CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Barriers to Mental Health Services Among Armenian-American Aged 55 and Over A graduate project submitted in partial fulfillment of the requirements For the degree of Master of Social Work By Marine Bambakyan In collaboration with Lilian Arellano May 2016 The graduate project of Marine Bambakyan is approved: _________________________________________ ______________ Dr. Amy C. Levin Date _________________________________________ ______________ Dr. Jodi L. Brown Date _________________________________________ ______________ Dr. Hyun Sun Park, Chair Date California State University, Northridge ii TABLE OF CONTENTS Signature Page ii Abstract iv Chapter 1: Introduction 1 1 Problem Statement and Research Question Chapter 2: Literature Review 3 Chapter 3: Methods 7 Research Design 7 Sampling 7 Data Collection 8 Measurement 9 Chapter 4: Analysis & Findings 10 Chapter 5: Discussion 13 Limitations 14 Implications 15 Conclusion 15 References 17 Appendix A: Table 1- Characteristics of Demographic Variables 19 Appendix B: Table 2- Barriers to Accessing Mental Health Services 21 Appendix C: Survey Questionnaire 23 Appendix D: Addendum 30 iii Abstract Barriers to Mental Health Services Among Armenian-American Aged 55 and Over By Marine Bambakyan Master of Social Work The purpose of this study is to identify the barriers that prevent older Armenian-Americans aged 55 and over, who live in residential buildings, from accessing mental health services. Limited research exists on the berries older Armenian-Americans encounter while trying to access mental health services. The available research found that there is a significant under-utilization rate of mental health services by ethnically diverse groups. This research was a quantitative study, for which sampling took place in Magnolia Towers, a residential building which houses a diverse group of older Armenian American adults. Survey questionnaires were distributed to one hundred Armenian residents at the building and a sample size of 37 completed surveys was collected as a result. Researchers concluded that, depending on the age, length of residency, language proficient and education levels, iv the significance of identified barriers of accessing mental health services might wary among Armenian American older adults. v CHAPTER 1 INTRODUCTION Problem Statement and Research Question Armenian-American older adults, ages 55 and above, encounter various barriers in obtaining mental health services. Sate of the State II 2013, articulates there is approximately half a million Armenians currently residing in the US and the number is growing. Despite the increasing population, there is a lack of research focused on issues of access and barriers to services as well as outreach strategies within the Armenian community. Therefore, a valuable and needed problem to be studied is the barriers older Armenian-American adults encounter when seeking mental health services. The purpose of the study is to identify the barriers that prevent older Armenian-Americans who live in residential buildings from accessing mental health services. Since mental health issues are viewed and understood differently by individuals from various cultures and ages, the identification of the barriers older Armenian-Americans encounter will provide an understanding of the specific barriers, which may relate to culture, stigma, societal views both in Armenia and United states, and familial experiences. An examination of barriers is vital to mental health providers for the purpose of understanding the issues of access and to determine how to improve greater access for older Armenian-American adults. The research is a quantitative study, which will utilize an anonymous survey that was developed by the study’s researchers. The survey seeks to address the study’s research question, which is, what are the barriers older Armenian-Americans encounter while accessing mental health services? The survey includes questions regarding participants’ demographics, as well as attitudes and beliefs about mental health. The 1 results of the study will demonstrate to be significant for the social work profession by adding to the limited research available regarding older Armenian-Americans. In addition, the results will promote a greater understanding of the Armenian-American culture and will encourage the development of methods to better serve the Armenian-American community. Furthermore, identifying barriers to accessing mental health services will improve providers’ ability to serve this community more effectively. 2 CHAPTER 2 LITERATURE REVIEW Within research, there are limited studies, which focus on Older-Armenian American adults and the barriers they experience when accessing mental health services. A reason for this may that racial and ethnic minorities in the United States have less access to mental health services and are more likely to receive poor-quality care compared to the dominant population (McGuire, & Miranda, 2008), therefore, creating less of an emphasis on the minority groups such as the Armenian population. According to McCarthy, Harutyunyan, Smbatyan, and Cressley (2013), there is a similar pattern of disregard internationally for Armenians, for example various research on mental health issues and counseling has recently been addressed in regards to “neighboring Turkey, Ukraine, and Iran, but the literature is scant on these topics specific to Armenia”. Hence, the lack of research is not only within the United States but also internationally, which further illustrates the need to develop a greater understanding and research on the Armenian population Within the research that is available, some studies have focused on the Armenian community in the United States and Armenia by identify the role religion and family dynamics have regarding ideas about the cause of mental illness, while others focus on the impact of acculturation stress, opinions about mental illness and attitudes about seeking psychological help, as well as the importance of maintaining cultural identity and the relationship with seeking services (Ayvazian, 2008; Baliotis, 2004; “State of the State II”, 2013; Yesayan, 2014). For instance, according to Baliotis (2004), “high religious and Orthodox Christian commitment strongly predicts high levels of religious ideas about the causes of mental illness and religious attitudes toward seeking treatment”. Although not explicitly stated, religion can pose as a barrier to accessing mental health services and can be difficult to penetrate due to the high value placed on religion within the Armenian culture. 3 Furthermore, many studies have highlighted the role family dynamics have on attitudes towards mental health issues and services. For instance, Van Baelen, Theocharopoulos, and Hargreaves (2005), identified that in Armenia, individuals with a mental health disorder are “hidden away by their family members, who are ashamed of them”. The family members of individuals with mental health disorders may be afraid of the stigmatizing label that can persist for a lifetime which may have indirect consequences on other members of the family since mental health issues are considered to be hereditary (McCarty et al., 2012). Currently, in Armenia, individuals with a mental health disorder and their entire family are socially isolated from the community due to the stigma associated with mental health disorders. Furthermore, Van Baelen et al. (2005), found that the Armenian government reinforces the stigma aimed at individuals with mental health disorders by requiring them to obtain a psychiatrists’ approval before applying for a driver’s license or a government level employment. The shame and stigma of mental health disorders and services perpetuated in Armenia are found to carry over with immigrant Armenians residing in the United States and may impact their willingness to talk about and seek mental health services. Along with shame and stigma, a lack of knowledge surrounding mental health disorders within the Armenian culture truly poses immense barriers in the pursuit of mental health services for those suffering with a disorder. Moreover, Older-Armenian Americans’ attitudes and beliefs about mental health may stem from Armenia’s mental health services’ history and current state. According to Von Schoen- Angerer (2004), there has been a blatant disregard for the care of those with mental health disorders in psychiatric hospitals in Armenia. For instance, in 1995 one of the psychiatric hospitals in Armenia cut the electricity at night during winter and disposed of patients’ dead bodies by carrying them over a hill and leaving them for the animals eat. The blatant disregard for those with mental health disorders in Armenia may have an immense impact on the value and attitudes towards not only those with mental health disorders but also mental health services in the United States. Despite the low number of studies done in Armenia, the studies present a 4 methodological strength due to the ability of tracing back perceptions of mental health to the populations’ country of origin. Additionally, these studies add to the understanding of mental health service systems as well as the stigma surrounding mental health disorders in Armenia, which in return, contribute to the attitudes, and beliefs Armenian-Americans have towards mental health. Immigrating to a new country can create various health disparities, which warrants greater research centered on minority groups. According to the surgeon general’s