‘HOPE FOR THE FUTURE’ Supporting Community Connections (SCC) ‘A Suicide Prevention & Early Intervention Project’ SCC Presentation, 2015

Purpose Of The Project The Hope For The Future Project offers cultural/age specific outreach activities and support services for Russian-speaking people with emotional, psychiatric and physiological problems with the goal of suicide prevention in the Sacramento County. StopStigmaSacramento.org

Russian-Speaking Community In Sacramento County  Over 150,000 immigrants/refugees from Russia and other republics (15) that formerly comprised the Soviet Union now live in Sacramento County.  Most of the immigrants from the former Soviet Union will speak Russian (“mandatory” language), although they may also know the specific languages of the republics where they used to live.  Providers should not assume that they are all “Russians” as a number of them are actually from the Ukraine, Belorussia, Moldova, Latvia, Uzbekistan, or other republics.

Russian-Speaking Community In Sacramento County  The population of the former USSR was composed of over 180 different nationalities speaking on 130 different languages. Russian was and still remains the language of interethnic communication.  Usually, all immigrants from the former Soviet Union are more or less fluent in Russian, therefore, it is more appropriate to refer to them as "Russian-speaking", instead of "Russians“ or “Slavic”, if you do not know their ethnic origin.

Leaders & Map of the Soviet Union before 1990 Lenin Stalin Khrushchev Brezhnev Gorbachev

 Community organized around 80+ churches, mostly Baptist and Pentecostal; many young adults attend American churches. Older immigration primarily Russian Orthodox.  Community leaders acting as the gatekeepers.  Special role of pastors in the Evangelical refugee community. Russian-Speaking Community In Sacramento County

 Many Russian-speaking immigrants resettling in the Sacramento have difficulty in adjusting to new physical setting, language, culture, the pressure to be self- sufficient, etc.  Language, cultural barriers, isolation, unemployment, and financial insecurity are the hardest obstacles to overcome. Moving to different cultural environment provided immigrant families with enormous stress. It negatively affected relations between family members, children, teenagers, etc. Russian-Speaking Community Refugee issues

Prevalence Rates of Mental Illness  In their homeland, Slavic people exhibit a high rate of mental illness. At least 10% of the Slavic population from former Soviet Union is in need of some kind of mental health care, with almost 3% having severe mental disorders (CDI, 2005).  Problems with addiction, depression, and suicide are endemic. In life satisfaction survey data, Russia, Ukraine, Belarus, and Moldova are among the lowest six countries out of 68 (the U.S. is 13th) (Veenhoven, 2001).

Russian-Speaking Community Cultural Background  To better understand the cultural and religious background of the Slavic population from the former Soviet Union, mental health services providers must consider the traumatic environment from which this population came.  Chronic deprivation of human rights, oppression of political and religious freedom, and oppression of various cultural and ethnic groups.

 Mental illnesses generally carried a strong negative stigma in the former Soviet Union, where these conditions were often treated by forced institutionalization under KGB supervision.  Psychiatry in the USSR was used by the state against those who opposed the regime. Shame and Stigma in Slavic Culture

 For most Slavic parents special education requests are viewed as a belief that a child is mentally handicapped. Most special education school system testing requests are usually denied.  In the Soviet Union, special education was a “special” school where severely mentally handicapped children were kept away from other children. Most parents do not understand the differences in the American school system. Shame and Stigma in Slavic Culture

 Slavic immigrant elders describe mental illness as the “profound and worst illness” – a bringer of disgrace that shames both the patients and their families. It is believed that mental illness is “hopeless” and “untreatable.” (Polyakova, 2006)  Mental illness is regarded as disgraceful, craziness, etc. For this reason, Slavic immigrants often do not disclose a family history of mental illness or past treatment. Shame and Stigma in Slavic Culture

Mental Healthcare Seeking Patterns  For many Slavic immigrants, “the U.S. health care system remains confusing, largely because of cultural and language differences” (Shpilko, 2006).  Slavic immigrants’ help-seeking patterns are characterized largely by a cultural preference for informal support and distrust of formal medicine/mental health institutes.

 Slavic refugees are more likely to use nonprofit agencies instead of public agencies. This pattern is understandable because public agencies, which are associated with the government, might not be perceived as trustworthy by persons from the former Soviet Union (impacting data reporting).  When in need of mental health/psychological assistance, many Russian-Americans turn first to home/families, religious organizations, bilingual community-based practices rooted in their traditions (rather than turning directly to health care provider). Mental Healthcare Seeking Patterns

 Among Slavic immigrants, mental illness is usually viewed as a disease of the soul, or “dusha” brought on by weakness of character and personal failing ( Polyakova, 2006 ).  There is an underlying distrust of formal medical treatment, especially drugs, medications, or anything of a chemical nature. These are seen as more harmful than helpful (Shpilko, 2006).  Slavic refugees may describe or express mental distress in physical or spiritual terms (e.g., “I have pain in my heart,” “The devil is busy with me,” “My head feels heavy”). Mental Healthcare Seeking Patterns

Language Barriers  The language barrier is a formidable challenge for American clinicians. Members of the Slavic community display highly variable levels of English ability, from perfect fluency or functional proficiency (youth, young adults), to severe limitation or lack of knowledge at all.  Language and cultural beliefs are the most significant barriers to mental health care for Slavic immigrants. Also, many work at jobs that do not provide health insurance…

Community Partnerships  Building Mutually- Beneficial Relationships between schools, churches, faith- based organizations, community centers, businesses, and Sacramento County… Radio/TV Forum about MH (with community/church leaders…)

Cultural Distrust  Even if American clinicians hire interpreters, there is still a pervasive sense of cultural distrust (impacting data reporting).  Russian speaking patients expect more compassion and emotional closeness with their doctor.  Thus in treating the Slavic immigrant population, clinicians face not only a language barrier, but also encounter complex issues of trust and cultural misunderstanding (impacting data reporting).

Risk Factors Related To Suicide  Current health risks, both for homeland Slavic people and those who have relocated to America, include “cardiovascular diseases, infectious diseases, cancer, and malnutrition,” with specific mental health concerns including high stress levels, tendency toward depression, and substance addiction problems, particularly alcoholism (Shpilko, 2006).  Significant increase in divorce, intergenerational issues, domestic violence, substance abuse, depression…  Language and cultural barriers (because of the stigma) to accessing mental health treatment.

Risk Factors Related To Suicide  In most cases, people in Slavic community (especially in conservative evangelical churches) have stayed fairly quiet about mental illness and suicide (“suicide taboo”). Many times mental illness does not get diagnosed or treated.  Struggling to understand mental illness (“Can a Christian get depressed or commit a suicide?”). A tendency to blame demon possession for mental illness in some circles.  Dismissing kids/teenagers mental health issues and parenting problems.