Facilitator: Richard KrzyzanowskiConsumer Employment Support Specialist, Center of Excellence;

Chair, Orange County Stigma Elimination Task Force;Client & Family Leadership Committee of the

California Mental Health Services Oversight & Accountability Commission

Panel PresentersGeorge Nguyen, President, OC Association for Vietnamese

Mental Health Awareness and SupportMelody Marler, Adult Mental Health Services- Recovery

Center North, OC HCA/BHSJenny Monge, OC Mental Health Board Arts Committee,

NAMI OCGregory Wright, Mental Health Board, NAMI OC Family-

to-Family Trainer

Definition of Culture“Culture” refers to the shared attributes

of a group of people.

People can share a culture, regardless of their “race” (= socio-biological category associated with visible physical characteristics such as hair, skin tone) or ethnicity (= heritage of a particular group)

Definition of Culture“Culture” is broadly defined as a common

heritage or learned set of beliefs, norms, and values (U. S. Department of Health and Human Services, 2001)

Example: people who work for a particular organization or participate in a social group may share the same cultural attributes.

Facts About Mental HealthMental health issues affect almost every

family in America.

People with mental health issues can and often do recover with the support of their peers, family, friends and communities, and by working with mental health professionals for proper diagnosis, treatment and medication.

Facts About Mental HealthRecovery can be achieved via tapping into inner strength, resilience, spirituality, self-

help strategies (self-responsibility and self-

determination), family/peer/community supports, and a sense of connection with other people and society.

People with mental health issues can and do make important contributions to our family and community systems, as well as to the mental health professions.

HopeEmpowerment

Self-determination Freedom of Choice

Knowledge of Rights Self-Confidence

Self-Advocacy Responsibility

Developing Peer & Other Support Systems

Stigma: Some definitions“A mark of disgrace or infamy; a stain or

reproach, as on one's reputation.”

“An attribute, behavior, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, ‘normal’ one.”

Confounding facts and fallacies

A social set of attitudes with institutional implications

Not always negatively phrased or ill-intentioned

Paternalism

Self-stigmaSelf-stigma is defined as negative attitudes about

mental illness and its treatment that are held by the individual with the stigmatized condition.

Self-stigma has recently been cited as a major public health concern, contributing to decreasedtreatment seeking, lowered self-esteem, and loweredself-efficacy.

Self-stigma is the prejudice which people with mental health issues turn against themselves.

Stigma and Its Negative Impacts

Stigma is one of the most prevalent and persistent obstacles hindering the transformation of any mental health system and of attitudes in the community.

Many clients still underutilize mental health services and remain un-served in

part because of the stigma against people

with mental health issues.

Stigma and its negativesFear of discrimination is the key barrier

that keeps many people from revealing symptoms and seeking help, services and treatment.

Stigma leads to low self-esteem, a sense of being misunderstood, hopelessness, shame and guilt.

Stigma also deters people from socializing or working with, renting to, or employing mental health clients.

Stigma: Two recent studiesCorrigan, P.W. (2005). On the stigma of

mental illness: Practical strategies for research and social change. Washington, D.C.: APA.

Pescosolido, B.A., Jensen, P.S., Martin, J.K., Perry, B.L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study—Children. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 339–349.

Confronting Stigma"If you focus on the competence of people with

mental illness, that tends to lead to greater tolerance.”

--- Pescosolido

Contact with people who have mental health issues tends to decrease stigma

Meeting people who have mental health issues weakens people's tendency to link mental illness and violence.

Client Culture: A Definition

Client culture shares some common attributes in that the life conditions or disability of a client, the attitudes and practices of the health care system, and ethnic/cultural contexts in many ways affect and mold the values, beliefs and lifestyles of the client as well as his/her family system.

Sharing Cultures

As lives are shared, each gains a new value …

Culturally Competent Practice From a culturally competent practice and perspective, (Cross et

al.,1989), systems, agencies and professional providers of services to clients/consumers would utilize a set of congruent values, practice skills, attitudes and policies in working effectively together in cross-cultural situations.

Culturally Competent Health Care ProvidersProvider’s awareness of his/her own cultural

values and biases is the pre-requisite for being able to accept and embrace similarities and

differences of client’s worldviews in order to become effective.

Accurate understanding of the life change events and illness of clients, their cultural and family systems would lead to a comprehensive understanding of client’s development, emotional, functional and cognitive process and behaviors.

Effective Mental Health Care Delivery

With a best-practice s approach, Mental Health Care Providers:

Respect persons with mental health issuesUnderstand and attend to clients’ real

needsIncorporate wellness into care and work to

create and maintain a continuous, healing relationship

Effective Mental Health Care DeliveryShow respect in the form of active listening,

take complaints seriously, evaluate and re-evaluate if necessary, attend to thorough follow-ups, being patient and kind with effective communication

Coordinate with other professional providers to deliver and link necessary care from housing to community-based supports in a timely manner

Are congruent and self-reflective with the ability to acknowledge one’s own limitations

Advocate on behalf of clients

Toward a Transformed Mental Health SystemBuild a path toward increasing respect for human

dignity and thoughtful understanding of our clients, their families, and cultural & contextual systems with more humanity, compassion and acceptance

Gain a deeper awareness of family systems, cultural context as well as quality care delivery within our health care systems