Living in Culture

Recently, I took a summer course at Brown University in Providence. I had a great time and absolutely loved my course. I studied Multicultural Psychology and found it fascinating to learn more about multicultural research, biases, and related topics. At the end of the course, we had the opportunity to chose a topic to write an annotated bibliography on. I decided to write about mental health in more remote communities, how they respond, and their feelings towards mental health. Below is some of the most interesting things I found as I looked more into the topic. I have linked the research article where I pulled information below my thoughts.

Alaska Natives and Native Americans: Veterans’ Access to the Veterans Health Administration.

This source highlights the disparities that many American Indian and Alaska Natives face. This is mainly due to mental health stigma, geographic isolation, and low awareness of veterans’ services, so the Tribal Veterans Representative was introduced. This program is composed of trained workers from within tribal communities to reconnect veterans with Veterans Affairs resources and care. The TVR is a culturally sensitive program that was effective with veterans. Through methods like peer-to-peer outreach, the TVR was able to overcome stigma and distrust and initiate support for things like health clinics that specifically focus on aiding veterans with their PTSD. This program has successfully trained 800 TVRs and has expanded into other remote parts of the country.

Given the article’s acknowledgment of mental health stigma and PTSD as major concerns in Native veterans, I would have appreciated seeing more follow-up data on the mental health services, even though the primary focus of the article is broader service access. Regardless, I enjoyed learning more about the TVR because it is rooted in cultural understanding, and the article showed how effectively it can be culturally tailored. That messaging is powerful, especially when there is a lack of programs that are multi-culturally aware.

https://link.springer.com/article/10.1007/s10900-014-9846-6

Australia: Mental Health Care in Remote Areas

This study explores the experiences of six mental health nurses in the remote Aboriginal communities in Australia. Their experience in the communities ranged from 1 to 25 years. It discussed how the nurses adapted their practices to cultural contexts. Mental health care in remote Aboriginal areas lacks structured support, so nurses had to adapt their care models in this isolated area. The study used conversational-style interviews that focused on how the nurses developed culturally responsive care. The nurses found that relationships were critical to care. They needed to gain the trust of the community, often slowly and indirectly. Additionally, the nurses focused on blending Western medicine with traditional healing methods and local interpretations of mental illness. Many nurses said that this changed their worldview and values, as nurses felt torn between Western health systems and the Indigenous beliefs. 

I enjoyed reading the firsthand narratives of how nurses adapt to working in these remote communities. It highlights the importance of culturally competent care as the nurses had to learn to adjust their methods to more relationship-based care. Overall, I loved learning more about this community as I had no prior knowledge of the remote Aboriginal communities. This study proves that when people are open to the ways of other cultures, everyone can benefit- in this case, the indigenous people received effective mental health care, and the nurses had a life-changing experience. 

https://journals.sagepub.com/doi/10.1177/1043659606298612

North-East India: Impact of Suicide Attempts on the Community

In this research, the authors explained how data had been collected before finding that more rural, or tribal, populations have higher suicide rates than their urban counterparts. This study specifically focuses on the Idu Mishmi tribe in North-East India and tries to validate earlier reports of high suicide rates and evaluate the psychological traits of many within the tribe. Researchers gave the Patient Health Questionnaire to 218 people, 182 school children, and 36 family members of 30 individuals who had died by suicide. They used data to evaluate how psychological variables like depression, anxiety, alcohol use, and eating disorders influenced suicide attempts. From the data, it was concluded that females had a much higher rate of attempted suicide, and depression was a strong and significant predictor of suicide attempts compared to other factors, although it was comparable to other national averages. 

The reliance on self-reported data and the open-ended interviews is a challenge to this study, as they may cause subjectivity or under-reporting, especially because suicide is considered a curse or a sin in this community. Additionally, the PHQ may not fully capture some specific expressions of psychological distress in tribal populations like that of the Idu Mishmi. Other than these few elements, I found the report informative and eye-opening. It was well written and well informed.

https://www.sciencedirect.com/science/article/abs/pii/S0165032713005831?via%3Dihub

New Mexico: Behavioral Health Reforms

Within this article, the authors detail how, in New Mexico in 2005, behavioral health reforms were intended to improve access, especially cultural responsiveness in mental care for Native Americans. However, these reforms were not successful mainly because of a poor understanding of the tribal system. There are laws guaranteeing health care like the Indian Health Service, but Native Americans still suffer the highest rates of problems like suicide, PTSD, substance abuse, etc. Through five years of fieldwork, informal conversations, interviews, and ethnographic observations, the authors acknowledged that very few tribes gained small funding, there was a lack of understanding by the state, and many screening tools and Western clinical treatments were culturally inappropriate. As a result, the reforms attempted by the state of New Mexico largely failed due to a lack of cultural sensitivity.

Within this article, I would have appreciated learning more from some state officials’ perspectives. Additionally, I think the article would benefit from diving deeper in depth into how effective traditional Native healing practices are. However, the article had many strengths, including a focus on marginalized voices through long-term, in-depth fieldwork. I would recommend this article to anyone studying cultural competency in healthcare, or more specifically, Indigenous health policies.

https://journals-sagepub-com.revproxy.brown.edu/doi/10.1177/1049732312440329

Conclusion

Overall, I loved researching this topic. I had never looked in depth into many of these communities prior to this opportunity, so I was shocked with a lot of the information I found. I theorized that mental health conditions would not be as widely accepted in many rural communities that are not as connected to mainstream media and life, however, I realized that another facet to the problem is access to mental health care. Additionally, I learned that many types of mental health care is not inclusive from a multicultural standpoint. This experience not only broadened my understanding of mental health perceptions across different communities, but also highlighted the urgent need for accessible, culturally inclusive care.