Crisis Intervention Training - PowerPoint Presentation

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Crisis Intervention Training

Mental Illness, Diversity and Cultural Awareness

1Slide2

Why Cultural Awareness?

Crisis intervention usually involves quick actions to restore a victim's equilibrium to safe and predicable living.

As

such, crisis intervention is usually an immediate and temporary intrusion into the life of a person

with referral to after-care remediation if needed. Typically, the focus of crisis intervention is directed to such personality factors as coping mechanisms and individual resilience, as well as to such environmental factors as the sources of emotional support.

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Culture insensitivity is the lack of knowledge or disregard of someone’s social appropriate behavior and manners.

On the other hand, cultural sensitivity is being aware that cultural differences and similarities between people exist without assigning them a value – positive or negative, better or worse, right or wrong.It simply means that you are aware that people are not all the same and that you recognize that your culture is no better than any other culture.

A

challenge, if you ask me, for members of

dominant cultures.3Slide4

Dominant Cultures

In life and work environments we frequently face situations where there is a dominant and a secondary culture. For instance, in the U.S. the European American is the dominant culture whereas Hispanic, African American and Chinese cultures are all secondary.

Cultural

sensitivity implies that both groups understand and respect each other’s characteristics.

Of course, this is always a challenge and even more so in large institutions, such as law enforcement where the dominant culture is the one Cops are expected to adopt.Remember, the Cop coming into a house is operating under the Use of Force continuum and is so interpreted as such by the family.

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Given dominant culturalism, the cultural context of crisis events is often neglected

This may increase the level duress already underway in the encounter, without the Officer actually doing or saying anything at the onset.Culture has a subtle but powerful influence of culture upon the appraisal of victims and circumstance. In this regard, helping the victims of trauma requires crisis interveners to become aware of their own cultural assumptions; demonstrate an ability to communicate an understanding, acceptance and appreciation of cultural differences; and identify available resources from the victim's culture to assist with crisis resolution and aftercare. 

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Concerning Interventions in General

Crises occur because helpers/significant others of mentally ill people in crisis often do not know what to do

In which case, they respond to their own cultural underpinnings to inform or guide their behavior.

Yet, they still need social support systems, case management and collaboration like anyone else.

Often times there will be denial and they resist your attempts to support them.In which case, you need to be prepared for culturally different reactions that range from

fear, repulsion, anxiety, embarrassment and avoidance to

achieving meaningful collaboration with the helpers with the sick one.

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If you find yourself unprepared of affronted

by multicultural responses to psychiatric based crisisThen honestly reflect on your own attitudes and the affront you are feeling concerning the difference in responses you are seeing in other people, relative to their gender, culture or ethnic origin.

Denial, Defense and Minimization is at work!

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Denial

At this stage of cultural sensitivity, people don’t recognize cultural differences and experiences. They believe their culture is the only “real” one and they tend to interact in homogenous groups and to stereotype everyone else. Example

: People who say,

“

We are all the same and I don’t understand why we have to learn about the different groups in the company. Why don’t they just learn how we do things in America? ”8Slide9

Defense

At the defense stage of cultural sensitivity, people recognize some differences, but see them as negative because they assume their culture is the most evolved, the best one. Example: People who say,

“Hispanics…you

can’t just get to the point and talk business. They want to tell you their life story. I don’t understand why they can’t just learn to be more direct and save everyone time

.”9Slide10

Minimization

Individuals at this stage of cultural sensitivity are unaware that they are projecting their own cultural values. They see their own values as superior. They

think that the mere awareness of cultural differences is enough.

These

people think we are all the same because we are more similar than different and, in the end, we all have similar physical, biological, psychological needs etc. They think they are wonderful because they see people as people but they are actually denying the influence of culture in every person’s experience. Example:

Statements

such as, “In the end, we all want to be liked,” or, “We are all people

.”

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Achieving Acceptance

At this stage of cultural sensitivity people are able to shift perspectives to understand that the same “ordinary” behavior can have different meanings in different cultures. They may not agree or even like the differences they observe but they are interested in finding out and learning about another culture.

They

are able to identify how experiences are influenced by one’s culture.

Example: People who approach others with genuine interest and curiosity about how they experience the same situations.

They

ask questions such as,

“

What would your family do in a situation like this

?” Or, “How

do

Latinos do

it

?”

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For instance, and in general, culturally sensitive issues facing you with 3 minority groups in dealing with Mental Illness will be:

Asian-Americans:

Feel Shame

and Obligation

Endure Rigid family roles and structuresHence, you interventions

should be problem focused and formal

Mexican-Americans

:

Are Enmeshed

family structure

There are Language

Barriers

Different Levels of Acculturation

Rely on a strong

Catholic

religious focus when in crisis

African-Americans

:

Have a History

of

enduring racism

dating back to slavery

Group with the most salient differences from mainstream group

Distrust of

mainstream Institutions, such as Cops

Use the clergy

as traditional support system when in crisis

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Specifically speaking, Asian Americans & Mental Health

Many Asian Americans to include the Hmong have considerable conceptual difficulties regarding the Western notions of mental illness and mental health services.Asian Americans frequently experience and express mental illness very differently from Westerners, often emphasizing

somatic

(i.e. bodily) rather than psychological or psychiatric symptoms

Individuals such as Asians who embrace the theory of mind-body holism often experience great difficulty distinguishing between psychological and physical ailments.13Slide14

Asian Americans & Mental Health

Asian Americans and Hmong are often uncomfortable with the concept of examining and

discussing one’s

inner thoughts and

feelingsThe commonly held Asian belief that the best way to deal with mental illness is to avoid morbid thoughts and repress emotions.

In

many Asian cultures, a mentally ill family member or friend is

considered a

disgrace and in some cases, the family quietly encourages

and or approves of that person committing

suicide, to spare the family the disgrace.

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Asian Americans & Mental Health

It follows, there is a consistent pattern of underutilization of mental health services among Asian Americans has been well documented for several decades.

Those who do receive mental health treatment are often greatly delayed in help-seeking, and thus tend to be more severely ill upon treatment initiation, oftentimes taking place following a crisis

situation

Be prepared…you may have resistance connecting with some Asians when your recommend their sick ‘significant other’ seek professional help.

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Asian Americans & Mental Health

Beliefs Specific to Chinese CultureMental

illness may be viewed as retribution for

the misdeeds

of ancestors or immediate family Interpretations of causes of depression include fate, imbalance

of energy in the body or disharmony

in natural

forces

Suicide

, a potential result of depression,

is discouraged

in Chinese society.

However

, it is

not considered

a sin—if the death is viewed as

relieving the

family of a

burden

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Asian Americans & Mental Health

Beliefs Specific to Japanese Culture

The

values most respected in Japanese-American culture are

self reliance, self-control, independence and family honor. Mental health issues

have been a taboo subject fraught with stigma

and associated

with

shame

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Older Japanese Americans have coped with trauma associated with internment based on their own resources.

“Shikata

go

nai

,” translated as “it can’t be helped,” is a dominant coping strategy, which continues to affect family communications and behavior associated with identity and controlSuicide has historically been more accepted as an honorable alternative to shame. In the face of depression, suicide may be seen as more honorable than facing the shame of mental illness.

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Asian Americans & Mental Health

Beliefs Specific to Hmong Culture

Once

a life event that may have resulted in

nyuaj siab (depression) is passed and a healing ceremony

has been

conducted to relieve the depression,

nyuaj

siab

will

no longer exist

If

this normal depression—

nyuaj

siab

—continues,

the individual

risks the label of “crazy,” resulting

in reluctance

to seek assistance either physically

or mentally

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Asian Americans & Mental Health

A few facts to know:

Asian

American adolescent boys are twice as

likely to have been physically abusedAsian

American women aged 15–24 and 65+

have the

highest suicide rates in the U.S. out of all

racial and

ethnic groups

40

% of Southeast Asian refugees suffer

from depression

, 35% from anxiety, and 14%

from posttraumatic

stress disorder (PTSD)

The

suicide rate among Chinese American

elderly women

has been found to be 10 times higher

than for

Caucasian elderly

women

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Specifically, African Americans & Mental

HealthHistorical and contemporary negative treatment

has led to mistrust of authorities

, many

of whom are not seen as having the best interests of African Americans in mindYou as a uniformed officer may suggest even more trouble for them at the onset in dealing with the crisis due to this fact alone.Therefore, understanding

why African Americans

with mental

illness may reject treatment

is essential

to breaking down barriers

and helping

them get the care they

need

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African Americans & Mental Health

The proportion of African Americans who fear mental health treatment is 2.5 times greater than the

proportion of

Whites

who do so… this stigmatized existence leaves many African Americans wide open to anti-psychiatry campaigns…Some messages warn black communities of a

genocidal plot

to place African-American children on Ritalin…

Others convey that psychiatry is evil and destroys religion

, which

is very important to African

Americans

Source

:

http

://

pn.psychiatryonline.org/cgi/content/full/36/20/19

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African Americans & Mental Health

Blacks of all ages are more likely to be the victims of serious violent crime than are whites…

The link between violence and

psychiatric symptoms

and illness is clear…One study reports that over one-fourth of African American youth who have been exposed to violence

have symptoms severe enough

to warrant

a diagnosis of

PTSD

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African Americans & Mental Health

Although schizophrenia has been shown to affect all ethnic groups

at the same rate,

Blacks

in the United States are more than four times as likely to be diagnosed with the disorder as whites

Only

16 percent of African Americans with a diagnosable

mood disorder

see a mental health specialist, and fewer than

one-third consult

a health care provider of any

kind

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African Americans and Mental Health

Only 16 percent of African Americans with a diagnosable mood disorder see a mental health specialist, and fewer than one-third consult a health care provider of any kindAfrican Americans are thought to make extensive use of alternative treatments for mental health problems.

This

preference is deemed to reflect African American

cultural traditions developed partly when African Americans were systematically excluded from mainstream health care institutions

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Latinos & Mental

HealthStigma and embarrassment remain major barriers to care among Latinos of all

age groups

In Latino culture, people

think that you are mentally retarded, not mentally ill if they know you see a psychiatrist.

In the Latino culture, they often confuse

mental

illness with

mental

retardation

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Latinos & Mental Health

Many Latinos do not view mental illness as a medical

problem and as a result, do not seek

help when

they experience mental health problems.Latinos may rely on home remedies “remedios

caseros

” and prayer when they are experiencing

a mental

health crisis instead of seeking medical care.

Maintaining

family members with disabilities in

the family

home is often an important goal for

Latino families

, who are less likely to place their

family member

in an outside

facility

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Latinos & Mental Health

Mental Health is often viewed as the result of balance

among one’s faith, nutrition and how

one has

lived his or her lifeFolk concepts of disease relate to the effects of intense negative emotions such as anger, envy

and fright

. Treatments can include rituals based

on purification

, social reintegration and penance

Susto

or fright illness is one of the adult folk

illnesses that

have some overlapping symptoms

with depression

such as nervousness, listlessness,

loss of

appetite, or insomnia

.

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Latinos & Mental Health

A few facts to know:Although

schizophrenia has been shown to affect all

ethnic groups

at the same rate, Latinos in the United States were more than three times as likely to be diagnosed with the disorder as Whites

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Native Americans & Mental

HealthThe diversity among Native American must

be noted

. There

are over 500 federally recognized nations, tribes, bands and Alaskan Native villagesSome tribal groups attach little stigma to mental disorders because no division exists between physical and mental illness.

Other

groups identify

mental health problems

as shameful

Some

traditions view depression as a form of

spiritual possession

, whereas others may see mental illness

as imbalance

with the natural

world

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Native Americans & Mental Health

Some Navajo elders view physical and mental illness as disharmony caused by an external force, such as a person or spirit

Western treatment traditions of personal insight, awareness or self-actualization often run counter to Indian traditions that value the balance of the physical, mental and spiritual, interrelationships over independence, and a shared sense of trauma.

Healing comes from identifying stress in the community, and is resolved through community ceremonies and traditional practices

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Middle Eastern and Arab Americans & Mental

HealthMental illness is considered to bring shame to

the family

. While honor, or

sharaf, plays an important protective social role in many Arab-American families, actions perceived as shameful can be ignored

or hidden

Family

tradition places the male in the role

of breadwinner

.

Unemployment

often affects men

more than

women deeply, triggering mental

distress

Isolation

for refugees and immigrants due to

economic hardship

, language and assimilation barriers

, separation

from other family members, and loss

of status

may lead to mental health

crisis

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Subgroups, the Disabled Population

For the disabled elderly: intervention must be holistic.

Alzheimer’s

dementia are stressful for entire family

About half of the elderly suffer from at least one severe disability33Slide34

People with Disabilties

Physical or mental impairment that substantially prevents or restricts the ordinary course of human development and accomplishments.Often viewed as weak, dependent, abnormal and inferior.Americans with Disabilities Act (ADA) challenges discrimination against disabled

34Slide35

Are also protected by the ADA

Include disorders such as major depression, bipolar disorder, schizophrenia, panic disorder, obsessive compulsive disorder, anxiety disorders, and PTSD.Mentally disabled people

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Gays, Lesbians, Bisexuals and Transgender (GLBT’S

) PeopleGay: typically refers to male homosexualsLesbians: female homosexuals

Bisexuals: male or females who are attracted to same sex and opposite sex partners

Transgenders

: People who feel that they were born the wrong gender and change from male to female or female to male36Slide37

Some drivers for GLBT Psychiatric Issues

SuicideFear of being discoveredFamily crises because expectations won’t be met

“Coming out”

Sex-change

surgery37Slide38

Developmentally Disabled People

Mental retardation, cerebral palsy, epilepsy, autismRights are a big issueLiving to be elderly nowNeed extensive and complex treatments

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