Mental Illness among Somali Immigrants - Term Paper Example

Mental Illness Among Somali Immigrants

IkraanAbdulle

Augsburg College

MENTAL ILLNESS AMONG SOMALI IMMIGRANTS

Introduction

The link between mental health and social justice is not immediately obvious because, while mental health is widely considered as an individual condition, social justice is considered as more of a social condition. Nevertheless, when considering social justice as an issue linked to fairness and equality with symbolic and material dimensions (Sauber, 2013), its relationship with mental health becomes clearer. Indeed, Farmer (2004) argues that economic and social inequalities play an important role in denying services to the poor and that equity is a key ingredient in ensuring respect for human rights in healthcare. Specifically, ethnic or racial groups like Somali immigrants that suffer discrimination and poverty are more likely to suffer higher prevalence and incidence of mental illness. In turn, persons suffering from mental health issues tend to be the most marginalized, discriminated against, stigmatized, and vulnerable members of immigrant societies. Although there have been steps towards improving this status quo, a lot more needs to be done in achieving social justice for these groups. Unless the differentiation stigma attached to mentally ill individuals is overturned, it is likely that their rights will be ignored, violated, invalidated, and marginalized (Sauber, 2013).Thus, it is important to ensure that the mentally ill in the Somali immigrant community are not subjected to social injustices that will exacerbate their condition.

Background and Context

Since civil war broke out in Somalia in the early 1990s, millions of Somali refugees have been displaced either within the country and other East African countries or have sought refuge in North America and Europe. Presently, there are more than one hundred thousand Somali refugees living in American cities like Seattle, Boston, Atlanta, Nashville, Columbus, and Minneapolis (Henning-Smith, Shippee, McAlpine, Hardeman, & Farah, 2013). The State of Minnesota hosts more than fifty thousand refugees from Somalia and is considered the largest concentration of Somalis anywhere in the world outside of East Africa (Pratt, Fadumo, Hang, Osman, & Raymond, 2016). Generally, immigrant mental health varies significantly with that of American non-immigrant populations since the latter tend to have more access to health screening, healthier lifestyles, and extensive social support compared to the former (Henning-Smith et al., 2013). Furthermore, changes in social status, acculturation stress, social isolation, and impact of trauma from war may contribute significantly to declining mental health for Somali immigrant and refugee communities in the United States.

As part of my practicum experience I had the opportunity to volunteer at Gargar Clinic, a local Somali clinic in south Minneapolis. In my conversations with some of the patients waiting to be served at the clinic, we discussed various topics including fashion, favorite food, and weather; during which I mainly listened and encouraged them to share their thoughts. Perhaps the most striking conversation I had was with a 57-year old widowed patient sitting about 5 feet away, who asked me why people praise America’s greatness so much and tell people that everyone has an opportunity to succeed. Seeing an opportunity to strike up an insightful conversation, I asked the patient to elaborate and share more of her thoughts on the problem. She said that having lived in the U.S. for the past 5 years; she had seen people living in poor conditions, homelessness, and poor health conditions with no insurance and could not afford medications.

The patient shared that she often questioned whether she was still living in a third world country or in America, the free world where all your dreams are supposed to come true. She went on to say that in the past 5 years, she had seen so more displaced and homeless people than she had seen in her entire life prior to coming to America. Watching the elderly Somali lady’s body language as she expressed her anger and frustration with the American healthcare system, I concluded that her living situation was also affected negatively by financial issues. Realizing that this patient had a lot she wanted to say, I moved closer and sat next to her. I wanted to know what she meant by saying that she had “seen so many people displaced and homeless”; thus I encouraged her to talk about this specific issue.

Hawo, the Somali lady, shared that she was a 57 year old Somali woman who was currently homeless and living at the women’s shelter. Having no family with her, Hawo admitted to feeling lonely and hopelessness. She also talked about her significant health history that included her newly diagnosed stomach cancer, for which she was unable to seek specialized treatment because she had no insurance through the state. Thus, she could no longer visit her Oncologist as she could not afford the co-pays. Finally, Hawo got around to speaking about her financial difficulties; agonizing over how best to spend the small amount of social security she receives from the government. Would she spend this money buying groceries, paying her phone bill, her medical respite bed, or send it back home to her children who depend on her for money? Since she had no car to get around the city, Hawo had to take the bus or even a cab and was entirely reliant on her interpreter to communicate with other people as she could not speak English.

Painfully, she confessed that although she was aware that she was living a better life than her children and family back home, she did not feel alive anymore. How, for example she asked, could a healthy human being live on a $ 297.00 a month let alone an unhealthy one? How can they afford to eat healthy foods to live a normal life while also constantly worrying about their daily needs, or even the day they would be kicked out of respite bed? The elderly people in America do not receive adequate help, and the situation is even worse elderly immigrant people especially those without money to afford living in assisted living housing. The situation is even worse for the sick, she said, who are just put into a nursing home where they ‘rot and die’. At the end of our conversation, Hawo thanked me for giving her a chance to get these issues off her chest. After leaving the clinic for the day, I realized that not only was Hawo living a marginalized life, but that her basic health needs were not being met as well. With her physical and mental health deteriorating, I questioned whether she had much hope of surviving any longer.

Changes in lifestyle and social status contribute to the increased vulnerability of Somali immigrants to mental illness, especially since Somali parents tend to learn English and American cultural norms at a slower pace than their children (Henning-Smith et al., 2013). As their children become more responsible for their parents’ communications, it creates a strain on the parents’ authority and creates a power imbalance in the family. In addition, the father’s role may shift as their skills are difficult to transfer to the American labor market, which could lead to feelings of worthlessness and guilt increasing their vulnerability to mental illness. Social isolation and limitations to healthcare access is another contributor to high mental illness rates among Somali immigrants in the U.S. This is exacerbated by the fact that majority of mentally ill Somalis are usually socially isolated, which is devastating because their culture is traditionally family-oriented and communal in nature (Henning-Smith et al., 2013). Thus, whereas mentally ill Somalis are isolated from their society and community, it is possible that their fear of stigmatization negatively affects their illness.

Somali immigrants in the U.S. have great needs and as they face complex challenges. Apart from the enormous language and cultural differences, they also have to contend with limited literacy skills, racism, and unemployment or underemployment (Kiang, Grzywacz, Marín, Arcury, & Quandt, 2010). As a result, the prevalence rates of post-traumatic stress disorder (PTSD) and depression are particularly high compared to the general U.S. population. Also, the impact of social isolation, social status changes, and impact of trauma from the Somali war make acculturation more difficult and significantly affect psychosocial adjustment. This makes it necessary to understand their unique circumstances and experiences in order to respond appropriately to the mental health needs. The loss suffered by the immigrants in terms of their homeland and loved ones, as well as the increased likelihood of violence, famine/malnutrition, torture, and political persecution, increases their risk of mental illness especially if they are not treated soon after resettlement(Kiang et al., 2010). This trauma tends to have a profound effect on their mental health functioning, which is exacerbated by lack of a support system, personal characteristics, and the lack of effective coping skills.

Perception of Mental Health and Illness among Somali Immigrants

Piwowarczyk, Bishop, Yusuf, Mudymba, and Raj, (2014) noted that while the prevalence of mental illness among Somali immigrants is particularly high not only in the U.S. but around the world, the community also under-utilizes mental health resources and services. Mental disorder treatments are generally an unfamiliar concept for the large proportion of Somali immigrants, who may seek help for mental health issues through counseling by family and elders or from faith healing. Therefore, they consider various forms of therapy as alien and instead prefer to rely on modes of ‘treatment’ that are related to their cultural norms. Further, exposure-based therapies and other forms of treatment that that are popular and familiar concepts in the U.S. also represent an incomplete approach to psychological treatment for Somali immigrants who may have multiple layers of trauma from the war and the move to a foreign land. Indeed, Piwowarczyk et al. (2014) noted that immigrants rated therapy and counseling outcomes as against Somali cultural norms and culturally unacceptable, while non-attendance for counseling and therapy sessions was also common.

Although there is a low tendency among Somali immigrants to seek professional mental health assistance, evidence shows that Somali men tend to fall within the statistical group of ethnic or black minorities who are thrice as likely to be admitted and detained for a longer period in psychiatric units (Wolf et al., 2014). One implication of this outcome is that there is a need to explore and assess the difficulties faced by Somali immigrants in accessing mental healthcare, particularly by questioning the reasons behind low access and high hospitalization figures (Wolf et al., 2014). Various barriers have been identified including stigma and discomfort linked mental health, as well as poor community knowledge and misconceptions about mental healthcare. Traditionally, the Somali culture tends to prevent its members from openly discussing issues related to mental health, while the Shamanism tradition prevalent among Somali immigrants suggests they tend to believe less in Western medicine and more in the supernatural. Moreover, various concepts used in mental health are not translatable in some Somali language (Wolf et al., 2014), with terms for severe depression, for example, indicating severe headaches or migraines. As a result, Somali immigrants are more likely to talk about somatic symptoms like headaches and muscle aches instead of their mental distress.

Furthermore, Somali society also tends to conceal and be fearful of mental illness because mentally ill sufferers are stigmatized and seen as hopeless and weak-minded, which may result in them being locked away or chained with little hope of recovery (Henning-Smith et al., 2013). As a result, Somali immigrants may, for example, rationalize that going to a psychiatrist is out of the question because the doctor will believe that they are psychotic or crazy, which in turn makes them crazy. One major barrier to the Somali immigrant community’s access to professional mental healthcare has to do with cultural misconceptions, which normally result in unmet expectations and discordant beliefs from the mental healthcare professional. For instance, Somali immigrants who suffer from mental illness and other mental health issues but are not hospitalized tend to live with their family and relatives and only visit a healer in order to receive medication and treatment. Such discordant healthcare belief systems could portend a major, negative impact on the Somali immigrants’ help-seeking actions and behaviors (Henning-Smith et al., 2013). Since social justice refers to the manifestation of human rights in the everyday lives of individuals at all levels of society(Merino, 2014), it is important to overcome the effects of these belief systems to ensure they receive adequate healthcare without stigmatization; thus overcoming the resulting discrimination and vulnerability.

Working in the acute care setting as a nurse, I have noticed that Somali patients are hesitant to consult with mental health providers either for fear of being stigmatized or the horror of possible social exclusion and being perceived as 'possessed by the ‘jin'. As an advanced practice trans-cultural nurse, therefore, it is important to express concern about the mental health issues of patients in a culturally appropriate way, while avoiding language that makes patients apprehensive about the potential of being labeled as ‘crazy' or 'depressed'."As a bedside nurse, I care for many patients labeled “non-compliant” who are administered with antipsychotic medications which causes them to suffer great deal. At times, I also come across patients suffering from manic episodes, as well as other patients that are disconnected from reality who get committed most of the time and get taken their rights away. In some of these cases, the patients are force-fed as required by court orders. In such cases, most families are very frustrated with the health care team because they think their family member is being administered with unnecessary medications and procedures, which they perceive as only making the patient’s condition worse.

Improving Mental Health and Social among Somali Immigrants

Perez et al. (2016) points out that it is important to adapt the current mental healthcare system in the United States to accommodate immigrant communities in the spirit of social justice, specifically to ensure that these groups do not suffer additional discrimination for their mental illness. Therefore, it is crucial to ensure that the mental healthcare system reaches out to Somali immigrants in a manner that takes their aspersions, doubts, and mistrust into account. This may include the involvement of bi-lingual primary mental healthcare providers, the provision of multi-disciplinary treatment, client advocacy, holistic treatment and health orientation, family and client education, and the provision of treatment aligned with their religion and culture. While the majority of social and health care workers tend to use interpreters when working with Somali immigrants, this model may have limitations despite its necessity in the current setting. For instance, interpreters may face significant limitations in relation to word-for-word interpretation because they lack appropriate skills required for cultural interpretation. As a result, this results in cultural misunderstanding and subsequent incorrect mental health diagnosis and treatment thus propagating social injustice (Wickham, Shryane, Lyons, Dickins, & Bentall, 2014).

Moreover, the use of different interpreters in every client contact means that there is a minimal ongoing relationship between them and the client; therefore interfering with care continuity and diminishing the building of trust between clients and mental healthcare providers (Perez et al., 2016). The helping relationship plays a critical role in the mentally ill client’s process of healing, while also positing that the best approach in providing mental healthcare to immigrants is by using the bicultural/bilingual model in the mental health setting. This model enables every client to have a primary contact community member trained in Western models of mental healthcare, which will allow the immigrant and the trained mental health professional to form a trusting relationship. In turn, this will ensure that the immigrants are comfortable with discussing their mental health issues and develop a positive health-seeking behavior thus reducing their fear of stigmatization and discrimination that propagate social injustice (Draine, 2013).

Providing mental healthcare to Somali immigrants to ensure fairness and equality in accessing the healthcare system may also require the use of a multi-disciplinary approach, which will include various professional healthcare providers. The approach encourages the involvement of Somali mental health therapists and counselors, a family therapist, psychiatric nurses, and licensed social work supervisors (Wickham et al., 2014). Additional professionals who could play a key role in overturning the differentiation stigma that faces Somali immigrants with mental health issues include psychiatrists, child psychologists, and adult psychologists. This approach should place a high priority on service coordination among the different providers so as to provide the best possible care and help to mentally ill Somali immigrants, as well as those at risk of developing mental health issues. This treatment team would also be required to meet often, specifically with the aim of reviewing client care for individual clients and discussing mental health issues in the Somali immigrant community (Wickham et al., 2014). By placing the needs of Somali immigrants at the center of the mental healthcare systems within their communities, the immigrants can receive the basis benefits of cooperation which are at the core of social justice.

Holistic treatment models are also critical in ensuring social justice for mentally ill Somali immigrants, specifically through the integration of the spirit-body-mind approaches to healthcare provision. The mental healthcare system should embrace the manner in which immigrants conceptualize mental health and illness through this integrative model, which will ensure that the treatments offered are more successful and that the immigrants are engaged more effectively (Perez et al., 2016). In this case, the contemporary Western model that involves therapy with a set period would be insufficient in the treatment of Somali immigrants. Instead, the holistic model would encourage the provision of government housing, employment, and immigration benefits in order to ensure that they are able to fulfill their societal roles and receive their just dues from society. By ensuring social justice for Somali immigrants, the mentally ill are less likely to feel isolated and ostracized and more likely to engage in help-seeking behavior as they feel part of the society (Draine, 2013). Further, the helping professionals should also be willing to work and walk alongside the Somali immigrant clients outside their offices to make them feel more included within the society and community.

Finally, the mental healthcare professional dealing with Somali immigrants must take it upon themselves to become advocates for their clients in order to help them break social mobility barriers caused by their mental illness. Further, they should also ensure that their clients have sufficient safety nets to avoid exacerbating the effects of being social isolated and ostracized due to their mental illness; while also accessing services within America’s mainstream mental healthcare system (Draine, 2013). Some barriers that the mental healthcare professional should advocate to overcome on behalf of their clients include poor mental healthcare and treatment system knowledge due to their immigrant status and poor educational levels, language access, poor understanding of treatment compliance importance, and conflicts between religious beliefs and recommended care. The mental healthcare professional also needs to consider the advocacy needs that Somali immigrants with mental health issues require within their community and family so as to reduce social isolation and stigmatization, specifically by educating the clients’ family about mental illness and health (Draine, 2013).

Conclusion

In conclusion, mental health issues among Somali immigrants are a major contributor of social injustice especially where the immigrant is ostracized, socially isolated, and discriminated against because of their condition. It is, therefore, incumbent upon mental healthcare providers and workers to ensure that mentally ill immigrants are provided with the opportunity to participate in their community and society to avoid exacerbating the effects of their mental health problems. This will require an appreciation of the problems faced by mentally ill Somali immigrants such as fearfulness of mental illness in the community, unfamiliarity with mental health concepts, and the influence of religion and cultural beliefs. Taking this into consideration, the mental health provider can then work towards ensuring social justice for their client by enhancing their help-seeking behavior and trust of the mental healthcare system.