditionally did not have Latino populations. Racism and discrimination related to higher rates of depression. (Acculturation) Currently Latinos have one of the highest rates of being uninsured access continues to be an issue.
An evolving meta-framework that proposes 16 different core components that embody macro/micro level intervention with Latinos Practice perspective/philosophy that upholds the values of diversity, collectivism, interdependence, and empowerment
Culture Language Family Respect Health Immigration Legal Status Education Achievements Customs Personalismo Complementary Healing Community Religion/Spirituality Social Justice Empowerment Economics LSWO Copyright 2004 (www.lswo.org) 312-491-8248
La Familia Perspective Framework Strengths Perspective Ecological Perspective Empowerment Perspective Latina Feminist Perspective Micro Level Mid Level Macro Level LSWO Copyright 2004 (www.lswo.org) 312-491-8248
Nonwhite groups tend to delay seeking treatment until symptoms are very severe Informal support systems and primary care doctors are the first ones they turn to for help. Mistrust of health care providers. Differences in perceived need Higher rate of reporting emotional distress compared to any other group with the exception of Native Americans (Bledsoe, 2008) So emphasis on access, but little discussion about access to what?
Focus on empowerment, community based alternatives Access to CAM Respect for community resources already used Community based, collaborative research Models of peer support Community action
A group of diverse medical and healthcare systems, practices and products that are not generally considered to be part of conventional medicine. (NCCAM, NIH, 2007)
Awareness of CAM is necessary- as viable option 38 percent of adults in US use CAM (NCCAM, NIH, 2007) $33.9 Billion out of pocket spending in 2007 (HHS)
CAM includes (Social Work Today, 2009) Acupuncture Meditation Herbal medicine and Massage
CAM practitioners view health as establishing a balance within the body to achieve optimum well being of the physical body, mind and spirit. Complementary therapy refers to supportive methods used in combination with conventional medicine (National Cancer Institute, 2001)
Most Common Uses Anxiety/Fear Depression Tension Stress Insomnia Pain Management (Ernst & Kanji, 2000; Mitzdorf et al, 1999)
1) Dissatisfaction with western healthcare system 2) Alternative options for illnesses that cannot be cured by western medicine 3)Perception of CAM effectiveness 4) Practitioner-Patient relationship 5) Immigration trends, cultural influences
Latinos use a pluralistic health care network (Gomez-Beloz & Chavez, 2001) Network includes: the patient, family, conventional and complementary medicine Complementary medicine includes: a local spiritualist/curandero, herbs, masseuse/sobador (Alferi, Antoni, Ironson, Kilbourn & Carver,2001)
In El Paso, TX (border city), 77% percent of Latinos use complementary medicine (Rivera, Ortiz,Lawson & Verma, 2002) In study of an urban neighborhood of Chicago, 67% of the participants used conventional medicine in combination with the natural medicine they used from the botanica (Gomez-Beloz & Chavez,2001)
In Latino culture(s) family is the essential unit of society and the basic hierarchical structure Medical information is passed down from older females to younger females The women decide when an illness is beyond their ability to treat and requires outside help (Gonzalez-Swafford & Gutierrez, 1983).
A study by Gomez-Beloz & Chavez (2001) showed that Botanicas or hierberias (natural medicine stores) serve as a viable and culturally appropriate health care option.
Order of help seeking: Informal level of family and friends Folk healer Conventional medicine The decision is often based on cost and perceived efficacy by family and friends. (Napolitano, 2001, p. 204).