CIT: RESPONDING TO MULTICULTURAL INCIDENTS

Co-authored: Dr. Kathy Harowski Ph.D., Special Agent Leah Billings, Amy Berg and Katie Kornder

Patti Kressly MAPro-Crisis LLC

Goals

Current CIT cultural responses. Demographics of Cultures in the United

States What is mental illness – culturally

speaking CIT response

Does you current CIT curriculum include cultural influences? What does it include?

Dominic Kavaventi

Immigrated from Zimbabwe when his citizenship was taken away.

Was jailed for writing and performing plays that depicted the social injustices of Zimbabwe at the time.

Refugee Arrivals by Country of Nationality (Department of State)

2009 2008 2007

Total 74,602 60,107 48,210

Iraq 18,838 13,822 1,608

Burma 18,202 18,139 13,896

Bhutan 13,452 5,320 ----------

Iran 5,381 5,270 5,481

Cuba 4,800 4,177 2,922

Somalia 4,189 2,523 6,969

States of Residence for Refugee in United States 2009 (Department of State)

California(15 percent)Texas (11 percent)New York (5.9 percent) Arizona (5.8 percent) Florida (5.6 percent)Michigan (4.7 percent)

Nearly one-half of all refugees settled in one of these six states.

Arrivals by Asylum (Department of State)

The total number of persons granted asylum in the United States decreased slightly from 22,838 in 2008 to 22,119 in 2009.

The number of persons who were granted asylum affirmatively through USCIS(U.S. Citizenship and Immigration Services – through judicial process) decreased from 12,095 in 2008 to 11,933 in 2009.

Unauthorized Entries into the US(Department of Homeland Security)

Between January 2008 and January 2009, the number of unauthorized immigrants living in the United States decreased seven percent from 11.6 million to 10.8 million.

An estimated 8.5 million of the total 10.8 million unauthorized immigrants living in the United States in 2009 were from the North America region, including Canada, Mexico, the Caribbean, and Central America.

The next leading regions of origin were Asia (980,000) and South America (740,000).

Mexico continued to be the leading source of unauthorized immigration to the United States. There were 6.7 million unauthorized immigrants from Mexico in 2009, representing 62 percent of the unauthorized population.

El Salvador (530,000), Guatemala (480,000), Honduras (320,000), and the Philippines (270,000).

What is Mental Illness?

The notions of health and illness are not clearly defined concepts. Perceptions vary.

Some cultural anthropologists believe that mental disorders are culturally created evaluations. They are dysfunctional deviations from the

normative patterns of social behavior.

Western societies believe that the concept of mental illness is based in the medical model. The training for psychiatry was and still is

based on medicine. The diagnosis and treatment of mental

disorders still remains predominately in the hands of psychiatrists.

Cultural Aspects of Mental Illness

The belief is that mental illness is present cross culturally.

Studies strongly suggest that culture can influence the expression of mental illness.

Most immigrants come from cultures in which interpersonal reliance and dependence are considered healthy cultural norms. Families, clans, healers are the first step in

dealing with mental illness.

Some immigrants are coming from their countries of origin with complex stressors. Death and loss of family members Victims of torture Witnessing years of war. Some coming from refugee camps.

CIT Cross culturally

Multidisciplinary practitioners in a multicultural setting.

Encourage awareness and sensitivity to verbal and nonverbal aspects of communication across cultures and across our teams.

Our biases and typical reactions contribute to the reactions often heard from those in diverse communities about our efforts and tactics.

Mental illness across a multicultural community: racial or ethnic group, with worldview differences; additional factors might include generational, socioeconomic, and language differences.

Assimilation – melting pot or tossed salad Awareness that a person who has limited

use or understanding of English is not necessarily an immigrant or not assimilated

History of the cultural group with authority figures/government

On the job

Nonverbal issues related to being impatient, misjudgment about motives, understanding that certain gestures and even facial expressions have different meanings across cultures.

Provide background or a reason for your need for information; consider this part of rapport building- those who are marginalized might need more time and information to place your request in context and to give them time to process if there are language barriers

On the job: people with mental illness as a cross cultural group

Expect that answers will be provided /expressed in a manner that is different than the response you will get from someone in the majority culture. The reaction/responses we learn to expect when working with a survivor/victim are often different because the cultural group often has a particular lens due to their life experiences.

Respect the cultural story telling style- is it linear, more circular, how do details emerge, understand some will go in to more detail than necessary. Memory may be changing/change, be difficult, uncertain

Look for ways in which to help the parties use their skills and decision making to solve the current and future problems without conflict, move forward, make a difference

Create Collaborations with Cultural leaders in your community

What is your cultural population? Create community collaborations to help

Law Enforcement better deal with the issues. Minneapolis as an example.

Crisis Intervention with the Hmong Population

Overview

• History• Hmong population in Minnesota/

Demographics• Cultural shifts• World view• Cognitive and behavior processes• Health issues (mental and

westernization)• Crisis intervention tips

History The Hmong are a

mountain dwelling people of Laos many of whom worked with the US to stop gun running into Vietnam during the Vietnamese War.

After the war ended, the soldiers sought safety in refugee camps in Thailand. These camps rapidly deteriorated, which precipitated the Refugee Assistance Act of 1975.

Hmong cultural history- Midwest and Twin Cities

Hmong immigration to the United States began in 1975 and consisted first of the soldiers and their extended families, followed by other Hmong who felt persecuted by the Vietnamese.

In the US, now in the second and third generation of this process; even with ongoing immigration, the majority of individuals of this cultural group have now been born in the US.

Cultural shifts

Tradition versus assimilation Hmong in Laos were/are farmers living in

poverty. Hmong born in America (second

generation) enjoy educational, professional, and political opportunities that their elders did not.

These successes have made Hmong people susceptible to discrimination from other ethnic minority groups.

Cultural shifts

The struggle between tradition and Americanization is a generational one.

According to a Hmong peer, the younger generation is moving away from the beliefs and traditions of their elders. They participate in the rituals to appease their elders/ ancestors and avoid negative consequences within their families.

Cultural shifts

Collectivism versus individualism Hmong families and the Hmong

community are very close knit and closed to the general population.

Minneapolis/St. Paul contains one of the highest populations of Hmong people in the US, with approximately 50,000 in MN; concentrated populations in MI, WI and CA as well.

There are approximately 210,000 Hmong people in the US (this number is probably underreported).

Worldviews

Messages are passed from the elders to the younger generations.

Hmong live in a closed society where they initiate consultation for guidance. They are not keen on unsolicited

advice, intrusion, or having outside influences impressed upon them.

Hmong are distrustful of authority and government because of their history with the Laotian, Thailand and US governments.

Cognitive processes Hmong people are

religious and practice Animist Hmong, Buddhism, Christianity, and Shamanism.

In their belief system, the spiritual and physical worlds are intertwined.

Language barriers are a major issue. Hmong speak Hmong (majority), English, Lao, and/or Thai.

Consult elders, clan leaders, or community leaders for more understanding about how religious beliefs influence behavior

Behavioral patterns

Hmong culture teaches by example. Following the teachings of elders is expected. Fitting in to the Hmong culture and society is

more important than cultivating individual differences.

Increasingly the second generation are becoming the leaders of their community; this group maintains their Hmong roots while incorporating some American values into their lifestyle and beliefs.

Social structures

Family units are clans and often number less than 20 in MN.

Extended family members are in close proximity, often with multiple generations in the same household.

The society is closed to non-Hmong. Interacting differently with media; not as in

tune with mass media. Hmong people gain the majority of current events/news from cultural and language specific Hmong radio stations. This is shifting with the third generation.

Mental health

The Hmong population does not acknowledge mental illness as separate from physical illness, bad spirits, the will of the ancestors, or bad karma. They are reluctant to enter into treatment/therapy.

Persons suffering from chronic mental illness are shunned or considered outcasts because they may have been cursed by the ancestors or have “lost their soul”.

General health

Common Diagnoses: Depression, anxiety (religious focus), PTSD (older immigrants)

Social Problems: Gangs, domestic abuse Use herbs and herb cocktails in lieu of

pharmaceuticals for treatment(baggie of herb may resemble baggie of marijuana).

When western, more mainstream medical care or law enforcement becomes involved, it is due to escalated symptomatology.

Integration of Western/Mainstream healthcare

Entrust Shamans for their medical needs.

In collaboration with Shamans, western medicine is slowly being more widely used.

Health care focus is on an emergency basis, not preventative or sustained care.

Medication noncompliance is a major problem, due to beliefs, high cost, lack of insurance.

Western medicine (continued

Shamans are consulted first; if that fails, Hmong are then more willing to try Western medicine

For more traditional Hmong, treatment includes the sacrifice of an animal

Marks on the body (resembling self harm) may be from past attempts at symptom relief (circular bruises and redness are most common)

Tips for CI with Hmong Individuals

Identify and address the head of the household first (father figure), not whomever speaks English.

Avoid shaking hands, especially with Hmong woman.

Avoid making positive or negative comments about Hmong children (e.g. you have a strong boy).

Avoid pressing Hmong to look at you or make eye contact.

Avoid placing your hand on the head of a Hmong person, especially a male.

Tips for CI with Hmong Individuals

Refer to the person by the name that they give you, not by what it says on their license or other documents (first name vs. second or family name)

You may not get an immediate “yes” or “no”. Hmong people are often introspective and do not want to answer too quickly or overpromise.

Ask rather than assume about family relationships, e.g., husband or wife. Extended families living together makes it easy to err. Should you err, this error is embarrassing for Hmong.

Tips for CI with Hmong Individuals

It is respectful to keep extra distance, especially when addressing someone of the opposite sex.

Be respectful when dealing with traditional and religious jewelry and clothes. Ask woman if they

would prefer to leave their jewelry with family.

SOMALI CRISIS INTERVENTION

Overview

• History• Somali population in

Minnesota/ Demographics

• Somali culture• Cultural views on

mental illness• Communication issues• Successful Crisis

intervention• Conclusion

History

Long history of political dispute

1991: Somalia state collapses

Since 1991: considered failed state

Today: Transitional federal government and al-Shabaab fighting for power

Somali demographics

MN has a large Somali population 10,000-60,000 in

Minnesota Most live in

Minneapolis, but also in Rochester and Owatonna

Most are refugees Majority are Sunni

Muslims

Somali cultural perspectives

Society organized by clans

Strong Islamic faith

Traditional dress General opinion

of law enforcement

Communication issues

• Gestures/Non-verbal behaviors to avoid:– Crossing legs– Putting hands in pockets

during conversation– Showing bottom of

feet/shoes– Using “thumbs-up”– Eating with or using left

hand– Pointing with index finger

• Somalis may avoid eye contact, especially females

Verbal Communication

Verbal considerations: Try to greet eldest

male first, and avoid greeting females first (especially handshake)

Older Somalis may not speak English

Always thank for hospitality

Communication

Somali language was only oral until 1972; Somalis are not universally fluent in writing as their culture relies on oral communication

Decision making is primarily based on discussion/consultation with family, clan, tribe, religious elders, religious teachings

Cultural views on mental illness

Use “mental illness” only with severe/untreatable conditions

Very negative stigma

Either waali (crazy) or not crazy

Mental illness comes from God or evil spirits

Successful Crisis Intervention

• Somalis tend to react emotionally to events– High levels of

empathy/sympathy work well

• Observe and respect cultural differences

• Work with local/community resources to obtain solutions– Elders/religious leaders

Somali views on mental illness Somalis do not see

war related trauma as the direct cause of their symptoms – instead focus on concrete issues like family reunification or resettlement stressors as a direct cause.

Because serious mental illness is believed to come from God or spirits, reading from the Koran is viewed as a traditional cure.

This culture does not have a spectrum of health, wellness and disease for medical and mental health difficulties

Religion and culture are key

Group counseling works best

Rapport, rapport, rapport

Native American crisis intervention

Definitions:

Native American/American Indians/Alaska Natives: includes many racial, ethnic, and cultural groups.

Indian Tribe: Body of people that:

1) Blood ties that are socially, politically, and religiously organized.2) Live together in a specific territory.3) Speak a common language.

Reservation: Land reserved by the federal government for a

tribe that relinquished other land areas through treaties.

Sovereign nation

Result of Cherokee Nation v. Georgia in 1831.

1) Govern own affairs, including authority to structure governments

2) Regulate membership3) Maintain justice4) Provide for public safety and welfare5) Develop tribal economies and regulate

businesses6) Tax

Statistics

• 351 Federally recognized tribes in the contiguous United States. – Minnesota has 11 tribes.

• 211 Federally recognized Alaskan Entities

• Of these, 224 operate gaming facilities. (40%) – Minnesota has 19 casinos.

• As of 2006 only 73 tribes distributed direct payments to individual members.– Huge success of a few tribes has created misperception.

11 FEDERALLY RECOGNIZED INDIAN TRIBES IN MINNESOTA TODAY

1. Bois Forte Band of Chippewas2. Fond du Lac Ojibwe3. Grand Portage Band of the

Minnesota Chippewa Tribe4. Leech Lake Band of Ojibwe5. Lower Sioux Indian Community6. Mille Lacs Band of Ojibwe7. Prairie Island Indian Community

(Dakota)8. Red Lake Band of Chippewa Indians9. Shakopee Mdewakanton Sioux10. Upper Sioux Indian Community11. White Earth Ojibwe

Native American culture

Because of long generational history and diversity of tribes, individuals experience their cultural connection in a unique way

Cultural identity varies from “traditional” to little knowledge or interest in traditional Elders tend to be traditional, younger

generations tend to be either multicultural or non-traditional.

Historical trauma and grief may play a role in shaping attitudes, sense of identity, and levels of trust.

Spirituality

• Strong respect• Traditional, Christian, or

combination of both• Community oriented• Specific practices vary among

communities. • Ask versus assume. Many

beliefs and practices are sacred and are not to be shared publicly or with outsiders.

• Imbalance between mind, body, spirit, and environment results in social/health problems.

Cultural views on mental illness• In the native American community, some

attach little stigma to mental disorders because no division exists between physical and mental illness.

• Others identify mental health problems as shameful.

• Mental illness may be viewed as a form of spiritual possession or as an imbalance with the natural world.

• Many different geographic places are considered sacred.

• Indian traditions value balance and the interrelationships of the physical, mental, and spiritual worlds

• Healing comes from identifying stress in the community

• Illness is resolved through community ceremonies and traditional practices.

• Many different plants and animals are used for medicine. Medicine Stick

Communication considerations• Casual conversation

is important to establish rapport- be genuine, use self-disclosure

• Avoid intrusive questions early in conversation

• Acceptable to admit limited knowledge of culture

• Avoid touching sacred items such as medicine bags, hair, and jewelry.

• Pointing with your finger may be interpreted as rude in many tribes

• Do not stand too close, talk too loud, or talk too fast.

• Avoid looking at your watch and do not rush things.

Successful crisis intervention

Observe and respect cultural differences Don’t take mistrust, frustration, or

disappointment personally Take your time to establish rapport Silence is often a sign of respect, it does

not mean consent or agreement. Only promise what you can deliver

Conclusion

What is your cultural population? What information will best serve your CIT

officers? Open the dialogue with cultural leaders

to obtain recourses and education for your CIT officers.

PATTI KRESSLYPRO-CRISIS LLCPROCRISIS@HUGHES.NET651-210-8036