Mental Health Disparities for the American Red Indians and the Pakistani Indians - Term Paper Example

Mental Health Disparities for the American Red Indians and the Pakistani Indians American Indians As the original in habitants of the lands that became the United States, mental health disparities for American Indian and Alaska Native populations are deeply rooted in the history of the country’s development. This history has resulted into dynamic and complex social, political, economic and cultural contexts that affect the mental health of this population. This paper begins with an over-view of mental health disparities in American Indian and Alaska natives with concentration on sociopolitical contexts, diversity of this population, and the current state of their health status and treatment. Attention is then focused on-patient provider interactions and the impact of the larger ecology in which these interactions are nested. An exploration of future challenges and directions for mental health services for American Indians and Alaska natives, with emphasis on the role of traditional treatments, the promise of the chronology and issues raised by evidence bases practices (Strong,2012). Mental Health of American Indians: History and Context Health disparities for minority populations are defined by sociopolitical contexts. American Indians are among American minorities in their historical and current relationship with the U.S. government. As a matter of fact, from their first contact, European settlers’ interactions with the native groups were characterized by conquest, seizure of resources, compulsory relocation, and systemic campaigns of genocide. The new government however continued these practices by developing policies of resettlement, attempted assimilation, and forced reservation relocation. By the 20th century, most American Indians tribes had been exterminated, dispersed, or driven onto federally created reservations.AS if not enough, on the reservations, the tribes continued to face threats to their identity from explicit government policies, for example, when federal laws banned traditional religious practices practices, the latter half of the 20th century for many American Indian native communities brought self determination, self governance, community and cultural rights, and greater awareness of the challenges facing American Indian communities. Disparities in mental health for American Indians are inherently tied to the history and current sociopolitical landscapes experienced by this population. There are more than are currently 562 federally recognized tribes representing a diverse array of distinct cultural groups and a wide range of accumulation. There are more than 200 different languages with more than a quarter million f the 4 million Americans (1.5% of the U.S. population) identifying themselves as having American Indian heritage who speak a native language at home. Through the 1980s,most American Indians lived on reservations or trust lands, but today only 20% live ,with greater than 50% of this population residing urban and suburban areas. The American and Indian communities have a unique relationship with the U.S. government as sovereign entities that retain all aspects of self government. Through treaty obligations the U.S. government is required to provide health care services, including mental health, to federally recognize to federally recognized tribes, which the Indian Health Service oversees. American Indian mental health disparities cannot be understood without understanding the health care resource gap that exists for this population. The definitive work on American Indian native health disparities appeases in the surgeon general’s report on mental health’s supplement on culture, race, and ethnicity published on 2001(5).It provides a detailed overview of historical contexts, currents status, mental health care needs, service utilization, service outcomes, prevention, and mental; healthcare needs, service utilization, service outcomes, prevention, and mental promotional for this population. Significant comorbility exists n this population between mental health and substance use disorders. These are unlikely to be dealt with in conventional treatment settings. The violability of culturally appropriate treatment, accessibly services and accompanying medical care is critical in the provision of effective services for the population. Significant comorbidity exists in this population between mental health and substance use disorders. The availability of culturally appropriate treatment, accessible services, and accompanying medical care is critical in the provision of effective service for this population. A better understanding of the financial and organization of mental health service for American Indians is needed to characterize the rapidly changing service delivery environment. South-East Asia is the most heavily populated and amongst the poorest regions in the world. It faces enormous social, economic and health challenges, including pervasive inequality, violence, political instability and hi9gh burden of disease (Strong, 2012). Women’s rights have been addressed in this region, activities have tended to focus on issues associated with reproduction, such as family planning and child bearing, while women’s mental health has been relatively been neglected. Women’s healths have been addressed in this region by activities tending to focus on issues associated with reproduction. In south East Asia, most of the societies are predominantly patriarchal. The customary thought of the people is that boys are born to earn and support the whole family. This thought is reflected through certain discriminative behavior of the people. The birth of a baby boy is celebrated with fervor even if from very poor families. On them other hand the birth of a baby girl is not celebrated. Sex selection in India during pregnancy in India is still very rampant, where women are forced to abort a female female fetus. The reason for it is that sacrificing a daughter guarantees a son in the next pregnancy. In Pakistan although such extreme behaviors are not practiced, couples are often forced to keep on taking chances for the birth of a baby boy, which in many case results in the birth of six or seven girls. In this region, some ancient traditional and customs are still being followed therefore promoting various forms of violence against women. These include honor killings, exchange marriages, marriage to Quran, Karo-kari, pride price , dowry, female circumcision, questioning women’s ability to testify, confinement to home, denying their right to choose a partner (Ross,2014). A meta-analysis of epidemiological studies of in different regions in India revealed overall prevalence rate of mental disorders in women of 64.8 per 1000.Women had significantly higher rates for neuroses, affective disorders and organic psychoses than men. A survey carried out in Nepal demonstrated that women had a higher psychiatric morbidity than men, with sex ratio of 2.8:1 in the health post, and 1.1:1 in the district hospital. If the woman abandons her marriage, she has to face innumerable challenges, like non acceptance from society, financial acceptance and emotional of children growing up without a father. The tendency of women to internalize pain and stress ,and their lower status with lower power over their environment, render them more vulnerable to depression when under stress. South Asians are very diverse population including sri lankas, Bangladeshis, Pakistanis, and Asian Indians. There are over three hundred languages spoken throughout the South Asian countries. However, in the U.S. South Asians speak primarily banglal,Burmese,gujarati,hindi,nepali,Punjabi,Sinhalese,tamil,and urdu. They are equally diverse in their religious practices, with followers of Buddhism, Hinduism, Islam, Jainism, sikhinism, Zoroastrianism, and Christians being the most common. Records show that in 70% to 95% of the families across the four major south Asian groups, English is not typically spoken at home. That from 1990n to 2000, South Asian sub groups had the largest growth rates compared to other ethnic groups. Cultural Views of Mental Illness The distinction of mind and body is not as sharply demarcated in South Asia culture as it is in U.S. mainstream culture. The mind and body balance for South Asians is holistic and fluid, such that an imbalance in the body is principally an imbalance in the mind. The concept of mind-body is reflected in the Indian model of Ayurveda, the traditional Indian system of medicine based on humarol theories. South Asians have a unique model for specific disorders like depression as social problems or emotional reactions to external circumstances, rather than external problems requiring professional treatment (Karask, 2005).Ayurveda has a unique classification of mental disorders. In addition to herbal and chemical treatments, Ayurveda also elaborates psychotherapeutic prescriptions for mental imbalances(Dube,1979).The main therapies include; suggestion, hypnotism, assurance, persuasion, ritualistic therapy, transferring of symptoms, confession ,penance and sacrifice, use of natural elements, medicine, endocrine therapies, tantric and yogic practices (Ross,2014). The Provider-Patient Relationship and Clinical Disparities Although, the majority of American Indians reside in urban areas, much of the work to date has focused on reservations or community residents, contributing to an important gap in knowledge about mental health disparities for urban native populations. The cultural formulation for DSM-1V is hereafter referenced as the cultural formulation widely used I psychiatry. It encourages one to consider the cultural identity of the patient, the patient’s cultural explanation of distress, cultural factors related to the psychosocial environment, and cultural factors in the treatment relationship, synthesizing these elements together in an overall cultural assessment for diagnosis and care. The background, past experiences, and cultural identities of both the patient and the provider set the stage for the clinical interactions, determining idioms of distress and cultural context that influence the treatment process. American Indians present an enormous array of cultural beliefs about healing, health, and illness. These beliefs affect a patient’s expression, manifestation of, and communication about their distress. In addition to the diversity of cultural idioms of illness, one’s degree of “acculturation” needs to be considered with respect to each patients and the extent to which each patient adheres to traditional tribal concepts of mental health and illness. This is complicated further by the cultural systems that patients are ready to identify with, which includes traditional beliefs, western culture, and regional cultural and urban verses rural cultural perspective. The interplay of this cultural beliefs coming with a unique cultural background determines a patient’s expression and communication of distress. Many American Indians have a strong narrative tradition. American Indian elderly patients with a traditional identity often have a narrative style of expressing themselves. This can lead to frustration from patients as well as the provider when the latter attempts to use a symptom checklist or follows a highly structured interview. Impact of Cultural Values on the Use of Mental Health Services Many South Asian cultures stress social duty over individual rights, and that talking about personal or intimate problems with someone is considered a cultural taboo (Randhawa &Stein, 2007; Das & Kemp, 1997).This is a source of conflict when a South Asian individual comes into contact with westernized practices such as psychotherapy which places emphasis on the self. This focus therefore may deter them or hinder them from seeking mental health treatment (Das & Kemp, 1997). References Strong, P. T. (2012). American indians and the American imaginary: Cultural representation across the centuries. Boulder: Paradigm Publishers Thomas, R. M. (2007). Manitou and God: North-American Indian religions and Christian culture. Westport, Conn: Praeger Ross, J. I. (2014). American Indians at risk Read More