Attendees of the November 23, 2005 Prop 63 30-day Public Review Presentation at the Palm Village BMD Rescare Garden Grove Facility

Attendees of the November 22, 2005 Prop 63 30-day Public Review Presentation at the St. Anselm’s Cross Cultural Community Center included many Vietnamese who received translation from Pierre Tran and Peter Nguyen.

“That you may retain your self-respect, it is better to displease the people by doing what you know is right, than to temporarily please them by doing what you know is wrong. "

—William J. H. Boetcker

On November 16, 2005, members and friends of the East African Community of Orange County gather for a photo after viewing the Orange County Health Care Agency’s MHSA presentation and Homeless Documentary, “Orange County, The Untold Story.” Executive Summaries of the Plan were given to all participants as well as invitations to the Dec. 8th Public Hearing as part of the 30-day public review process. Public Comment Forms were given and received. EACOC Case Manager Ali Mohammed provided language translation.

Winter, 2005

The Mental Health Recovery Model

Casey Dorman, PhD
CYS

Recovery means a lot of things to a lot of people. In medicine, recovery usually means the restoration or return to health from sickness or injury and signifies an endpoint. In substance abuse treatment, it is emphasized that recovery is a process, sometimes one without an endpoint, presumably because the underlying disease (the addiction) never goes away.

In mental health, recovery can signify either an endpoint or a process. The crucial difference between the mental health concept and the medical and substance abuse concepts is that, in mental health, recovery is not related to an underlying illness, but rather to one’s quality of life. Recovery still refers to the restoration of something that has been lost, though in some cases, the reality is that what is being recovered was never fully attained.

Nothing is perfect and neither is anyone’s life, so quality of life is a graded concept—quality can be better or worse. Quality of life is also a broad concept —it includes health, medical care, mobility, means of transportation, finances, housing, education, recreation, work, and role fulfillment, to name only some of its dimensions. A crucial aspect of the concept of quality of life is that two people who are equally sick (no matter what the illness) can have different qualities of life depending upon their access to medicine, to health providers, to caretakers, to adequate housing, to income, to family and friends, to enjoyable recreational pursuits, etc.

The concept of recovery in mental health is associated with a model of services that emphasizes efforts to help a person improve his or her quality of life both by reducing the person’s mental illness and its symptoms and by improving other aspects of the person’s life, regardless of the status of their mental illness. This is often contrasted with the medical model in which services are directed solely at the symptoms of the illness and the sole goal is to reduce symptoms and cure the illness. In a recovery model of services, assistance is provided in areas of life that go well beyond the symptoms and the current state of the illness.

Recovery does not just concern how or what services are offered to the person with mental illness. Part of the recovery concept is the idea that gaining control over one’s life is also an aspect of quality of life. Thus, independence, choice, and responsibility are included in models of mental health recovery. A recovery model of mental health has the individual with mental illness at its center. That person is knowledgeable about his or her mental illness, is aware of treatment options and involved in making a choice among them. He or she takes responsibility for making and following informed choices, and has opportunities for living as independently as possible, within a system in which he or she can make choices and gain assistance in pursuing educational goals, can achieve adequate living and transportation arrangements, can develop realistic work options, and can achieve his or her recreational and social goals.

It is obvious that the concept of recovery is intimately tied to the concept of quality of life. In turn, this latter concept is intimately tied to the culture in which one lives. Different cultures value different roles, define independence differently, and have different views of mental illness and its treatment. Within some cultures for instance, achieving independence from one’s family of origin is the ultimate sign of living optimally. In other cultures, living interdependently and in an integrated way with family members is one of life’s main goals. In some cultures persons define themselves primarily in terms of their family roles (father, son, parent, etc.), while in others they may place greater emphasis upon work roles.

A satisfactory quality of life has different meaning for these people and a recovery model takes into account such personal and culturally determined meanings in how a person defines his or her quality of life. A mental health service delivery system that values cultural competence and strives to offer help to consumers within their own cultural framework is part of the recovery model, as are efforts to reduce stigma associated with mental illness that may prevent families or individuals from addressing such illness and taking advantage of the services that are offered.

Winter, 2005

Mexican Illegal Aliens: A Mexican American Perspective hits the shelves

Rafael D. Canul, PhD, licensed clinical psychologist with HCA/ BHS Cultural Competency was recently honored at the Libreria Martinez in Santa Ana, where he led a discussion and book signing on illegal immigration. Dr. Canul states, “ I have been writing this story my whole life.” Regarded as “providing the first comprehensive, Mexican American historical perspective of the Mexican American illegal immigration to the United States during the past 50 years,” Dr. Canul remains humble. “I didn’t write this book for fame or fortune… I wrote it to give voice to those who are too afraid to speak.”

“Culture is the widening of the mind and of the spirit. —Jawaharlal Nehru”

Child sexual abuse of females in the Latino community

Richard Skaff, Psy D
CYS

Prevalence statistics of child sexual abuse among Latinas tend to vary: several studies have found prevalence rates for sexual abuse among Latinos lower than those for African Americans and whites. Others, however, report rates that are comparable. Prevalence rates range from 3% to 33%, with most victims reporting abuse that occurred during elementary high school. These studies did not take in consideration the high rates of non-reporting in the Latino community, which would have made the number of sexual abuse incidents much higher.

However, a recent study that was funded by the National Institute of Mental Health( NIMH) reported that Latino children experience higher rates of sexual abuse by extended family (Intra-familial abuse) members than whites or African Americans. The study examined the prevalence of child sexual abuse in a community sample of Latinas, 18 to 50 years of age. Per the study, 1 in 3 Latinas reported incidents of sexual abuse, regardless of acculturation or citizenship status. More than one third of women also experienced revictimization, with more than 80% of initial incidents occurring from the age of 7 years on. Four women were forced to marry perpetrators of their abuse. (Hispanic Journal of Behavioral Science, Vol. 21, No. 3, 351-365, 1999).

The study also discussed the non-reporting rates of abuse among women in these studies, which ranged from 25.3% to 60 %. Some of the reasons for non-reporting included the following:

• Feeling afraid of not being believed, being blamed, being physically punished or otherwise getting into trouble.

• Not having anyone to tell.

• Feeling ashamed, embarrassed or dirty.

• Wanting to protect others.

• Forgetting the incident or not being able to recall why disclosure was not made.

• Investigators express concerns that non-reporting may also stem from fear of deportation.

• Non-reporting by Latinos is of particular concern, because both male and female Latino victims report higher rates of severe abuse than African-Americans and whites.

(Hispanic Journal of Behavioral Science, Vol. 21, No 3, 351-365 (1999).

An essential strategy to address this problem is to devise a culturally sensitive educational program that would non-threateningly address the issue of sexual abuse and its prevalence in the Latino community. The program would also reach recent immigrants and would help them become more connected to supportive resources in the community, which in turn would encourage and increase the reporting of abuse.

Due to the lack of empirical study with this population, the clinical approach to treatment stems mostly from clinical experiences by Latino therapists. Culturally competent recommendations include the following:

• All practitioners can benefit from improving their awareness of and respect for other cultures.

• Clinicians must recognize that discrimination affects clients on national, state and local levels.

• Practitioners must address individual and institutional discomfort about differences.

• It is more important to do this than to refrain out of fear of doing or saying the wrong thing.

• Practitioners must be aware of aspects of their own culture that affect their work, as well as the relevant beliefs and values of other cultures. For example, clinicians who provide treatment for sexual abuse must know the prevailing beliefs about sex and gender roles in their own culture as well as in the cultures of individuals they are treating.

Overcoming language barriers is essential as well. The language barrier can take many forms.

Miscommunication may also occur with use of standardized tests, in English or Spanish translations. Therefore, results should be used with caution.

There are culture-based behaviors of those in treatment that may also conflict with treatment:

• Avoidance of eye contact.

• Avoiding expression of “negative” feelings like anger.

• Expressing agreement, regardless of what is really felt, or failing to ask questions when something is not understood in order to save face or defer to authority figures.

Cultural issues may also hinder the discussion of the offenses:

• The concept of “Verguenza,” or shame, which is a strong conviction, that individual behavior reflects on the entire family.

• Taboos about discussing sexual behaviors that many Latinos regard as deviant, such as oral sex, masturbation and sexual arousal with boys or other men.

• Prohibitions against discussing sexual matters that involve children or offenders who are respected elders.

• Concern about retribution from members of the victim’s family.

Some Latino beliefs may lead to victim blaming by relatives and friends. Abused girls may be treated as sullied and partly responsible for losing their sexual purity. Boys abused by males are sometimes viewed as homosexual and/or shamed by the role of victim.

Group educational sessions with other Latinos can also be very effective in promoting communication and educating about sexual abuse. (Loredo, Carlos M. (1999). “Intervention with Hispanic Sexual Abusers.” pp. 121-149 in cultural diversity in sexual abuser treatment: Issues and approaches.)

In conclusion, the sexual abuse of children is a horrendous crime. It violates the boundaries of children, objectifies and dehumanizes them, and renders them confused, ashamed, and helpless. These children will never be the same!! Sexual abuse has a high correlation with dissociative and eating disorders as well as drug and alcohol abuse.

The resolution begins by encouraging an open dialogue about the problem of sexual abuse, and by creating culturally sensitive outreach and educational programs to increase awareness and reduce shame about sexual abuse in the Latino community. Therefore, averting the disastrous consequences caused by the tragedy of child sexual abuse.

Winter, 2005