MH Education Should Be Tailored to Minorities' Values

Christopher Amenson, Ph.D., offered a telling example of the hazards of assuming that Euro-American strategies to help families cope with mental illness will be universally applicable.

In many cultures, he said, people are reluctant to go to strangers when they are in trouble. Reaching out beyond the extended family for support or even information can be viewed as evidence that the entire family has failed. Yet self-help groups are premised on the idea that unrelated people who share a serious problem can provide valuable help to each other.

In the lecture “Outcomes for Psychoeducation for Diverse Patients,” Amenson told attendees at APA's 2005 Institute on Psychiatric Services about the impact of the disconnect between Euro-American values and practices and those of other cultures on efforts to provide education to families affected by mental illness.

He is faculty chair of the Pacific Clinics Institute, which provides education and training promoting recovery for people with serious mental illness. The institute serves an ethnically diverse population in southern California.

The National Alliance on Mental Illness gave Amenson the Outstanding Psychologist award in 2001 for his work with families who are caring for a person with mental illness.

Amenson told the audience, “Remember a basic principle of psychotherapy: `Begin where the patient is.' We need to apply that idea to family psychoeducation as well.”

Disproportionately few families of color participate in family psychoeducation programs, he said, but outcomes can be as positive as those for Euro-American families when the programs are tailored to reflect the participants' cultural values and practices.

Such tailoring begins with methods of recruitment. Recognize the importance of personal connections in encouraging a family or individual to seek help, he advised.

Neither brochures nor invitations to educational meetings are effective outreach methods among members of some cultures, said Amenson. “Invite families to a `get-acquainted' social event,” he suggested. Working through community and religious leaders has been successful in his experience to encourage participation.

The need for a social exchange is important even at the first encounter with an agency. “The person who answers the phone should be willing to spend several minutes chatting with the caller rather than merely trying to schedule an appointment,” he said. “You might get only one chance with that family.”

Acknowledgement of the existence of cultural differences has also been an effective strategy for Amenson. He tells families on the first visit about an instance in which his well-intentioned actions offended a family because of his unfamiliarity with their significance in that family's culture.

Amenson contrasted Euro-American values of independence and autonomy with those of other cultures that emphasize harmony and family unity. Rather than trying to promote independence from the family for the person who is ill, a therapist should try to build on the family's strengths and use community supports to help the person find a more satisfying life within his or her cultural framework.

Amenson gathered more than 40 members of an extended Latino family together in a Los Angeles backyard to develop strategies to help a young man with schizophrenia. The man's sister realized that he could safely serve as a babysitter for her children. His brother arranged for him to become an unpaid manager of a soccer team.

A prayer group at the man's church “adopted” him and enabled him to sit through services without becoming a distraction. The priest gave him volunteer work as a gardener, after seeing changes in his behavior. After a year of improvement, a grocer, who had attended the initial backyard meeting, offered the young man a paid job stocking shelves.

“The young man never attended a session at the clinic,” Amenson said. “Instead we used the natural supports in the environment.”

Amenson pointed out one final challenge in working with some families of color. “It's hard to get into a family, but it's also hard to get out.... You are part of the family forever. People will come to you for advice because you have become the `family helper.'”

The rewards, however, are “tremendous.” A success with an extended family of color can be “greater and more profound,” he said, because change affects such a large network of people.

Information about Pacific Clinics Institute is posted at<www.pacificclinics.org>.▪