1. Asian American and Pacific Islander: Facing Mental Wellness Nguyen Nhat Minh Transportation Coordinator Fairfax-Falls Church CSB

2. Asian American and Pacific Islanders (AA/PI) Highly diverse, consisting of at least 43 separate ethnic groups While the per capita income of AA/PIs is almost as high as that for whites, there is great variability both between and within subgroups For example, there are many successful Southeast Asian and Pacific Islander Americans; however, overall poverty rates for these two groups are much higher than the national average Collectively exhibit a wide range of strengths - family cohesion, educational achievements, and motivation for upward mobility Risk factors for mental illness such as pre-immigration trauma from harsh social conditions Diversity within this population and other hurdles make research on AA/PIs difficult to carry out

3. Collectivism vs. Individualism Emphasizes the interdependence of every human in some collective group Priority of the group goals over individual goals The whole is greater than the sum of its parts Emphasis is placed on independence and self-reliance Promotes ones goals and desires while opposing most external interferences

4. Facing Truth or Lies Do our masks mirror our true identities Do our masks hide our true identities

5. Facing Truth or Lies

6. Face or Mask Giving Face Not Giving Face Losing Face Mirrored Sense of Self-Worth

7. Masks of the World

11. Makes of the World

12. Saving Face To not appear weak To not look bad in the eyes of others To avoid embarrassment, shame or guilt Its not just about pride

13. What is Face Face is an interaction between ourselves and others Face is an internal response to other peoples perception of self Face is the internal motivation to create and exhibit the external self (our masks) The degree of face a person demonstrate is depended on the position or status of the other person

14. What is Face The position/status of the other person is also an internal assignment created by us, the perceived We would appoint or assign a degree of importance to the other person If we do not care about the other person, we would not fear losing face in front of that person

15. What is Face If we care about the other person, we would be motivated to put our best face forward This is somewhat of an internal self- assessment based on the external visual cues that are projected from the perceiver

17. What is Face By attributing high esteem for someone and being able to solicit the positive feedback about oneself, one assesses oneself as a person of worth and value

18. Face, the Motivator A study conducted by Bouchey and Harter (2005) shows that scholastic achievements is directly related to the students perception of competence as it relates to their parents, teachers and classmates perceptions

19. Barriers of Saving Face

20. Facing Stereotypes

21. Face, the Barrier Face can be lost when one appears to be weaker or less competent Extreme overcompensations to avoid looking bad Denial and rigid thinking

23. Perception of Mental Illness

24. Defective Disgrace Flawed Responsible Shame Quilt

25. Substance Abuse and Mental Health Services Administration, 2002

26. Virginia Summary Report, 2002 Race/Ethnicity: 0%American Indian/Alaskan Native 1%Asian 29%Black or African American 0.2%Native Hawaiian/Pacific Islander 62%White 1%Multi-Racial 6%Hispanic or Latino 7%Race not available

27. Virginia Summary Report, 2008 Race/Ethnicity: 0.3%American Indian/Alaskan Native 1.1%Asian 25.4%Black or African American 0.1%Native Hawaiian/Pacific Islander 62.3%White 1.5%Multi-Racial 4.9%Hispanic or Latino 9.2%Race not available

28. Isolating Face Fear of Losing Face Stigma Lack of Knowledge or understanding of mental illness and symptoms Language Barriers Cultural Competence Credibility and Trust

29. Facing the Bridge Five steps to build trust and save face Step 1. Apologize Step 2. Take a Time-Out Step 3. Don't Introspect Step 4. Remain Somewhat Present Step 5. Generosity

30. Need for Services Available research, while limited, suggests that the overall prevalence of mental health problems and disorders among AA/PIs does not significantly differ from prevalence rates for other Americans Thus, contrary to popular stereotypes, AA/PIs are not, as a group, "mentally healthier" than other groups. Refugees from Southeast Asian countries are at risk for post-traumatic stress disorder as a result of the trauma and terror preceding their immigration

31. Surgeon General Executive Summary: AA/PIs EXECUTIVE SUMMARY MENTAL HEALTH: CULTURE, RACE, AND ETHNICITY A Supplement to Mental Health: A Report of the Surgeon General DEPARTMENT OF HEALTH AND HUMAN SERVICES U.S. Public Health Service

32. Availability of and Access to Services Nearly half of AA/PIs have problems with availability of mental health services because of limited English proficiency and lack of providers who have appropriate language skills About 21 percent of AA/PIs lack health insurance, but again there is much variability. The rate of public health insurance for AA/PIs with low income, who are likely to qualify for Medicaid, is well below that of whites from the same income bracket

33. Utilization of Services AA/PIs have lower rates of utilization compared to whites This under-representation in care is characteristic of most AAPI groups, regardless of gender, age, and geographic location Among those who use services, the severity of their condition is high, suggesting that they delay using services until problems become very serious Stigma and shame are major deterrents to their utilization of services

34. Appropriateness and Outcomes of Services There is very limited evidence regarding treatment outcomes for AA/PIs Because of differences in their rates of drug metabolism, some AA/PIs may require lower doses of certain drugs than those prescribed for whites Ethnic matching of therapists with AAPI clients, especially those who are less acculturated, has increased their use of mental health services

35. Executive Summary Recommendation Every person, regardless of race or ethnicity, should seek help if they have a mental health problem or symptoms of a mental disorder In the meantime, anyone who needs help must hear a simple, yet resounding, message of hope: Treatment works and recovery is possible

36. Executive Summary Recommendation Individuals are encouraged to seek help from any source in which they have confidence If they do not improve with the help received from the first source, they are encouraged to keep trying At present, members of minority groups may experience limited availability of, and access to, culturally sensitive treatments With time, access to these services should improve as a result of awareness of this problem and the courses of action identified in this Supplement

37. Your Best Face Forward

38. Put Your Best Face Forward

39. If you need to wear masks, they should protect you

40. Or for fun…Happy Halloween

41. Thank you