Mental health and aging in the 21st century

This article reviews pressing issues in mental health care for older adults in the 21st century. After examining current forces for change in older adults' mental health care and coverage, the authors discuss barriers to accessing mental health care resulting from the fragmentation of the United States health care system as well as the history behind the multiple and competing systems of care for older adults. The article continues with a discussion of goals for the provision of good mental health service delivery for older adults and concludes by addressing potential responses and future target areas regarding mental health care for older adults as well as a potential realistic collaboration to address mental health and aging.     

Community need for university-based mental health services: identifying the top 5

The purpose of this study was to determine the community need for mental health and health promotion services provided by advanced practice nursing faculty at a small university in the midwestern United States. Fifty participants from a three-county service area were selected to complete a needs assessment survey. Survey results indicated strong community need for primary mental health services for low-income residents, older adults, pregnant women, and families with children. Mental health services (particularly for depression), health promotion, wellness information, and primary mental health care were among the leading areas of need. In addition, low-cost mental health services were identified as the most significant need, which was magnified in the underserved, Hispanic population.     

Multiple roles and mental health in cross-cultural perspective: the elderly in the United States and Japan

This paper examines how multiple roles affect the mental health of the elderly in Japan and the United States, two countries with vastly different cultures. Hypotheses were drawn based on the cultural differences in role experiences, and these hypotheses are tested by analyzing nationally representative samples of the elderly in these countries. The results show that Americans are more likely to be involved in roles related to family, work, and community, while the Japanese are more likely to be involved in only those roles related to family and work. Multiple roles are also found to be less beneficialfor the mental health of Japanese elderly compared to American counterparts. National differences in the effects of individual roles and role configurations on mental health are also documented. Overall, the results show the importance of broad cultural contexts for understanding the relationship between roles and mental health.     

Integrating creative art into a community-based mental health program for Asian American transition age youth

This paper advocates for the use of creative art as an adjunct in the delivery of mental health care for Asian American transition age youth in the United States. A case study of a participant in a community-based mental health program called Project FOCUS in Orange County, California details how art was used to assist a young woman to identify and achieve her personal goals, mitigate her emotional and behavioral problems, and reach a sense of overall well-being. The findings in this paper lay the groundwork for future research into how art can be systematically incorporated into community-based mental health programs to facilitate service utilization. Further, this study demonstrates that Asian American transition age youth face mental health challenges typical of their cohorts, despite being putative members of a “model minority.” The use of creative art transcends cultural and language barriers, and empowers Asian American transition age youth to explore their identity and express their emotions, which ultimately promotes their mental well-being.     

Western voodoo: providing mental health care to Haitian refugees

This article described certain aspects of Haitian life, voodoo and its role in Haitian society, the quality and quantity of psychiatric and mental health care for Haitians in Haiti, and suggestions for providing appropriate mental health care to Haitian refugees in the United States. Conway and Buchanan (1985) described what has helped Haitian refugees adapt in the transition to life in the United States: the strengths from their cultural heritage, such as fortitude; perseverance in the most arduous circumstances; deep religious faith; high self-respect; reliance on the extended family; and the tradition of sharing. Building on these assets may assist Western mental health-care providers in offering culturally sensitive mental health care to Haitians.     

Motherhood,homeschooling, and mental health

Homeschooling fits neatly under the umbrella of intensive mothering, a prominent parenting style in the United States. Intensive mothering has been shown to increase the emotional distress of mothers, which may be exacerbated when mothers take on the additional burden of being responsible for the formal education of their children. Given that intensive mothering ideologies negatively impact maternal mental health, it makes sense to examine how homeschooling may exacerbate this outcome. In this paper, I examine the literature on intensive mothering, homeschooling, and mental health to demonstrate a need for further exploration to show how homeschooling mothers, encouraged by intensive mothering ideologies, may be putting their mental health, and more, at risk in their endeavors to be both “good mothers” as well as “good teachers.”     

The idealized cultural identities model on help-seeking and child sexual abuse: a conceptual model for contextualizing perceptions and experiences of South Asian Americans

In this paper, we propose an interdisciplinary framework to study perceptions of child sexual abuse and help-seeking among South Asians living in the United States. We integrate research on social marginality, intersectionality, and cultural psychology to understand how marginalized social experience accentuates South Asian immigrants' desire to construct a positive self-identity. Using model minority ideology as an example of such a construction, we highlight its role in silencing the topic of child sexual abuse within this immigrant community as well as its impact on attitudes towards professional mental health services. We contend that our framework, the idealized cultural identities model on help-seeking and child sexual abuse, provides a unique analytical model for clinicians and researchers to understand how South Asian Americans process, experience, and react to child sexual abuse.     

The Idealized Cultural Identities Model on Help-Seeking and Child Sexual Abuse: A Conceptual Model for Contextualizing Perceptions and Experiences of South Asian Americans

In this paper, we propose an interdisciplinary framework to study perceptions of child sexual abuse and help-seeking among South Asians living in the United States. We integrate research on social marginality, intersectionality, and cultural psychology to understand how marginalized social experience accentuates South Asian immigrants' desire to construct a positive self-identity. Using model minority ideology as an example of such a construction, we highlight its role in silencing the topic of child sexual abuse within this immigrant community as well as its impact on attitudes towards professional mental health services. We contend that our framework, the idealized cultural identities model on help-seeking and child sexual abuse, provides a unique analytical model for clinicians and researchers to understand how South Asian Americans process, experience, and react to child sexual abuse.     

Cultural diversity for health professions

The purpose of this article is to help focus attention on why clinical health professionals need to be concerned about cultural diversity. It is not intended to be an exhaustive report on cultural diversity. Rather, attention is focused on the practitioner and how this provider can and should use and understand cultural diversity. While most of the examples in this article come from the press in the United States, the information has a much broader, universal and global implication.     

Barriers and Promoters of Mental Health Services Utilization in a Latino Context: A Literature Review and Recommendations from an Ecosystems Perspective

ABSTRACT

This article focuses on the problems of disparities in mental health service utilization in the Latino population in the United States. It begins with an overview of the Latino population within the United States, an exploration of the diversity within this group, and shared cultural values and traits with a particular focus on the problems of Latino poverty. A review of the literature follows, including identified barriers to and promoters of mental health services utilization. These are contextualized in a Latino perspective using an ecosystems framework. Recommendations are made for future practice, research, and policy regarding mental health and mental health services utilization in the Latino community.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Perspectives on American Kinship in the Later 1990s

This paper reviews the current status of kinship research in the United States and identifies factors that might account for the declining interest in the subject among family researchers. The analysis uses both structural and cultural factors to illustrate how they can determine the diversity in kinship functioning that ranges from those family systems where kinship relationships flourish and those where they play a small part in family life. The structural and demographic variables determine the numbers and availability of kin, whereas the cultural variables determine the norms that establish the motivation to sustain kinship bonds. To illustrate how these factors operate among subgroups in the United States, I analyze three types of kinship systems: the lineal emphasis in White families of the very old; the collateral emphasis in the families of their Black counterparts; and the egocentric emphasis of White suburban families that are undergoing marital change.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Planning minority health programs to eliminate health status disparity

The purpose of this research is to determine program characteristics that are essential to address the problem of health status disparity between minority and nonminority populations. The respondent group consisted of a sample of 50 minority health organizations currently listed as participants in the Minority Health Resource Network in the United States Public Health Service Office of Minority Health. A three-round Delphi technique was used to reach consensus by collecting data and assessing agreement and disagreement on the issue of health status disparity from a widespread national group. Findings indicate that there is strong consensus among respondents that cultural awareness is the top priority area to address in order to eliminate health status disparities.     

Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.     

“Who Can You Tell?” Features of Arab Culture That Influence Conceptualization and Treatment of Childhood Sexual Abuse

The literature on child sexual abuse reflects growing recognition of the manner in which culture impacts the conceptualization, experience, and treatment of such cases. Despite heightened visibility of Arab Americans within the United States, population due to recent media attention, little empirical research exists on the occurrence of child sexual abuse within this population. Arab culture is often characterized by an emphasis on collectivism and familial obligations, and such features may prove to either facilitate or impede assessment and treatment of child sexual abuse, depending on how they are manifested. In terms of reporting child sexual abuse, cultural values pertaining to shame and honor as well as the stigma attached to mental health problems may influence the response to abuse. As such, enhancing the cultural competence of the therapist is key to facilitating effective cultural practice. Empirical research is required to investigate and substantiate these concepts as they relate to child sexual abuse in Arab-American populations.     

Dietary assimilation and health among hispanic immigrants to the United States

Three important findings emerge from this study using New Immigrant Survey data to examine dietary change and health among Hispanic immigrants. First, individuals who have been in the United States longer report a greater degree of dietary change. Second, after controlling for behavioral characteristics and preexisting diet-related conditions (diagnoses of high blood pressure and diabetes prior to coming to the United States), more dramatic levels of change in diet are associated with higher measures of body mass index. Based on respondents' comparisons of their current health to their health just prior to their most recent trip to the United States, change in diet as a result of immigrating to the United States is positively correlated with both better health and worse health. Among individuals reporting greater levels of dietary change, those with worse health have been in the United States for longer and are more likely to report the use of English at work than those reporting better health, factors that indicate acculturation and exposure to broader U.S. society.     

Safer Sex in Later Life: Qualitative Interviews With Older Australians on Their Understandings and Practices of Safer Sex

Rates of sexually transmitted infections (STIs) are increasing in older cohorts in Western countries such as Australia, the United Kingdom, and the United States, suggesting a need to examine the safer sex knowledge and practices of older people. This article presents findings from 53 qualitative interviews from the study Sex, Age, and Me: A National Study of Sex and Relationships Among Australians Aged 60+. Participants were recruited through an online national survey. We consider how participants understood “safer sex,” the importance of safer sex to them, the safer sex practices they used (and the contexts in which they used them), and the barriers to using safer sex. Older adults had diverse understandings, knowledge, and use of safer sex practices, although participants tended to focus most strongly on condom use. Having safer sex was strongly mediated by relationship context, trust, perceived risk of contracting an STI, concern for personal health, and stigma. Common barriers to safer sex included erectile difficulties, embarrassment, stigma, reduced pleasure, and the lack of a safer sex culture among older people. The data presented have important implications for sexual health policy, practice, and education and health promotion campaigns aimed at improving the sexual health and well-being of older cohorts.