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Thinking about Mental Health Policies: Vulnerable Population II

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Hor Yan Lai

on 12 April 2011

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Transcript of Thinking about Mental Health Policies: Vulnerable Population II

Thinking about MH Policy: How can we improve quality of MH services for vulnerable populations Disaster Victims Facts: Gender disparity
in MH problems Why vulnerable? Discussion:
To what extent do you think t women have a higher risk of to developing MH problems than men? For girls/ women...

Childhood: anxiety
Puberty: Depression & Eating Disorders
Adulthood: Depression (anxiety --> depression) Challenges e.g. Elderly women Postpartum and pregnancy Inadequate training?
Fragmentation of services? Women Elderly Facts: Growing Concern? In 2009, 39.6 millions people over 65, 12% of total population Fragmentation of services Vertical : Fragmentation of services across different health care systems Horizontal: Continuity of services and access to MH services, underlying factors? Elderly with MH problems: Impact on family members/ partners? Ethnic
Minorities Defining ethnic minority: African Americans and Hispanics in the U.S. are at higher risk of ...

developing lifetime disorder (Robins & Reier, 1991).

being infected with HIV (CDC, 2011). Barriers to MH services ? Beliefs about mental illness... ...

Symptom may be different : symptoms of depression among Asians (Kelinman, 1988).

MH disorder is a sign of weakness. Service Providers ... ...

Underrepresentation of service providers who belong to ethnic minority groups.

Class difference.

Cultural competency. Existence of alternative resources LGBTQIA History of social stigma
Homosexuality as a mental illness? APA declassified Homosexuality as a mental illness in 70s.
Religious Beliefs: against the course of nature?
Misconceptions: association between AIDS and homosexuality. Why vulnerable? Family Support (Young Adults)
Rejection: attempted suicide, depression, substance abuse.
Acceptance: self esteem, positive MH outcomes.
(Ryan et al., 2009, 2010) School and peers acceptance (Youth)

Correlation between openness and victimization (D'Augelli, 2001).

Lack of positive role models/ School avoiding the issue (Harris, 1997).

Internalization and self-blame. Facts:

More likely to have emotional problems or mental disorders.

More frequent service use (may not be for MH needs ).

(Cochran et al., 2003) 2. Training of service providers?
Homogenity of needs.
Negative Stereotypes. 1. Stigmatization as barriers to MH care . 3. Lack of evidence based interventions for this population. What about populations with the issue of "Double Jepordary"? Barriers to MH services? e.g. Postpartum Depression Barriers to MH appropiate services: Why vulnerable?
Acculturation
(particularly for new immigrants) Prejudice and Discrimination Studies on refugees in the U.S. :

Intergration (teens) : higher self worth and positive adjustments (Kovacev et al. 2004 ; Birman, 2002) .

Barriers to integration (adults) : language , education level, occupation (Colic-Peisker et al., 2003).
Consider... ...

Interdisciplinary models?
Training for services providers?
Evidence-based practice?
Understanding the structure of health system? Homeless
Persons
Why vulnerable? Chronic medical disease Frailty and Aging cognitive impairment, deteriorating health, decreasing psychological reserve, loss of love ones (bereavement). At risk for mental disorders: e.g. Alzheimer's disease and depression Various perspectives:
Biological
Evolutionary
Socio-economic Facts:

Represented by various group of people

Characteristics : Poor physical health; mental health disorders.

approximately 25% have serious Mental illness. Why Vulnerable?

Family;
Social;
Economic;
Individual. Barriers to MH services Ways to improve quality of MH services: Prevalance of MH problems : Acculturation (Berry, 1994) :

Maintaining own culture
Having contact with host culture
Integration Story of a father...

What about family members of LGBTQIA? Do they need MH services?
Some ideas to share before talking
about improving quality of services... When thinking about MH services, think from a ecological perspective. A group of people within a state :

which is numerically smaller than the rest of population.

which is not in a dominant position.

which has culture, language, religion, race etc. distinct from that of the rest of the population.

whose members are citizens of the state where they have the status of a minority.

(Smihula, 2009) Thinking about MH... Barriers to MH services? Thinking about MH policy... Idea of having double disadvantage to MH (Dowd & Bengston, 1978) Need for special services decreasing cognitive capacity, medical comorbidity, physical frality (Borson et al., 2001 ) Elderly with severe mental illness need for long term MH and general health services. (Borson, et al. 2001) Lack for research in the area e.g. different treatment plan for older people and adults with depression (Reynolds et al, 2006). Thinking about MH policy:

What are the consequences of maternal depression on children's outcomes? (Dickey, 2000; North, 1993) Discussion: No medicaid or Medicare? lack of preceived need.
service providers competency.
MH not on priority list. (Cochran et al., 2003)
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