2 of 13

Culture

The Importance of Culture

Culture shapes communication
Mental health
Community

Cultural Groups

Hispanic
Afican- American
Asain American

Cultures affect how people communicate to each other and to health professionals.Particularly, it can affect how symptoms are described and reported. What a person might be feeling physically and emotionally might be communicated differently or interpreted wrong by an individual from another culture.

Cultural values determine and define mental health and mental illness. For many cultures, there is a stigma around the topic of mental health. The cultural beliefs on mental health affect client communication about the subject.

Another reason culture is significant when discussing about mental health is because of it shapes the attitudes of the community. Cultures that stigmatize mental health often create a community that lacks support care and openness about mental illness.Individuals suffering from mental health issues are forced to hide their issues or are left to find treatment on their own.

References,

Watters, E. (2010, January 8). The Americanization of Mental Illness. The New York Times. https://www.nytimes.com/2010/01/10/magazine/10psyche-t.html.

Rubina, K. (2019, July 11). Four Ways Culture Impacts Mental Health. Mental Health First Aid. https://www.mentalhealthfirstaid.org/2019/07/four-ways-culture-impacts-mental-health/.

3 of 13

Cultural Variations of Mental Health

Hispanic

Connectedness with family
Spirituality
Attitude towards life (resilient, hard worker)

African- Americans

Strong family ties
Church and Spirituality
Community engagement

Hispanaics or Latinos, African-Americans, and Asain-Americans are all composed of muti racial and multicultural groups. The diverse nature of these groups will leads to variations in the view of mental health. For a majority of these cultural groups, mental health is not defined.From extended research, it can be inferred that the western definition of mental health is the gold standard. However, the values held within these cultures can give a perspective of what mental health looks like in each culture.
In the Hispanic culture, spanish is the predominant language. Individuals within this culture value religion, strong family and extended bonds, and a hardworking demeanor. An individual in this culture who is mentally healthy will have a strong familial relationships, they will actively participate in religious activities (most likely with family members) and will be recognized as a hardworking.
Within the African-American culture, family, kinship, connection to one's spirituality and the church, and community are valued. Similar to hispanic culture, an individual that is mentally healthy will have strong family bonds, they will be spiritual and have close ties to the church, and they will be engaged in the community.

References,

Black/African American. NAMI. (2020). https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American.

Latinx/Hispanic. NAMI. (2020). https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Latinx-Hispanic.

Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). Philadelphia: F. A. Davis Company.

2019 - Mental Health at the Intersection of Culture & Technology. (2019). University of California. https://www.ucop.edu/student-mental-health-resources/training-and-programs/best-practice-conferences/culture-technology-2019.html.

4 of 13

Cultural Variations of Mental Health

Asian- Americans

Loyalty to family
Education oriented
Emotionally strong
Holistic health practice

In the Asian -American culture values, loyalty to family, spirituality, education and holistic health practice. The Asian-American culture is made up of traditionalists and those who embrace western culture. A mentally healthy person will be loyal to his family, pursue an education, emotionally strong and will care about his or her overall health. A traditionalist would hold Eastern values of collectivism and emotional suppression.

References,

Grey, H., & Hall-Clark, B. (2016). Cultural considerations in Asian and Pacific Islander American mental health. Oxford University Press.

Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). Philadelphia: F. A. Davis Company.

5 of 13

Cultural Barriers to Mental Health

Barriers in Hispanic Culture

Language
Health insurance
Stigma

Barriers in African-American Culture

Socioeconomic disparities
Stigma
Discrimination in healthcare

Barriers in Asain-American Culture

Stigma
Language
Transitioning

Language can as a barrier for communication if a client is not proficient in english or does not speak english at all.When talking about sensitive and personal issues like mental illness, it can be complicated for the client who speaks another language to express themselves effectively to a provider.
Lack of health insurance is another barrier to mental health care. A study by the Kaiser Family Foundation (2018), found that 19% of hispanic people have no health form insurance. Without health insurance, people from this cultural group cannot receive care.
Stigma is another issue limiting mental health care for hispanincs. The Latino community tends to be private, keeping their daily struggles and sensitive issues at home. This can hinder communication about important issues within the community. Having a mental illness and talking about it can be viewed as a taboo and one can be called “loco” (crazy) that causes shame.

African Americans

African-Americans face many socioeconomic disparities. This can be attributed to years of systemic racism and injustice. African-American often lack and are excluded from health, educational, social and economic resources. In 2018, the Henry J Kaiser Family Organization conducted a survey and found that almost 12% of African-Americans were without a form of health insurance.
The other significant barrier to mental health for African-Americans is stigma. Mental illness is commonly viewed as a personal weakness within this culture. The negative connotation forces people in this culture to hide and deal with their mental illness alone. Those who do have mental illness that are not willing to talk to a health provider will often go to the church to find support. The church and spirituality are vital parts of the African-American culture.
Last but not least, African-Americans face inequality in the healthcare. Prejudice and discrimination agianst this culture is preodminant within the healthcare system. Health providers that are biased and lack cultural competence do not provide equitable mental health care that leads to mistrust in the African-American community.

Asian-Americans

Just like the other cultures, stigma is also an issue in the Asian-American community. Cultural stereotypes often label those with mental illness as “crazy” and lack of education about mental health attribute to the stigma. The way Asian-Americans communicate can also make this stigma worse.Some aspects of Asian-American culture value “soft-spokenness” and emotional suppression. A person of Asian descent might not share their emotions instead sharing the physical manifestations of their mental illness.
Language is another barrier for Asain-Americans. Asian- Americans are a diverse group of people who speak many different languages. Communication about illness with a provider that is not competent in a particular language makes care ineffective.
Lastly, Asian-Americans are a group that are in transition. Those who immigrate to the United States and those who have been settled for years are at different stages in the acculturation process. A person settled in the United States for years is more likely to embody western values of health compared to a new immigrant.

References,

Black/African American. NAMI. (2020). https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American.

Grey, H., & Hall-Clark, B. (2016). Cultural considerations in Asian and Pacific Islander American mental health. Oxford University Press.

6 of 13

Prevalence of Mental Health

Hispanics

SAMHSA survey 2018
16.9% (6.9 million) with mental illness
Serious mental illness rising (+2%)

African-American

SAMHSA survey 2018
16.2% (4.8 million) with mental illness
Serious mental illness increasing

Asain-American

SAMHSA survey 2018
15.1% (2.3 million) with mental illness
Serious mental illness growing (+2.7%)

The Substance Abuse and Mental Health Administration conducted a national survey in 2018 on the prevalence of mental illness in the Hispanic, African-American, and Asian-American population. Participants in this study were 18 and over.
In the Hispanic population, the survey determined that 16.9 percent(6.9 million) of the Hispanic/Latinx population had a mental illness. Among those with a mental illness, 25 percent(1.5 million) had a serious mental illness.
Serious mental illness in this group is rising. From 2008 to 2018, serious mental illness rose at least 2 percent in multiple age categories.

African-Americans

The survey found that 16.2 percent(4.8 million) of african-americans reported having a mental illness. Of the sixteen percent that reported having a mental health illness, 22.4 percent(1.1 million) had a serious mental health issue (SAMHSA, 2018). Also, this survey found that from 2008 to 2018, there has been a rise in people that report they have a serious mental illness.

Asain Americans

Among those surveyed in the Asain-American population, 15.1 percent(2.3 million) had a mental illness. Of the 15.1 percent with mental illness, 2 in 13(345 thousand) are said to have a serious mental illness. Similarly to other cultural groups, Serious mental health illness is rising. This group saw a rise 2.7 percent rise in serious mental health illness reports for the ages 18 to 25 from 2008 to 2018.

References,

SAMHSA. 2018 National Survey on Drug Use and Health (NSDUH): African Americans. https://www.samhsa.gov/data/sites/default/files/reports/rpt23247/2_AfricanAmerican_2020_01_14_508.pdf

SAMHSA. 2018 National Survey on Drug Use and Health (NSDUH): Asians/Native Hawaiians and Other Pacific Islanders (NHOPI). https://www.samhsa.gov/data/sites/default/files/reports/rpt23248/3_Asian_NHOPI_2020_01_14.pdf

SAMHSA. 2018 National Survey on Drug Use and Health (NSDUH): Hispanics, Latino, or Spanish Origin or Descent. https://www.samhsa.gov/data/sites/default/files/reports/rpt23249/4_Hispanic_2020_01_14_508.pdf

7 of 13

The impact of Stigma

Barrier to nursing mental health care!

Stigma

Client reluctance to seek care
Negative attitudes and behaviors: discontinuation of treatment and poor quality/ ineffective treatment

Stigma and patient labeling act as a barrier to mental health care.

Stigma can present a barrier to care because it can make people from various cultures reluctant to seek nursing care. The harsh societal attitudes in cultures that stigmatize mental illness causes people to deal with their issue alone or to find help from an unlicensed mental health professional. The outward societal views on mental illness can be internalized by a person with mental illness. This can make mental illness worse and prolong the time it takes for them to get help.

There are many caring and culturally competent healthcare professionals that provide excellent mental health care. However, there are many healthcare professionals who are also plagued by the stigma and patient labeling. When nurses dismiss, devalue, and provide insufficient care to clients with mental illness, this creates distrust. Clients who have had negative interactions with healthcare professionals will not be willing to seek care or will not be as open during treatment because of the negative interactions they have experienced. If the client is not forthright about their symptoms and feelings and if the provider has biases as a result of stigma, quality of mental and physical health care is reduced significantly.

References,

Greenstein, L. (2017, October 11). NAMI. 9 Ways to Fight Mental Health Stigma. https://www.nami.org/Blogs/NAMI-Blog/October-2017/9-Ways-to-Fight-Mental-Health-Stigma.

Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum, 30(2), 111–116. https://doi.org/10.1177/0840470416679413

8 of 13

Recognizing Countertransference

Transference

Sigmund Freud
Clients feelings, emotions, and experiences directed to a health provider

Types of CounterTransference

Reactive (helpful)

Provider consciously expresses feelings, emotions, and experiences

Defensive (unhelpful)

Provider unconsciously expresses feelings, emotions, and experiences

Identifying Cultural Countertransference

Requires cultural self awareness
Requires cultural competence
Provider awareness of countertransference

Transference and CounterTransference are concepts first developed by the psychologist Sigmund Freud. Transference is defined from the perspective of a person seeking psychological treatment. Using transference, The person in treat will redirect his or her feelings for others onto the therapist. In response to transference, CounterTransference occurs. CounterTransference means that the therapist transfers his or her emotions to the client in treatment in response to transference. There are two types of countertransference: defensive and reactive. Reactive countertransference is helpful because the therapist is making a conscious effort to share his or her emotions to facilitate a therapeutic relationship. Defensive countertransference is unhelpful because the therapist is expressing his or her emotions unconsciously. This does not facilitate a therapeutic relationship.
To recognize countertransference, cultural competence of one's self and others is critical. Countertransference is based on the reactions a therapist or health provider gives to a client's feelings. This client may or may not be in the from the same culture. Regardless of the culture, a therapist has to understand the differences between cultures and how feelings, emotions, and experiences may be expressed. If a health provider participates in defensive countertransference, they are projecting emotions and feelings that are not beneficial for therapy. These emotions and feelings are based on the cultural upbringing of the health provider not from the cultural outlook of the client. Any provider of care needs to develop an understanding of his or her culture and its biases. Once a provider has cultural self-awareness, reactive counterfrence can take place. The provider can consciously share culturally sensitive feelings and emotions that shows the client that the provider understands him or her and is not passing judgement.

References,

Countertransference. (2019, September 25). GoodTherapy. https://www.goodtherapy.org/blog/psychpedia/countertransference.

Mardoche Sidor, M. D. (2018, November 29). Wearing Your Psychodynamically Informed Hat: The Countertransference. SWEET Institute. https://www.sweetinstitute.com/sweet-institute-blog-and-news/2018/11/29/wearing-your-psychodynamically-informed-hat-the-countertransference.

9 of 13

Interesting Cultural Facts

African-Americans

Commonly misdiagnosed with Schizophrenia rather than a mood disorder

Hispanics

U.S. born Hispanics report higher rates for psychiatric disorders than immigrants

Asain-Americans

Eastern practices such as spiritual healing and herbal medicine are used to treat mental illness

Asian-Americans

Compared to whites individuals, African-Americans are more commonly misdiagnosed with schizophrenia instead of a mood disorder. As a nurse, I will pay special attention to how african-americans communicate symptoms of mental health issues because it differs from other cultures.

Hispanics

Within the hispanic population, those who are born in the United States report higher rates of psychiatric disorders compared to their immigrant peers. Because more mental health issues is reported in U.S. born I will try to assess this group more frequently for mental health problems.

Asain Americans

Some Asain-Americans use eastern practices like spiritual healing and herbal medicine to help treat mental illness. When working with an Asian-American client, I will assess their need for the use of complementary therapies to aid in treatment.

References,

Fortuna, L. (2020). Working with Latino/a and Hispanic Patients. Working with Latino Patients. https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-latino-patients.

Jayaram, G. (2020). Working with Asian American Patients. American Psychiatric Association . https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-asian-american-patients.

Starks, S. (2020). Working with African American/Black Patients. Best Practice Highlights. https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/best-practice-highlights-for-working-with-african-american-patients.

Trajkovska, B. (2019, June 3). 10 European startups revolutionizing mental health. EU. https://www.eu-startups.com/2019/06/10-european-startups-revolutionizing-mental-health/.

10 of 13

Social Media Post

11 of 13

References

Black/African American. NAMI. (2020). https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American.

Countertransference. (2019, September 25). GoodTherapy. https://www.goodtherapy.org/blog/psychpedia/countertransference.

Fortuna, L. (2020). Working with Latino/a andHispanic Patients. Working with Latino Patients.https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-latino-patients.

Greenstein, L. (2017, October 11). NAMI. 9 Ways to Fight Mental Health Stigma. https://www.nami.org/Blogs/NAMI-Blog/October-2017/9-Ways-to-Fight-Mental-Health-Stigma.

Grey, H., & Hall-Clark, B. (2016). Cultural considerations in Asian and Pacific Islander American mental

health. Oxford University Press.Jayaram, G. (2020). Working with AsianAmerican Patients. American Psychiatric Association.https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-asian-american-patients.

12 of 13

References

Latinx/Hispanic. NAMI. (2020). https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Latinx-Hispanic.

Mardoche Sidor, M. D. (2018, November 29). Wearing Your Psychodynamically Informed Hat: The Countertransference. SWEET Institute.https://www.sweetinstitute.com/sweet-institute-blog-and-news/2018/11/29/wearing-your-psychodynamically-informed-hat-the-countertransference.

2019 - Mental Health at the Intersection of Culture & Technology. (2019). University ofCalifornia. https://www.ucop.edu/student-mental-health-resources/training-and-programs/best-practice-conferences/culture-technology-2019.html.

Rubina, K. (2019,July 11). Four Ways Culture Impacts Mental Health. Mental Health First Aid. https://www.mentalhealthfirstaid.org/2019/07/four-ways-culture-impacts-mental-health/.

SAMHSA. 2018 National Survey on Drug Use and Health (NSDUH): African Americans. https://www.samhsa.gov/data/sites/default/files/reports/rpt23247/2_AfricanAmerican_2020_01_14_508.pdf

13 of 13

References

SAMHSA.2018 National Survey on Drug Use and Health (NSDUH): Hispanics, Latino, or Spanish Origin or Descent. https://www.samhsa.gov/data/sites/default/files/reports/rpt23249/4_Hispanic_2020_01_14_508.pdf

Starks, S. (2020). Working with African American/Black

Patients. Best Practice Highlights. https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/best-practice-highlights-for-working-with-african-american-patients.

Townsend, M. C. (2014). Psychiatric mental health nursing:Concepts of care in evidence-based practice (9th ed.). Philadelphia: F. A.Davis Company.

Trajkovska, B. (2019, June 3). 10 European Startups revolutionizing mental health.EU. https://www.eu-startups.com/2019/06/10-european-startups-revolutionizing-mental-health/.

Watters, E. (2010, January 8). The Americanization of Mental Illness.The New York Times.https://www.nytimes.com/2010/01/10/magazine/10psyche-t.html.