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Asian Americans and Cultural Values : Encountering and Overcoming

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Asian Americans and Cultural Values : Encountering and Overcoming Smith ScholarWorks Theses, Dissertations, and Projects 2010 Asian Americans and cultural values : encountering and overcoming sociocultural barriers to community mental health services : a project based upon an independent investigation William Lee Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Lee, William, "Asian Americans and cultural values : encountering and overcoming sociocultural barriers to community mental health services : a project based upon an independent investigation" (2010). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/527 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. William Lee Asian Americans and Cultural Values: Encountering and Overcoming Socio-cultural Barriers to Community Mental Health Services ABSTRACT This qualitative study explored the narrative experience of Asian American/Pacific Islanders (AA/PIs), who have received or are currently receiving community mental health services. This study was an attempt to illuminate their experience of encountering and overcoming socio-cultural barriers to these services. Historic underutilization of mental health services among AA/PI communities motivated the need to explore what cultural and/or institutional factors reduce barriers to services. Four AA/PIs, with an average length of 7.25 years in treatment, were recruited from a community mental health agency in San Francisco, CA. They participated in 45- minute to one hour semi-structured interviews discussing their experience in seeking and accessing mental health services. Thematic analysis was used to identify prominent themes in the narrative data. The study identified that individuals encountered specific socio-cultural barriers to services and utilized both personal and institutional factors in order to manage these barriers. Participants managed stigma with positive emotional and resource support that came mainly from their parents. Participants overcame lack of mental health services knowledge by complying with referrals, and trusting in clinician and agency outreach to manage personal and family issues. Findings also underscore the significant collective role of institutional factors of language services, cultural competency, location and Medi- Cal (California Medicaid) payment acceptance in outreaching and engaging AA/PIs. Support from immediate family members (with the exception of extended families) and friends was crucial in retaining participants in treatment. ASIAN AMERICANS AND CULTURAL VALUES: ENCOUNTERING AND OVERCOMING SOCIO-CULTURAL BARRIERS TO COMMUNITY MENTAL HEALTH SERVICES A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the degree of Master of Social Work William Lee Smith College School for Social Work Northampton, Massachusetts 01063 2010 ACKNOWLEDGEMENTS This thesis could not have been possible without all the people who have intersected and shaped my life with their investment, wisdom and support. First and foremost, I thank all the participants who shared their personal experiences in hopes to benefit other AA/PIs. I am deeply grateful for my thesis advisor, Mod Ono, LCSW, who guided, supported, pushed and encouraged me throughout this journey. This thesis is reflective of her commitment to my success. I could not have asked for more. I need to thank my family (Dad, Mom and Rebecca) for their ongoing support and belief in my ability to reach this far. I thank Jacky, Jeffrey, Jeniva, Kent, Wilbur, Queena and Sora for their years of love, friendship and for growing together with me. I would like to thank Nancy Kim and the Asian American/Pacific Islander Resource Center (AA/PIRC) for setting the foundation of this study during my undergraduate. Thank you Alan Kawamoto, Ph.D. and Qiang Liu, Ph.D. for paving my way into Smith College. I need to acknowledge Debra Salan, MSW, Ph.D., Nora Lindahl, LCSW, and Clifton Hicks, ASW, Ph.D. for their supervision and affirmation in shaping my social worker identity. Finally, thank you Smith community who has taught and challenged me in so many ways. Thank you for all the friendships and support in defining my Smith experience. i TABLE OF CONTENTS ACKNOWLEDGEMENTS…………………………………………………… i TABLE OF CONTENTS……………………………………………………… ii LIST OF TABLES…………………………………………………………….. iii CHAPTER I INTRODUCTION……………………………………………………… 1 II LITERATURE REIVEW………………………………………………. 5 III METHODOLOGY……………………………………………………… 40 IV FINDINGS……………………………………………………………… 49 V DISCUSSION…………………………………………………………… 73 REFERENCES………………………………………………………………….. 91 APPENDICES Appendix A: Human Subjects Review Approval Letter………………………… 96 Appendix B: Agency Approval Letters………………………………………….. 98 Appendix C: Informed Consent Letter…………………………………………… 101 Appendix D: Recruitment Materials……………………………………………… 105 Appendix E: Interview Guide……………………………………………………. 109 ii LIST OF TABLES Table …………………………………………………………………………. Page 1. Table 1: Demographics………………………………………………… 52 iii CHAPTER 1 INTRODUCTION This qualitative study explored the narrative experience of Asian American/Pacific Islanders (AA/PIs), who have received or are currently receiving community mental health services, and to illuminate their experience of encountering and overcoming socio-cultural barriers to these services. The study focused on exploring the narrative descriptions of socio-cultural barriers on cultural and institutional levels with an emphasis on the influence of cultural values in defining how barriers were encountered. Additionally, stigma and community involvement were highlighted in the context of overcoming these barriers. Other issues include exploring initial feelings about mental health services, referral sources, alternative treatment options and service retention. AA/PIs are currently one of the fastest growing minority groups in the United States, comprising 5% of the total U.S. population (13.5 million), and projected to increase up to 10% by 2050 (Reeves & Bennett, 2004). For the past thirty years, AA/PIs, particularly from those who identify as first and second generation, were found to underutilize mental health services (Abe-Kim et al., 2007; Kung, 2003; 1 Matsuoka, Breaux & Ryujin, 1997; Sue & McKinney, 1975; Uba, 1994). Recent empirical studies found socio-cultural barriers on both cultural and institutional levels affect utilization rates among AA/PIs (Atkinson & Gim, 1989; Chang, Tracey & Moore, 2005; Kung, 2003; Shea & Yeh, 2008). Identified socio-cultural barriers include culturally-influenced stigma (Mallinckrodt, Shigeoka & Suzuki, 2005), conflict between Asian and Western values (Kim & Omizo, 2003; Miville & Constantine, 2007), a lack of language accommodations (Uba, 1994) and a dearth of culturally sensitive mental health providers (Sue & Sue, 2003). If the AA/PI population doubles in 40 years, underutilization rates may continue to rise without attention to addressing the issue. Although there is a growing body of research on AA/PIs and mental health services, the majority of studies are quantitative in nature which does not capture the rich narrative of the AA/PI individual experience. Research in this area mainly focuses on help-seeking attitudes of AA/PIs who have not yet sought mental health services. Many of these studies focus only on college-level students as their sample population, which limits the generalizability of AA/PIs who are not college educated. Due to the lack of qualitative research on AA/PIs who have received community mental health services, this study serves as an exploratory attempt to elucidate the role cultural values play in the experience of AA/PIs who seek mental health treatment. 2 This study may be beneficial to the social work field by offering AA/PIs’ narrative perspective of the socio-cultural barriers they face as well as an understanding of whether and how they overcome these barriers to successfully access mental health services. The knowledge gained from the clients’ perspective can lead to developing tools for AA/PIs who face these barriers but are unable to overcome them. The study may also be a resource for AA/PI communities, clinicians, and community mental health providers to further develop outreach and gain a better understanding of how to approach AA/PI individuals in need. This study was motivated by my own personal experience in witnessing friends and family members suffer through long-term mental health issues without proper support. I have seen families deny the existence of psychological issues altogether. I have observed families crumble when they burden themselves to solely care for individuals. I have witnessed relatives feel unworthy of having children to prevent passing on their “illness.” And I have seen the lack of community attention to address the fact that my female counterparts (AA/PI women) are more likely to contemplate and attempt suicide than compared to all other ethnic groups in the U.S. (University of Washington, 2009). Thus, this study is an attempt toward this inquiry: what is the tipping point for AA/PI individuals to elect becoming consumers of mental health treatment? Can the same methods of overcoming barriers be applied to 3 other AA/PIs who face them? This study was conducted by interviewing four English-speaking AA/PI adult individuals who received or who are
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