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BEHAVIORAL HEALTH AMONG MICRONESIANS Behavioral Health Teleecho Clinic

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BEHAVIORAL HEALTH AMONG MICRONESIANS Behavioral Health Teleecho Clinic BEHAVIORAL HEALTH AMONG MICRONESIANS Behavioral Health TeleECHO Clinic August 20, 2019 Davis Rehuher, BA1, Earl S. Hishinuma, PhD1, Keisha Willis, BS1, & Sidney Roberts, BS1 Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number U54MD007601 1Department of Psychiatry, John A. Burns School of Medicine, University of Hawai‘i at Mānoa OBJECTIVES BACKGROUND MENTAL CULTURAL AND CONTEXT HEALTH ASPECTS Micronesia In the Micronesian Cultural Geography region considerations Political Status Among migrants in Resources the US Interests Implications and Indicators Recommendations Migration MICRONESIA, MELANESIA, POLYNESIA MICRONESIA FEDERATED STATES OF MICRONESIA UNITED STATES AFFILIATED PACIFIC ISLANDS - MICRONESIA US Territories COFA Nations THE MICRONESIAN REGION Selected Selected Indigenous Indigenous Area Political Status Citizenship Populations Languages Guam Unincorporated Territory US Chamorro Chamorro Commonwealth Chamorro Chamorro N. Mariana Islands US Territory Carolinian Carolinian F. S. Micronesia Freely Associated State FSM Chuukese Chuukese Chuuk State FSM State FSM Carolinian Carolinian Kosrae State FSM State FSM Kosraen Kosraen Pohnpeian Pohnpeian Pohnpei State FSM State FSM Nukuoro Nukuoro Kapingamarangi Kapingamarangi Yapese Yapese Yap State FSM State FSM Ulithian Ulithian Marshall Islands Freely Associated State Marshall Islands Marshallese Marshallese Palau Freely Associated State Palauan Palauan Palauan GUAM NORTHERN MARIANA ISLANDS FEDERATED STATES OF MICRONESIA FEDERATED STATES OF MICRONESIA FEDERATED STATES OF MICRONESIA FEDERATED STATES OF MICRONESIA REPUBLIC OF THE MARSALL ISLANDS REPUBLIC OF PALAU RECENT HISTORY COLONIAL HISTORY Country Period Spain 1886 - 1899 Germany 1899 - 1914 Japan 1914 - 1944 United States 1944 - 1995 Trust Territory of the Pacific Islands (TTPI) 1947 - 1994 TTPI was 1 of 13 Truk (Chuuk) Trust Territories of Ponape (Pohnpei) the United Nations Kusaie (Kosrae) post World War II Yap United States Marshall Islands mandated to Palau help develop Northern Mariana self-sufficiency Islands Nuclear Weapons Testing in the Marshall Islands “FOR THE GOOD OF MANKIND” Between 1946 and Equivalent to 1958, 67 nuclear tests 7,200 were conducted Hiroshima bombs Displacement from Health effects homes, evacuation (cancer, birth defects) to other islands linger to this day Nuclear Weapons Testing in the Marshall Islands Largest ever American nuclear blast The blast left a crater 2,200 yards across and 80 yards deep, shaking islands 120 miles away Radioactive fallout reached Australia and Japan 42 coral species missing, with at least 28 locally extinct Destruction of Bikini Atoll, March 1, 1954 Nuclear Weapons Testing in the Marshall Islands Effects of radiation Illness from acute radiation exposure Illness from chronic radiation exposure Loss of land Cultural and social disruption Nuclear Weapons Testing in the Marshall Islands Runit Dome, Enewetak Atoll Constructed in 1979 to temporarily store radioactive waste from nuclear testing Concern of potential for waste to leak from underneath the dome and contaminate surrounding areas Nuclear Weapons Testing in the Marshall Islands Brewery named after Manhattan Project, first nuclear weapons developer, released in 2019: Bikini Atoll – no Bikinians live there today, except for 4-6 caretakers Half-Life – refers to length of time for 50% of nuclear decay Hoppenheimer – Hops (beer ingredient) + Oppenheimer (father of nuclear bomb) Plutonium -239 – extremely dangerous; stored in Runit Dome; half-life of 24,000 years Nuclear Weapons Testing in the Marshall Islands Not the first time Bikini Atoll has been appropriated in popular culture Bikini Atoll Beer Bikini – two piece bathing suit. Named in the late 1940s to capitalize on “explosive” social reaction Compacts of Free Association (COFA) United States with: “Compacts allow for citizens of the Freely Associated States Federated States of Micronesia (FAS) to enter the 1986 - Present USA to engage in occupations and Republic of the Marshall Islands establish residence 1986 - Present as non- immigrants” - US Department of Republic of Palau Commerce 1994 – Present Compacts of Free Association (COFA) What does the US get in return? MILITARY STRATEGIC MILITARY RIGHTS DENIAL INFRASTRUCTURE Strategic rights US can deny US has the to the region any other right to over water, country military establish land and use of the military bases airspace Micronesia any time and region anywhere in the region ECONOMIC AND HEALTH INDICATORS SELECTED INDICATORS Life Average Underage Expect. Per Capita HouseHold Unempl. Area Population (%) (Years) GDP (US$) Size Rate (%) Guam 159,358 36 79 30,000 3.8 8.4 N. Marianas Islands 53,883 36 76 15,359 3.3 16.8 Federated States of 102,843 43 69 2,341 6.1 16.2 Micronesia Chuuk State 48,654 44 n/a 1,411 6.9 24.6 Kosrae State 6,616 44 n/a 2,323 5.8 23.0 Pohnpei State 36,196 43 n/a 3,138 5.8 9.0 Yap State 11,377 39 n/a 3,532 4.9 6.0 Marshall Islands 53,158 46 72 2,918 6.8 34.0 Palau 17,501 28 72 11,145 4.0 4.2 HEALTH ISSUES Cancer Heart disease Diabetes Stroke Sepsis Lung disease Malnutrition Obesity OTHER CONCERNS Unemployment Climate change Education Food security Infrastructure Natural disasters Political status MIGRATION REASONS FOR MIGRATION Employment Education Health care MICRONESIAN POPULATION HAWAI‘I 2010 Ethnic group 2000 2010 Growth Guamanian or Chamorro 4,221 6,647 57% Micronesian 6,492 11,645 79% Marshallese n/r 6,316 n/r Chuukese n/r 2,563 n/r Palauan n/r 1,216 n/r Pohnpeian n/r 775 n/r Kosraen n/r 494 n/r Yapese n/r 281 n/r MICRONESIAN POPULATION UNITED STATES 2010 Guamanian or Chamorro 147,798 Marshallese 22,434 Palauan 7,450 Chuukese 4,211 Pohnpeian 2,060 Saipanese 1,031 Yapese 1,018 Kosraen 906 Carolinian 521 Mariana Islander 391 Thousands MICRONESIAN POPULATION GROWTH UNITED STATES 2000 - 2010 Chuukese 544 Kosraen 301 Marshallese 237 Carolinian 201 Pohnpeian 194 Yapese 177 Mariana Islander 177 Saipanese 117 Palauan 115 Guamanian or 60 Chamorro Percentage MENTAL HEALTH IN THE MICRONESIAN REGION SUICIDE Most studied mental health problem Hezel and Rubinstein published several studies Most studies from 1970s through 1980s, a few in the 1990s Most recent are from Guam (Booth, 2010; Twaddle et al, 2011; Ran, 2015) Since peaking in the late 1980s, suicide trends since the 1990s are unclear due to lack of research data (Ran, 2007) SUICIDE RATES Area Deaths/100,000 Guam 21.0 Chuukese 52.9 Chamorro 30.0 Other Micronesian 12.4 Palau 21.7 Federated States of Micronesia 13.0 Marshall Islands 24.5 SCHIZOPHRENIA Most schizophrenia studies in Micronesia are on Palau Palau has one of the highest lifetime prevalence in the world: 2.77% for males and 1.24% for females (Myles-Worsley et al 1999) Higher prevalence in western Micronesian (Palau and Yap) than eastern Micronesia (Chuuk, Pohnpei, Kosrae, Marshall Islands) (Dale, 1986; Hezel & Wylie, 1992) Males have more than twice the rate as females (Hezel & Wyle, 1992; Myles-Worsley et al 1999) SUBSTANCE ABUSE Alcohol Tobacco abuse is a serious use is widespread – smoking issue across the region and with betel nut Marijuana Methamphetamine high prevalence use in Guam, Northern throughout the region Mariana Islands, and Palau Inhalants Heroin (sniffing glue and gas) in serious outbreak Chuuk and Palau in Palau in the 1980s Sakau Betel nut (kava) in Pohnpei a traditional tradition in Yap, Palau, Guam practice and N. Mariana Islands INTIMATE PARTNER VIOLENCE Federated States of Marshall Micronesia Palau Islands Percentage ever-partnered women reporting having 32.8 25.2 48.0 experienced physical violence in their lifetime Of above, percentage with experiences in the past 12 34.7 8.0 16.0 months MENTAL HEALTH CARE RESOURCES Workforce Development Marshall Islands (WHO, 2015) • 0 appropriately trained mental health professions Federated States of Micronesia (WHO, 2015) • 1 rotating psychiatrist Based in Chuuk (may have left By 2018) • Trained mental health counselors and outreach workers Palau • 1 psychiatrist (Palauan) Pacific Behavioral Health CollaBorating Council • Provides suBstance aBuse counseling across the region MENTAL HEALTH CARE RESOURCES Availability of Mental Health Facilities Marshall Islands (WHO, 2011) • 2 mental health outpatient facilities • 0 day treatment facilities • 0 psychiatric beds in hospitals Federated States of Micronesia (WHO, 2011) • 4 mental health outpatient facilities • 0 day treatment facilities • 0 psychiatric beds in hospitals Palau (WHO, 2011) • 4 mental health outpatient facilities • 8 day treatment facilities • 8 beds psychiatric beds in hospitals TREATMENT GAP World Health Organization estimates of treatment gaps in Micronesia Federated States of Micronesia 92% Marshall Islands 90% Northern Mariana Islands 90% On Guam, of almost 15% of adults reporting a serious mental illness, only 5% reported receiving treatment (David & Rosadino, 2015) MENTAL HEALTH AND BEHAVIORAL WELLNESS AMONG MICRONESIAN MIGRANTS IN THE UNITED STATES NEED FOR MENTAL HEALTH SERVICES IN HAWAI‘I FOR MICRONESIAN MIGRANTS Needs assessments found need to provide mental health services to Micronesian migrants: Statewide (Healthcare Association of Hawai‘i, 2015) Micronesian community memBers (University of Hawai‘i Department of Public Health Services, 2009) Homeless shelter (Lee, et al., 2007) HOSPITALIZATIONS IN HAWAI‘I Micronesians hospitalized at younger ages and often sicker than comparison groups, including for mental health (Hagiwara
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