Ingrid Ramos, MACharlottesville League of Therapists

April 8th, 2010

Mental Health as a Vehicle for Cultural Understanding

Issues of Poverty: food, safety,

shelter, education

Migration :Legal: Reunite

with family, work, opp.

Illegal: Crossing the border

Expectation in USA: Work,

comfort, School, Reconnect with

Family

Reality: -No Familism

-No Personalism-No work/ no dignity-No Language und.

-NO status

Coping Mechanism:- “God’’s will

-Aguantarse/Controlarse- Family (in country of

origin)

Emotional Symptoms:

-Worthless- being no body

-Lost “What am I doing here?

-Paranoid (If)- Women: Depressed,

over-reactive- Men: Out of

control Anger/ abuse of alcohol/ drugs

- Nostalgia: Issues of grief and loss

Increased Stress and Emotional Symptoms when the Dominant Culture intervenes

through:-School System- Department of Social Services

- Police- Legal System

Latinos’ Values and Beliefs

System:Dominant Culture

Values and Systems

Confronted with

Case Rosy is a 6 year old girl referred by Social

Services. Her school teacher made a report to CPS due to Rosy having a mark on her face and reporting that Dad hit her. The school counselor, social worker and family support worker addressed this issues with her parents, but they denied the child’s version and reacted angrily with school staff. They expressed feeling discriminated and misunderstood by personnel involved. They threaten to take the child out of the school.

Case – Family BackgroundAndrea and Julian have been together for 10

years. They migrated to the USA using the help of “coyotes” when they were single, 17 and 18 years old. The woman traveled from Honduras to the USA to reunite with her parents who left her 5 years ago. In her journey she was raped and had to fight for her life with the coyote. At the border, people rescued her and contacted her family in the USA.

The husband was sent by his parents to the USA to join other family members as a way to run away from a “brujeria’s work” (bewitchment) that a women put on him.

Case – Family BackgroundThe couple met in Texas. The intensity of the

domestic violence and husband’s drug addiction deteriorated the relationship and the wife’s family members tried to protect her. The attempts were in vain and the family decided to abandon her to her luck and decisions. The woman reported suffering “ataque de nervios”.

Common Family Patterns:1. Significant trauma in country of origin

(war, poverty, parents’ migration )2. Trauma at the border crossing, especially

for women (raped, starvation, long walks, stolen, unwanted pregnancy, etc.)

3. Domestic violence and alcohol consumption (or drug) usually by men

4. Isolation and lack of support system (even if having family around, economic issues raise stress among family members).

Common Family Patterns:5. Women overwhelmed by parental

responsibility because of lack of support from partner and family; Women trapped in abusive relationship

6. Issues of spirituality, beliefs influencing emotional state or decision making

7. Overreaction to any encounter with community services due to experience of perceived or real racism (prejudice based on community rumors or personal experience) as well as fear because of lack of understanding of the system.

Common Family Patterns:

8. Difficulty finding a job due to legal status

9. Difficulty maintaining job stability due to seasonal changes in the economy and inability to save on minimum salary wages.

10. High risks of being homeless, malnourished, and getting in trouble with legal system

Common Family Patterns:11.High stress levels lead to common health

issues or symptoms: stomachache, headache, chest pain, etc.

12.Grief and loss due to missing support of family and friends and feeling out of context in a different culture.

13.Parents don’t speak English and are illiterate in Spanish .

14.Children dealing with language and/or developmental delays .

Therapeutic Approach1. Intervention by a native speaking therapist

and an American Therapist2. Getting to know the family, interest in

understanding their lives and views, and validation of their experience allowed space for increased trust and joining.

3. Education about the American School System and parental responsibility in the USA.

4. Mediation between the family, social services and school.

5. Case Management to support client’s acculturation process and support in crisis (housing, health, school, food, etc.)

Outcome:Stabilization of home environmentPreserving the family Learning by modeling: Social skills,

parenting skills, etc.Integrating the family with the

community (introducing them to services, developing confidence, referring, etc.)

Contribution to their acculturation process: appreciating their own culture while assimilating dominant culture

Challenges In Therapeutic Sessions

1. Latinos’ stigma about Mental Health2. Sense of “Pride” limits disclosure in

sessions3. Sense of “Politeness”4. Identification of authority/ powers in

decision making in the family5. Language barriers between parent and

children/ sense of children’s identity.

Challenges in Providing Adequate Comprehensive Services

The complexity of Hispanic cases or refugees tend to create high stress level in the therapists providing services:

Limitation in funding sourcesLimited access to bilingual therapists in

the communityLimitation in case management

compared with the magnitude of the family’s needs

What can you do?

Identify the need for services Behaviors/ Symptoms/ Level of Stress Level of functioning (work, school, home,

community) Level of Risks

Know the Resources Support Groups Church Mental Health Providers in the area Emergency Phone number at Region 10

Provide a Bridge for Cultural Understanding

Thanks!!