podcasts

Minority Mental Health Month – Podcast

By Jason Clayden on July 6, 2023

In honor of National Minority Mental Health Month, a panel of LifeStance Health professionals discuss the unique challenges faced by racial and ethnic communities in accessing mental health treatment. Our panelists include Dr. Areum Kim, a psychiatrist from Independence, Ohio, Dr. Tiffany Truesdale, a psychologist from Newton, Massachusetts, and Dr. Jonathan Llamas, a psychiatric nurse practitioner from Pasadena, California.

Listen and Subscribe Here

Nicholette Leanza:

Welcome to Convos from the Couch by LifeStance Health, where leading mental health professionals help guide you on your journey to a healthier, more fulfilling life.

Hello, everyone, and welcome to Convos from the Couch by LifeStance Health. I’m Nicholette Leanza, and on this episode, I’m excited to have a panel discussion in honor of celebrating National Minority Mental Health Month, which is dedicated to raising awareness of the unique challenges that racial and ethnic communities face regarding mental health treatment. I am joined today by Dr. Areum Kim, a psychiatrist from our Independence, Ohio office.

Areum Kim:

Hello.

Nicholette Leanza:

I’m also joined by Dr. Tiffany Truesdale, a psychologist from our Newton, Massachusetts office.

Tiffany Truesdale:

Hello.

Nicholette Leanza:

And I’m also joined by Johnathan Llamas, a psychiatric nurse practitioner from our Pasadena, California office.

Jonathan Llamas:

Hello. Thanks for having us.

Nicholette Leanza:

So, welcome, everyone. To get us started, I want to throw out there that according to the CDC, racial and ethnic communities are less likely to receive diagnosis and treatment for their mental health concerns, and have less overall access to mental health services. So, I really look forward to this important discussion today as we talk about these key issues.

So, let’s get started. Dr. Tiffany, let’s talk about what are some of the cultural factors that influence mental health in minority communities?

Tiffany Truesdale:

Yeah. I think one of the main things, as you mentioned, a big word is culture, and I think it’s recognizing that each ethnicity or each minority has its own culture, and it’s important to respect those different aspects of each culture. And knowing that based on people’s culture, they have their own thoughts, feelings, and views when it comes to mental health.

And so, being able to have those conversations with clients about those things and being able to respect different minority’s backgrounds and their cultures is super important. Because it plays an integral part in how they talk about their experiences, how they talk about their mental health, whether they talk about their mental health or not. And knowing that each of the minorities have their own backgrounds and traditions and thoughts on mental health, and so, just being able to be open and having those conversations and respecting the cultures in general is super important.

Nicholette Leanza:

I definitely agree. Johnathan, anything you’d like to piggyback with what Dr. Tiffany’s saying?

Jonathan Llamas:

Sure. Based off of my experience and based off my understanding, culture typically refers to a group of shared set of beliefs, norms, and values. Right? And what Tiffany stated, every culture has their own very unique view and perspective of the world, as well as their cultural traditions that they pass on from generation to generation. And as that gets passed along, as a result of that, the things that they’ve learned from their parents and their parents before them, gets passed down to the upcoming generations.

And sometimes the things that they learn from their parents or the generations before is not always necessarily the most healthy ways to maybe cope with certain stressors or things like that. The important thing, especially in today’s society, is that we’re very fortunate that we are starting to become more aware of this, the perpetual and sometimes maybe the toxic patterns of behavior that we’re starting to recognize. And I think now, especially as psychiatric clinicians, we have a duty to make sure that we continue to empower and educate our patients that it’s okay to seek help and it’s okay to talk about these things that maybe they once thought were taboo.

Nicholette Leanza:

Yeah, very true. Dr. Kim?

Areum Kim:

I would agree with everything that Dr. Tiffany and Dr. Llamas was saying. Now, in terms of culture, I think outside of just looking at normal things we’d look at in culture, race, ethnicity, religion, spiritual kind of things, gender, sexuality, I think also how culture is presented is really important, especially with media, with the news, with current events, politics, all that out there. I think is so important to people’s cultural identity and how that impacts their cultural identity.

Although, obviously we all agree on how important culture is, I think also keeping up to date on culture and how that impacts folks, keeping up to date on current events, all of that is going to be so important to be really culturally minded.

Nicholette Leanza:

Oh gosh, yes, I agree. I’m glad you’re emphasizing staying up to date with it too. For sure. What are some of the unique challenges that racial and ethnic minority communities face when it comes to mental health and access to mental health care? Tiffany?

Tiffany Truesdale:

I think we can’t ignore that there has been a lot of history of racism, prejudice, discrimination, that’s been in the past, and that’s unfortunately, currently still happening. And so, a lot of times because of this, a lot of minority space, a lot of economic and social-economic disparities that impact their access to health, education, proper housing, and getting those resources that they need in order to access the mental health services that they need.

And so, I think without the understanding or recognition of that, it’s hard to be able to change all those other barriers that are also a part of the difficulties of seeking mental health services or even just the experiences. So, recognizing that there’s different biases. A lot of times, unfortunately, lack of adequate healthcare or health insurance. We all know without health insurance, it’s really almost impossible to get the care that you need, especially with the high costs.

Nicholette Leanza:

Right.

Tiffany Truesdale:

And then again, just the limited access, especially in communities where minorities reside or especially if there’s minorities living in the country or if there isn’t access to transportation, if there isn’t access to even wifi now. Thankfully we have telehealth, which gives more access to folks, but unfortunately too, it’s still something that costs. So, being aware of that.

And then also, just limited awareness of what the resources are or what an experience can be when accessing mental health. And then, a lack of representation. When minorities do get to a point of accessing mental health, there’s also a lack of that representation, which sometimes also deters them from continuing to seek services.

Nicholette Leanza:

Yeah, definitely a fair point. Johnathan, your thoughts?

Jonathan Llamas:

In terms of some of the unique challenges regarding racial and ethnic minority communities, I’m going to speak primarily just based off of my experience being raised from a Filipino background. And the thing I want to mostly talk about is essentially the stigma attached to mental illness, especially among Filipinos and some historically marginalized groups that oftentimes prevent individuals from acknowledging their mental health symptoms until they become severe.

So, example of this is that maybe sometimes the stereotypes of Asian Americans being looked on as the model minority myth. Areum can talk a little bit more about that as well, or add on to that. But essentially, the model minority myth talks about particularly Asian Americans being seen exclusively as hardworking, intelligent, law-abiding people. And while on the surface that may appear to be somewhat of a positive assessment, this stereotype can oftentimes be also associated with higher levels of pressure to succeed, which can result in mental distress. Moreover, having this underlying pressure to succeed, it also deters sometimes Asian Americans from actually seeking treatment for mental illness, because of the fact that if you’re not feeling well, then parents would be like, “You should do what I do. You should just bury it down or just handle it yourself.”

Or, if you’re religious or you come from a Catholic background or a faith-based background, you be like, “You need to pray more.” Or, something like that. And so, these type of things, I feel, even though it may come off as if you’re looking at just briefly, you might think of it as a positive thing, but in reality, this is also something that can be fueling a lot of the stigma that’s attached to mental health.

Nicholette Leanza:

Very true. Very true. Areum?

Areum Kim:

I certainly could speak to being a model Asian immigrant child, having also gone to medical school and made my parents very happy with that. And what that means for me, I also think not allowing that to make me biased and feel as though everyone’s experience is the same as myself. I think that’s something culturally that we also have to keep in mind.

In regards to the cultural disparities, I think there’s so many factors that can contribute. I think something that Dr. Tiffany mentioned is insurance. So, uninsured Hispanic Latinos, it’s two to three times more likely than Black and white counterparts. A huge area that is of need here in the United States especially, is our Native American population.

Nicholette Leanza:

Yes.

Areum Kim:

Our Alaskan populations have very high rates of suicide, which are just growing in numbers. And so, I think looking at disparities, especially in terms of suicide statistics, it’s the most alarming, I would say, and something that we should all really watch out for.

I think we all understand, I’m sure, that white men are most likely to complete suicide. I think the other statistic that is alarming is the rate of growth, which in the male Black population is growing for suicide rates. The increase in suicide rates among our youth, especially our youth in marginalized populations in terms of sexual minorities and transgender populations, and the risk factors for a lot of violence towards these folks.

Thinking along the lines of COVID, the pandemic and PI hate and everything that brought about in the communities where Asian Americans were experiencing very high rates of anxiety, depression, but were not necessarily presenting to mental health centers more often with that. I think there are a whole lot of disparities that we have to keep in mind. And again, looking at political climate and everything going on in terms of the news and social media, I can’t emphasize that enough. That also impacts people and knowing that they’re more aware of mental health too, especially younger generations, and not necessarily getting the support that they need from older generations, and how that can impact folks as well. I think there are lots of caveats that we have to keep in mind, and I’m sure there are things that we haven’t even thought of yet.

Nicholette Leanza:

Oh my gosh. Areum, thank you for bringing all of that up. I definitely agree, and especially the part that there’s probably things that we haven’t even brought up or even thought of. I agree.

Jumping back, I know, Johnathan, you brought up stigma. How can we address the stigma around mental health in minority communities? Let’s jump back to Tiffany.

Tiffany Truesdale:

Yeah. I think a big thing even that we’re doing today is conversation. There just needs to be a lot of space and room for compassionate, open ears to have conversations and having different conversations with people from different backgrounds and cultures and minorities to be able to understand their experience. I think there’s too much focus on our differences a lot of times, where it’s not always a positive focus, and if we’re able to create a space where people are feeling safe enough to talk about their experiences in a positive way, so then we can see, hey, actually, there’s more things that we have in common, or even with these differences, can we be able to understand them? So, then we know how to be able to help people.

If we’re able to understand people’s different identities and their cultures and what’s going to be helpful for them, then we can be in a better space to be able to provide that support, because we have more of the knowledge, we can have more of the compassion and empathy for them with understanding their experiences. And then with that, being able to have providers who are also able to understand those things and to learn about, “All right, how can we implement these things to be helpful for folks?” Of course, we have our Western medicine, but we have to know that also doesn’t help everybody. And especially those from different backgrounds it’s like, all right, we have to see what’s actually really going to help everybody individually and tailor our help to them specifically.

Nicholette Leanza:

Oh, I can’t agree more with that. Johnathan, anything else you’d like to add about stigma?

Jonathan Llamas:

No, I think Tiffany said it great. The only way that we can continue to reduce stigma is to have these open and honest conversations with our peers, our family, friends, and especially our patients. I’ve been very fortunate just because, again, we grew up in a time now, where everyone is very accommodating and welcoming. People seems to be more empathetic or more understanding as opposed to maybe previous generations.

But we need to continue to foster that empowerment over shame and continue to foster that sense of curiosity as opposed to judgment and understanding that we have our own prejudices, even though we may or may not believe that we do sometimes. And so, just being-

Nicholette Leanza:

Right, those unconscious biases.

Jonathan Llamas:

Yeah. Those unconscious biases can sometimes fuel how we treat certain people without us even recognizing. So, we have to be mindful of that as well.

Nicholette Leanza:

Areum?

Areum Kim:

So, I think diversity, representation and mental health is certainly very important. I definitely have lots of folks who schedule with me to see their kids in particular, who are of Asian descent, who find a little bit of comfort or solace in that. Sometimes, I will say they maybe over-identify with me, and so there’s certainly navigating that within our treatments.

I also think having representation out there in specific clinics, Spanish speaking mental health clinics, I know various practices and facilities that’ll do that. Trying to have more specific community-driven awareness events, I think could also certainly be much more helpful for those communities that are getting missed. I think in terms of stigma specifically with patients, asking them about how they feel about mental health, “What are your thoughts on medications? How do you feel about taking meds? How do you feel about therapy?” I’m often asking these kinds of questions because it can be very elucidating in terms of stigma that people who are getting mental health do against themselves even sometimes, or they’re self-stigmatizing. Asking those questions to elucidate any potential for stigmas, and then also not assuming that people have stigmas as well.

So, I think for the Asian population, we could very easily assume that they’re not addressing their mental health and they’re shoving it all down and not dealing with things, right? But maybe that’s not the case. And always asking those questions, particularly in those initial appointments, I think, is so important to set the tone.

Nicholette Leanza:

I agree. So, Areum, what do you think are some tips clinicians who may be working with a client different from their own cultural background, what are some things they can do?

Areum Kim:

I think having open conversations and asking your patients about culture, about their upbringing, about what childhood was like, about what their parents were like. Learning from clients, I think, has been the most helpful in terms of opening up my cultural awareness and understanding.

And I’m often asking those questions. I know that for most of us folks here at LifeStance in our intake, we’re asking about cultural or spiritual concerns that might be impacting their care or how they see mental health in general. And so, I think that’s such an important, nice thing that we here do at LifeStance with all of our intakes is emphasizing, that’s important that we’re asking and talking about those kinds of concerns with patients because that’s a big part of what can impact their opinions, the way that they view mental health, the way that they view their treatment and the way that they actually get benefits, right? If they think a lot of this isn’t going to work and it’s all terrible and doesn’t actually exist and isn’t real, it’s probably not going to work. Right?

So, having all of those things in mind, I think is so important to set the tone in terms of treatment expectations and navigating appropriate conversations with patients. The biggest thing I can emphasize is, talk to your patients.

Nicholette Leanza:

Of course, right. Seems like a basic thing, but yes, definitely. Tiffany, your thoughts and tips for clinicians?

Tiffany Truesdale:

Yeah. I definitely agree with everything that Dr. Areum also mentioned. And then I think, too, as clinicians, it’s on top of being able to have those conversations, being able to do our own work as well, being able to have our own conversations with clients, being able to do our background research and being able to always educate ourselves, so we also have knowledge about the things that are going on, not just in our textbooks, but also what’s going on in society. What are those different things that are going on in research that we are learning about clients and our patients and things like that? So, we do have more knowledge, so that can decrease our biases and our stereotypes that we may hold on about other people and their identities and things like that.

So, we can help to continue to de-stigmatize a lot of these things and de-stigmatize receiving help, de-stigmatize mental health in general. So, there can be overall more conversations about those things, and for clients and clinicians to feel more comfortable overall, knowing that there’s just so much information that we can learn from each other in being able to help each other and knowing, overall, mental health is supposed to be a space where we’re coming together and cooperating together to help each other.

Nicholette Leanza:

I agree. And Johnathan?

Jonathan Llamas:

Yeah. So, I think both Dr. Tiffany and Dr. Areum eloquently stated pretty much some of the tips, but again, just to tie things together, what I found is that obviously with working with these clients that comes from different cultural backgrounds, it really does require a sense of sensitivity, respect, and a willingness to learn. As clinicians, as providers, we need to be the ones to empower and cultivate that sense of cultural self-awareness, understanding our own cultural values, beliefs and biases, and understanding our lens in which we approach our patients with an open mind to reduce the potential for misunderstandings.

And also, the importance of empowering a sense of cultural humility, that it’s okay that we may not have the answers, and we need to be humble about that and open-minded. Like Dr. Tiffany and Dr. Areum said, we have to continue to have those conversations so we can be willing to learn from the patients and not have our own prejudices and biased things that subconsciously that we are putting out there when we are coming into these interactions. And lastly, at the end of the day, we need to embrace that ongoing learning. Right?

Nicholette Leanza:

Mm-hmm.

Jonathan Llamas:

We need to continue to understand that this is an ongoing thing, it’s an ongoing process, but with self-reflection, humility, and a commitment to want to learn more and to want to hopefully provide the highest quality of care possible, that’s really going to help us in the long run continue to provide excellent care for these patients.

Nicholette Leanza:

Oh my gosh. Thank you, Johnathan. Thank you, Tiffany, and thank you, Areum. This was an amazing conversation, very important conversation and I respect what each of you brought to the table as we had this discussion. So, thank you again.

I would also like to thank the team behind the podcast, Jason Clayden, Juliana Whidden, and Chris Kelman, with a special thanks to Jason Clayden who edits our episodes. Take care, everyone.