ANTHROPOLOGY IN APPLIED CLINICAL MENTAL HEALTH RESEARCH Sheila A.M. Rauch, Ph.D. Clinical Director Emory Healthcare Veterans Program Emory University School of Medicine Atlanta VAMC

The views expressed in this presentation are solely those of the author and do not reflect an endorsement by or the official policy of the Department of Defense, the Department of Veterans Affairs, or the U. S. Government. The authors have no conflicts of interest to disclose.

MY CAREER Experimental paradigms for sexual perpetration and victimization Behavioral health intervention Program evaluation on small and large scales Treatment development, dissemination, and implementation Policy development Biomarkers and risk in the development and treatment of disorders Clinical trials for outcomes and translational treatment outcomes research

ANTHROPOLOGY IN MENTAL HEALTH RESEARCH Underutilized currently but growing within health services Qualitative methods of assessment Study of systems and culture Implementation science Can provide methods to study: Social context Historical perspective Influence of culture/s Some limited examples from my experience where we consulted with people in anthropology as well as one example where we did not but I see lots of potential

QUALITATIVE METHODS Focus groups Methodology to examine themes and pull out consistencies across less structured interview styles Look for themes within groups Veteran focus groups examining access and satisfaction with care Look for themes across groups Are the themes similar or different across genders, ethnicities, etc? Look for direction for next steps Can the themes inform treatment modifications or provide insight into creation of quantitative methods that can be applied to a larger population

VISN 4 MIRECC Behavioral Health Laboratory- Lead by Dr. Katz and Dr.Oslin New process being implemented to improve access to MH care in VA Designed based on focus groups with veterans Across veteran demographics they wanted to access options for MH care in PC Wanted immediate access to MH resources without referral Quantitative satisfaction and other measures developed based on these focus groups as well Looking at scheduling data for access Asking veterans about their satisfaction with quality, speed of scheduling, and access to specific MH resources

DISCONTINUATION OF BENZODIAZEPINES IN OLDER VETERANS Focus Groups examined Beliefs about benzodiazepines Long-term effects Tolerance Risk of falls an injury Efficacy Willingness and when they would consider reduction or discontinuation Able to determine that beliefs about benzodiazepines were often inaccurate and problematic Few people wanted to discontinue even when they know the associated risks in older adults

IMPACT OF PROGRAM DESIGN Focus group analysis informed: Intervention design Focusing on provision after risk events (such as falls or reduced cognitive function) when people most amenable Integration of MI to increase motivation for reduction when needed Measure design included outcomes of concern and value to the veterans that may not have been apparent Sleep even for those not taking the medication for that purpose Social function

TRIPLE DISASTER, JAPAN On Friday, March 11, 2011, an earthquake with a magnitude of 9.0 on the Richter scale occurred about 40 miles off the coast of Sendai, Japan. Officially known as the Great East Japan Earthquake, the disturbance caused a tsunami of waves up to 120 feet high traveling as far as 6 miles inland. The earthquake is the largest to have ever occurred in Japan and is the fourth largest in the world since recording began in 1900 (US Geological Survey, 2011). The Tsunami caused failures at the nuclear power plant leading to contamination. The disasters were associated with over 24,000 deaths or missing people and over 5,000 injuries (Japanese National Police Agency, 2011); additionally, between 400,000 and 170,000 individuals have lost or were evacuated from their homes within the month following (Japanese Fire and Disaster Management Agency, 2011).

COMMUNITY REQUEST FOR HELP Team of Psychologists went to Mito and Tokyo to work with community activists and mental health professionals to respond to the needs of the Japanese people. Expertise is in trauma response, recovery, and treatment of PTSD and related issues. Expertise is NOT Japanese language, Japanese culture, and Japanese mental health systems.

PREPARATION Preparatory calls with our Japanese colleagues Research on Mental Health System in Japan Resources available Translating materials Slides Videos Measures Group discussions Working with Japanese culture Set up problem solving tasks and small groups to share results

WHY CONSIDER ANTHROPOLOGY? CONTEXT Cultural context Historical context Systems context Assist with effective implementation What are the ways that this culture disseminates knowledge naturally? Can we utilize some of those existing systems? What are the absolute low likelihood methods for this system? What should we avoid? What are the most salient issues for this population and how can we address them in interventions and assessment?

SUMMARY Not extensive experience with anthropology but see its value across MH research Anthropology can provide: New perspectives Context Establish themes Improve intervention and assessment Much more