Bostons Haitians Population in Regards to Mental Health - Assignment Example

A Survey of the healthcare experiences of the Boston’s Haitians population in regards to Mental Health due to their cultural beliefs. Date Background History and Location Boston is the capital city of the commonwealth of Massachusetts. It is the largest city in the commonwealth and is the seat of Suffolk County, too. Boston covers an area of 124 square kilometers (about 48 square miles). An estimated 645,966 people lived in Boston in 2014; the greater Boston area, however, has a population of 4.5 million people (Singh & Bajpai, 2008). Boston is ranked the 24th biggest city in the United States of America (Jacobson, 2007). The Puritan settlers who came from England began the city of Boston in 1630 on the peninsula of Shawmut (Jacobson, 2007). The beginning of Boston included events such as the Boston massacre, Boston Tea Party, Boston Siege, and the Battle of Bunker Hill. After the establishment, Boston attracted many settlers from without because it became an interregional center for education, medicine, socialization, and business (Chowdhury, 2012). The city was a regional leader in innovation and economic development. The changes that occurred in Boston made the population grow very fast with the influx of immigrants and investors. The groups that migrated to Boston included Germans, Syrians, French, Canadians, and Haitians, among others. This migration made a blend of many ethnic communities, which changed the operations and interactions of the city drastically (Byrne & Deane, 2011). Demographics of Boston Boston has a population of 645,966 people, about 10% of Massachusetts’ population, which is 6,708,874 (Love & Sajatovic, 2011). Over half of Boston’s population is made up of Caucasian people, a quarter African-Americans, Hispanic Latinos 17.5, and 8.9% Asians, and American Indians 0.4 (McCuskee, 2012). This makes Boston a blend of many cultures with variations in belief systems and values. The Boston Haitians The Boston Haitians started to migrate to Boston in the 20thcentury. They were fleeing the dictatorship of Francois Duvalier (commonly known as Papa Doc). Today, the population of Haitians in Boston is only third in United States after Florida and New York (Johnson, 2015). In 2005, for example, there were 40,000 Haitians in Massachusetts. The paper illustrates how Haitians are treated in the medical sector in Boston. The focus is specifically on mental health with a specific focus on the contributions of cultural beliefs. This study will be done among the Boston Haitians with the involvement of professionals in medicine, sociology, and history. Reason for Survey This survey explains the approaches to the treatment of the Haitians by the healthcare providers in Boston. The research aims at finding the disadvantages that Haitians’ cultural beliefs about mental health bring towards their own medication in Boston. Implications of Study Development The data collected and final implementation of recommendations would help improve the health sector in-service provision. International rights organizations could also use the data results of this research to mobilize governments towards respecting the rights of mental health patients. The data collected might also be used in averting the negative experiences of the mental health patients amidst their own relatives and friends. Literature Review Introduction Haitians, due to past experiences in their own country like the 2010 earthquake, have been forced into the United States as refugees (Byrne & Deane, 2011). However, the disparity in the language and other cultural misunderstandings has complicated their access to the vital necessity of healthcare (Singh & Bajpai, 2008). This paper, therefore, will look into how the cultural beliefs of Haitians affect their ability to access mental healthcare. Review of Theoretical Literature According to McCuskee (2012), access to healthcare has three distinct but sequential stages, namely: access to healthcare, willingness to go for the treatment, and ability of the patient to communicate with the service provider. Unfortunately, the differences in the healthcare system in Haiti, or the complete unavailability of it, make it hard for the Boston immigrants to adopt the new healthcare system without struggle. Almost 100% of the Haitians speak Haitian Creole, with about 8-10% speaking broken French (Jackobson, 2007). This makes it hard for them to interact in the United States. Unfortunately, Jacobson (2007) reiterates that due to the inability to understand French, a good number of them underperform due to linguistic mismatch, leading to them being misdiagnosed as having mental disabilities simply because they are tested in languages they do not understand (Chauncey, 2006). To bridge the cultural and language gap in healthcare and still ensure that competent mental healthcare is given to the patient, the government and supportive bodies embarked on the following: ensuring patient /provider communication is improved; ensuring a shared decision-making; ensuring respect for the patients; experience leading to trust or distrust, experience of discrimination; and language competency (Ngo-Metzger et al., 2006). A serious difference exists in the understanding of disability among the West compared to the African Americans of Haitian origin (Myrne & Deane, 2011). Unfortunately, things that are considered treatable or manageable in the West, like emotional stress or learning disabilities, are treated as a curse (Kirmayer, Guzder & Rousseau, 2014). Children with these mental health issues are branded as failures in life, and other parents might be against their children being in the company of such a child (Byrne & Deane, 2011). Many Haitian families in the Boston area participate in a program called the Haitian Family Support Program, which is sponsored by the Massachusetts Department of Mental Retardation. The philosophy is that the family is best suited to know how to meet the needs of a child’s disabilities and most qualified to look for and determine how to use such resources (Jacobson, 2007). Haitians normally believe that illness is supernaturally induced and a strain in one’s relationship with God can result in the body being weak or sick (Chowdhury, 2012). They believe the illness can arrive from: i) strained relationship with God; ii) curses or evil spells; and iii) the powerful spirit of Voodoo religion (Stokes, 2012). It is not surprising that most Haitians manage health symptoms by consulting family members and spiritual healers and only use mainstream healthcare as a last resort (DeSilva, Nicolas, Grey, & Gonzalez-Eastep, 2006). The 2010 earthquake had a major impact on the Haitian people, especially since it is a country that was already suffering from of high level of rural and urban poverty, unstable governance structure, crime and frequent sporadic violence outbreaks, and high-levelenvironmental degradation (Raviola, Eustache, Oswald,&Belkin, 2012). Therefore, Haiti in 2010 needed a safe, effective, and culturally sound mental healthcare system even though the country was in a sorry state, ravaged with social changes, poverty, and serious human losses. Partners in Health (PIH) and ZamniLasante (ZL) were called upon to bring a solution to the developing mental health care crisis. According to Raviola, Eustache, Oswald,&Belkin(2012), the groups that had higher chances of developing a mental problem were the physically injured, the internally displaced persons, children in need of protection, and gender-based violence victims. This vulnerability level was higher among the people with pre-existing mental disorders or prior history of trauma. The challenge of the fight to stabilize the mental health condition was on two fronts: handling the emergency after the earthquake and building sustainable capacity to handle the menace in the future. At the time of formation of the ZL/PIH partnership, the key areas to focus on were: i) finding support and treatment for the patient with basic psychosocial needs and patients with acute mental health conditions; ii) building capacity for the overall mental issues to handle preventive and clinical issues in ZL sites; and iii) supporting the Haitian ministry to develop long term mental health solutions through a proper national health plan (Raviola, Eustache, Oswald, & Belkin, 2012). According to the World Health Organization, WHO (2011), the United National International Children Education Fund, UNICEF, and IOM have the measures necessary to reinforce the proposed national plans especially for mental health and psychosocial support in a three-month work plan. The above named bodies plus others like ZL/PIH are focused towards achieving: i) provision of mental healthcare access at second healthcare and primary health care level; ii) training non health workers to become skilled in basic mental health; and iii) increasing the number of mental healthcare staff across the country (Raviola et al., 2012). Therefore according to Raviola et al., (2015), the 2010 earthquake Haiti experienced illustrated insufficient preexisting modern biomedical mental health facilities, integration of mental health as an important part of the health care system, exposed the old school traditional system initially used to address mental health and disorders traditionally, and finally the need to be more innovative especially in the line care delivery model. Critical Literature Though the impact of the 2010 earthquake was huge, it is quite easy to find the failure loopholes to be of Haiti’s own making. This is because according to Chowdhury (2012), Raviola et al. (2015), and Jacobson (2007) the Haitians had no stable government, no proper mental healthcare in place, and a lack of proper education and language barriers complicated everything. Their traditional beliefs regarding disorders and lack of enough qualified experts to handle the emergency situations took the rehabilitation and emergency plans further back. Therefore, the Haitians lack of understanding, personal values, judgmental attitudes, cultural blindness, cultural imposition, cultural imperialism, and racism has affected the immigrants’ access to proper health care facilities in Boston and other states (Jacobson, 2007). This is because communication and understanding is a major factor in seeking healthcare and the stopgap methods like use of translators have not been fully successful. However, the future is promising as healthcare experts understand the disparities and find measures to eliminate such disparities. According to Nicolas et al., (2007), clinicians and healthcare providers have to take culture into consideration to enable them to deliver competent services to the Haitians and achieve successful interventions, reduced dropout rates from treatment, and to reduce the health service disparity in United States. Survey methodology has been used in research for quite some time; early researchers used to collect data from each element in the research space population. Thus, adequate representation of the population is realized. Singh & Bajpai (2008) believe sampling methods were developed later in the 18th century and started its application in the 20th century. After the Second World War, the survey research method was used to ascertain the unemployment level by a stastician named Morris Hansen (Stokes, 2012). People’s attitudes and opinions about the war were also researched using the survey methodology by the federal government. Survey methodology is commonly used to describe a situation that seeks answers or explanations. The main results of a survey-based study are the appropriate ways of addressing the mental health issues among the Boston Haitians. There are descriptive and comparative survey methods: the results of each of the types must be reliable, valid and also replicable (Grove, 2009). One major objective of the survey is to determine the prevailing practices in mental health treatment. Survey ought to take into consideration the cultural practices and beliefs of the respondents; the culture of the researcher must be appropriate to ensure that there is no clash with the belief system of the society. As stated by Johnson (2015), a researcher should be able to communicate in an acceptable way with the audience of his or her research. Traditions, language, and beliefs of the respondents must be reflected. In health survey, cultural competency improves awareness creation and the development of knowledge and skills of communication. A word may mean differently in different tribes and sub tribes: the right words must thus be used in the survey. Medical studies about psychiatry and other diseases are sensitive in nature and need more understanding of the specific cultures before they are done (Stokes, 2012).Survey Development This survey will be done with a focus on the health experiences that Haitians go through because of their cultural beliefs. The content will include real life experiences from respondents who have had challenging feelings because of cultural backgrounds. This research will also administer questionnaires among the Haitians in Boston to get the first hand information about this topic. The findings will include the origin of the negative beliefs about mental health and how the same belief has been passed on without being eroded with the contemporary education system. The efforts that the government in Boston has put in averting the beliefs and negative practices will be a factor of great concern too in this survey. One example entails the organization of public seminars to educate people of effective approaches of dealing with mental illnesses. The format of the research is less tedious and effective, so as to appropriately achieve desired outcome. The questionnaires are to be short so that the respondent does not lose focus. The survey will involve one-on-one interviews, and also phone interviews for the respondents who in far places that cannot be easily accessed by the researchers. The interviews will be restricted to Haiti community residing in Boston. The people to be involved in the interviews will include Haitians from diverse backgrounds. The survey will be done in Massachusetts areas where Haitians live in, specifically in the Boston area. Questionnaires will be administered in these areas: the survey sample for questionnaire administration will be selected in a non-probability random manner to ensure equal chances of involvement. Random sampling will be applied in selecting the professional sample space by using the database to call them up. The survey will alleviate the temptation of being biased in any manner by reflecting only the information given by the respondents. Interview notes will be taken alongside tape recording of the exchanges to ensure adequate recording of information. Written consent is received from the respondents, as part of the research ethics. Survey questionnaire for the healthcare experiences of Boston’s Haitian population in regards to Mental Health due to their cultural beliefs Thank you for taking the time to participate in this survey. The purpose of this survey is to gather information regarding any experiences that you have had in either using or trying to use mental health and/or social services in the Boston area. We are especially interested the ways in which your cultural and/or religious beliefs influenced your decision to seek outside help from a mental health professional. This should take about 10 minutes to complete. Thank you for agreeing to participate!Instructions: 1. Please do not indicate your name on this form. The responses given here are anonymous and will only be used for this survey. 2. We do not expect you to have any adverse reactions to these questions. 3. There is no compensation for your participation. 4. Please answer the following questions as honestly as you can. Opinions are very important to future policy making in our community. Kindly answer all the questions you are able to. Demographic information Please tell us a little about yourself (Please check one). What is your age? 18-24 years old  25-34 years old 35-44 years old 45-54 years old 55-64 years old  Prefer not to answerWhat is your gender? Male Female Other (please specify) __________ Prefer not answer What is your marital status?  Single  Married  Divorced or separated  Living with another  Widowed In what city do you live (do not include street address)? _____________ How long have you been living there? Less than a year 2-5 years 6-10 years  11-15 years  More than 16 years How many people live in your home? _____ Adult(s) _____ Child(ren) Employment Status: Are you currently…  Employed for wages  Self-employed  Out of work, looking for work  Out of work and not looking for work  A homemaker  A student  Military  Retired  Unable to work If you are currently working outside the home, what kind of work do you do? ___________________________________________________________________________ The following questions relate to your understanding about mental illness. There are no right or wrong answers. Remember, this survey is anonymous so we ask you to share your honest opinions and beliefs. When people are described as being “mentally ill” or having a “mental health problem”, what does that mean to you? _____________________________________________________________________________________________________________________________________________________ What do you think causes these kinds of problems? ______________________________________________________________________________________________________________________________________________________ When a person is “mentally ill”, how can you tell? In other words, what do they look like or how do they act that tells you that they are mentally ill? ______________________________________________________________________________________________________________________________________________________ Other than “mental illness” is there a term that you use to better describe these kind of problems? ______________________________________________________________________________________________________________________________________________________ What helps someone who has a mental illness get better? ______________________________________________________________________________________________________________________________________________________ Have you ever sought treatment for a mental health problem? (Please check one)  Yes  No  Not sure If yes, how do you cope with the situation? (Select all that apply) Saw a therapist  Prayed Took medication Kept it secret  Talked to a friend/family member Went to a spiritual advisor / voodoo priest  Talked to a member of the church/elder  Did nothing and just tried to get by  Other (Please specify) ______________________ On a scale of 1 to 10, how helpful was this choice in terms of making you feel better? Not at all helpful Extremely helpful 1 2 3 4 5 6 7 8 9 10 What do you believe causes these kinds of mental health problems? (Select all that apply). Spirits or ghosts Experiencing disasters or other terrible events Magic, spells or curses Punishment by God. Bad experiences in childhood. Disease or other medical problem  Grief or the loss of a loved one.  Other (please specify) _____________________ The following item asks you to rate things from Best to Worst. When a person has a mental health problem, the best way to get help would be to ask: Best Worst The spirits, or a medium for the spirits 1 2 3 4 5 The hospital 1 2 3 4 5 Parents, grandparents, or other elders in the family 1 2 3 4 5 A mental health therapist 1 2 3 4 5 Their medical doctor 1 2 3 4 5 Other (specify): 1 2 3 4 5 (BY THE WAY I DO NOT LIKE THESE CATEGORIES BUT DON’T WANT TO WRITE THEM) How would you rate the following in terms of how helpful they are in helping a person deal with mental health problems? Best Worst Home remedies 1 2 3 4 5 Medication from healthcare provider 1 2 3 4 5 Prayers 1 2 3 4 5 Voodoo remedies 1 2 3 4 5 Healers 1 2 3 4 5 Other (please specify) 1 2 3 4 5 What kind of information, if any, would convince you to seek help from a mental health professional if you were experiencing these kinds of problems? If you went to see a mental health professional, what would they need to understand about you in order to be helpful? What are the main reasons that you would chose to NOT see a therapist, or NOT go back to a therapist after one or two sessions? Is there anything else you would like us to know about this topic before you finish the survey? ____________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________ Thank you for taking the time to complete our survey! Plans for Implementation This survey will be implemented as soon as possible; questionnaires will be administered individually. Interviews will be organized in centers or offices, as it will be convenient for the respondents. The data collected will be kept in protected folders and analysis done by excel. We expect to finish the survey in two months and compile the final report by the end of the third month. Pilot Testing Five experts took part in the pilot test. These experts are illustrated below: Dr. Hyde Justeen --------- Survey Update-3.docx(Director of Research and Evaluation Institute for Community Health/ Instructor) Dr. St. Louis Germima ----------Culture and Mental Health Survey-2.docx (Faculty, Clinical Psychology Department)Dr. Richard Patrick --------- Survey update-PR-2docx(Assistant Professor of Health Economic) Dr. Cruz-Davis ----------- JG Survey Update acd4-15-2docx(Interim Director Department of Public Health) Stephen Merther ----------Survey update-4-docx(Psychology Professor) Dr. Hyde majorly illustrates that the most suitable person responsible for handling mental health isues among the Boston Haitians is the mental health therapists. Dr. St. Louis also supports this view, because the mental health therapists are adequately trained to handle the mental health matters in a competent manner. Dr. Richard explains the importance of the home remedies for addressing the mental health issues. The remedies enables the family members understand how to cope with an assist the mental health patient recover. Dr. Cruz-Davis illustrates medication from the healthcare providers as the most effective measure for addressing mental health issues. Stephen also illustrated the psychological benefits prayers in the recovery process of the mentally challenged patients. References Kirmayer, L.J. (2010). Culture and Mental Health in Haiti: A Literature Review. Canada: Macmillan. Loue, S. & Sajatovic, M. (2011). Encyclopedia of Immigrant Health. New York: Springer. Selin, H. (2003). Medicine across cultures: History and practice of medicine in non-Western cultures. Dordrecht: Kluwer Acad. Publishers. Al- Isā, I. (2003). Ethnicity, immigration, and psychopathology. New York: Plenum Press. Marcella, A. et al. (2008). Ethno cultural perspectives on disasters and trauma: foundations, issues, and applications. London: Springer. Videbeck, S., (2011). Psychiatric-mental health nursing. Philadelphia: Wolters Kluwer Health. Kirmayer, L., Guzder, J., and Rousseau, C., (2014). Cultural consultation: encountering the other in mental health care. New York: Springer. Byrne, M., & Deane, F. (2011). Enhancing patient adherence: Outcomes of Medication alliance training on therapeutic alliance, insight, adherence, and psychopathology with mental health patients. International Journal of Mental Health Nursing, 20(4), 284-295.doi: 10.1111/j.1447-0349.2010.00722.x Chauncey, D. (2006). “Medication access through patient assistance programs.” American Journal of Health-System Pharmacy, 63(13), 1254-1259.Doi: 10.2146/ajhp050457 Chowdhury, A. (2012). Culture, Psychiatry and Cultural Competence, Mental Illnesses. ISBN: 978-953-307-662-1. Jacobson, E. (2007). ‘An Introduction to Haitian Culture for Rehabilitation Service Providers.” CIRRIE. Retrieved from http://cirrie.buffalo.edu/culture/monographs/haiti/ Ngo-Metzger, Q., Telfair, J., sorkin, D., Weidmer, B., Weech-Maldonado, R., &Hurtado, M. (2006). “Cultural competency and quality of care: obtaining the patient’s perspective.” Common Wealth Fund, 3. Nicolas, G., DeSilva, A. M., Subrebost, K. L., Breland-Noble, A., Gonzalez-Eastep, D., Manning, N., Prater, K. (2007). “Expression and treatment of depression among Haitian immigrant women in the United States: clinical observations.” American Journal of Psychotherapy, 61(1), 83. McCuskee, S. (2012). Restructuring Urban Healthcare: Beyond the Cultural Model For Immigrants’ Healthcare Disparities. Global Health Review. Retrieved from http://www.hcs.harvard.edu/hghr/print/spring-2011/urban-healthcare/ M. DeSilva, A., Nicolas, G., Grey, K., & Gonzalez-Eastep, D. (2006). “Using a Multicultural Lens to Understand Illnesses among Haitians Living in America.” Mental Health. World Health Organization, (2011).Earthquake in Haiti-one year later. Pan American Center www.paho.org/Disators. Raviola, G., Eustache, E., Oswald, C., &Belkin, G. (2012). “Mental Health Response in Haiti in the Aftermath of the 2010 Earthquake: A Case Study for Building Long-Term Solutions.” Harvard Review of Psychiatry, 68-77. Raviola, G., Severe, J., Therosme, T., Oswald, C., Belkin, G., & Eustache, E. (2015). The 2010 Haiti Earthquake Response. NY: Wiley. Singh, Y. & Bajpai, R.B. (2008). Research Methodology: Techniques & Trends. New Delhi: APH Publishing Corporation. Groves, R. (2009). Survey Methodology. Hoboken: Wiley. Johnson, T.P. (2015). Handbook of Health Survey Methods. New Jersey: John Wiley & Sons, Inc. Stokes, J. (2012). How to Do Media and Cultural Studies. New York: SAGE publishers. Read More

 

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