African American's View of Mental Health

African American’s view of Mental Health

Introduction
Mental illness in any culture can be viewed with stigmatism, which is based on cultural beliefs. People have various ways of coping with instabilities of the mind and are deeply influenced by the environment in which they have been exposed to or by the experiences in which they have lived.
Admission
The patient of interest is an African American female eighteen years of age with bipolar type I and Asperger’s disorder. She was brought to the hospital by her mother and step-father, and she was admitted on a voluntary status to the psychiatric mental health hospital for increasing agitation, mood lability, self-harm thoughts, as well as threats toward her family. Her mother reported her aggression increased after the patient discontinued her risperdol medication. The patient’s mother had been married to her step-father since 2005. The patient has four siblings living in the home whose ages are 17, 14, 2, and 1. The patient reported that her relationship with her 17 year old sister was the worst with frequent aggressive behavior’s such as hitting and yelling. The patient reported suicidal ideation with no plan and depression, she was told by her family that they did not care if she killed herself. She also admitted that she was not taking her medication as prescribed and skipping a few days because she would forget. The patient said she felt “shy” because she was the only African American on the unit. In 2010 patient had four previous psychiatric hospitalizations. The patient’s Diagnostic & Statistical Manual of Mental disorders (DSM): Axis I, bipolar disorder type I mixed with Asperger’s disorder, Axis II, deferred, Axis III, seizure disorder and ventriculoperitoneal shunt in place, Axis IV, psychosocial stressors: severe, and Axis V, global assessment of functioning (GAF) of 35.

Cultural Views
The African American culture and its view of mental illness is no exception, as with all other cultures there are spiritual and religious beliefs about what may be the cause of mental illness. In this culture mental illness is not viewed as a health problem, it can have causes such as the “blues,” a weak mind, or a troubled spirit (American Psychiatric Association, 2010). Many are reluctant to seek help for a mental illness due to the stigma of being perceived inferior to others and as a threat to society. In the African American community “mental illness is associated with shame and embarrassment, and both the affected individual and the family hide the illness” (Heidrich & Ward, 2009, Attitudes section, para. 1). Previous healthcare experiences or hearing about someone else’s experiences of being misdiagnosed has led to other measures of coping with mental illness and mistrusting the healthcare provider (National Alliance of Mental Illness, 2011).
African-Americans seek support through other pathways such as through their family, communities, and their religion rather than going to a physician or psychiatrist for treatment (American Psychiatric Association, 2010). African Americans family dynamics are composed of close kinships, the care of the family is equally shared by both the mother and the father. Therefore; “family participation in a support group or a church group can improve the family’s ability to care for family members with mental disorders and cope with the emotional distress of being a caregiver” (American Psychiatric Association, 2010). The religion chosen by the majority of African-Americans is Christianity, which has a deep influence on how mental illness is perceived and treated. In Christianity, mental illness is viewed as being taken over by spirits and can be rid of with prayer. The use of prayer and community involvement is often used as a form of coping with stress. Another factor to consider is the way in which mental illness is expressed as compared to other cultures, such as a sudden collapse which is a way of showing mental distress or emotion (National Alliance of Mental Illness, 2011).
Mental Exam The patient appeared to be clean, anxious, and restless during the interview. She was shaking her leg and moving around a lot in her chair. The patient was cooperative; however she was evasive and vague when answering questions and would respond with, “I don’t know.” The patient would occasionally slur her words during the interview. Her affect was incongruent as she was smiling while speaking about hitting her mom. She admitted to feeling anxious, with a racing heartbeat and a shaking leg, and she stated she was anxious about where she will go after discharge. She denied symptoms of a panic attack such as hyperventilation, sweating, and a heart attack feeling. The patient had depression since 2005. She denied changes in appetite, energy, or sleep, body mass index (BMI) was 26. She felt hopeless and helpless from an unknown cause. She denied suicidal ideation at the time of interview. She has a history of attempted suicide in 2008 by taking too many oxcarbemazepine (Trileptal), four pills more than the usual dosage. She didn’t remember treatment, only that she was taken to the hospital. Denied homicidal ideation, however she had a recent history of violence in the past year of hitting her mother when she was upset; she identified her triggers as others cursing, yelling, or kicking her or when others hit her first. Her thought content was intact, she denied delusions and hallucinations. The patient was alert and oriented to person, place, and time. Her immediate memory was intact, her recent memory was good, but she had poor memory of past events; she stated she could not remember a memory of being four or five years old. Her intellect was good, she was in the twelth grade and was earning good grades. Her insight was fair; she stated her treatment goals were to be safe, take medication, not curse, or say racist or mean things. The patient’s information was not completely reliable due to her evasiveness and vagueness when being interviewed. Her judgment was fair; she stated if she saw someone steal at school she would tell the teacher or tell a cop. She denied any use of illicit substances.
Priority Focus The priority focus for the patient was medication compliance. The patient admitted to occasionally skipping days and said she would forget to take her medications as directed by her psychiatrist. As a consequence to her medication non-compliance the patient was a danger to herself and to others by being physically aggressive and verbally abusive toward others. Plan of Care
The plan of care for this patient was to discharge to her home with her mother and step-father. The patient was to continue with therapy on an outpatient basis with her current psychiatrist, Dr. Patel and also with family therapy sessions at Palomar family counseling center in Escondido. The patient and her mother were given the phone numbers and addresses upon her discharge. With the patient’s culture in mind more resources for family therapy such as the Association of Black Psychologists - San Diego Chapter (P.O. Box 23810, San Diego, CA 92103 phone [phone] Voice/Fax). The patient was given information and instructed on how to correctly take her oxcarbemazepine (Trileptal), the side effects of the medication and the importance of not discontinuing use suddenly because it may cause seizures. Discussed with the patient the negative consequences of medication non-compliance such as readmission to the psychiatric hospital, getting hurt or arrested, and that parents won’t allow her to stay in home. The patient was instructed the importance of medication compliance and ways to remember taking medication such as marking calendar with scheduled dosing times and putting a pill boy on the refrigerator with a magnet. The patient was instructed to call her doctor if she had new or worsening symptoms such as mood or behavior changes, depression, anxiety, or if she felt agitated, hostile, restless, hyperactive (mentally or physically), or if she had thoughts of suicide or hurting herself. Phone numbers for suicidal hotlines were given and she was advised to call when having thoughts of hurting herself. Suicidal signs and symptoms discussed with her family included giving away belongings, saying goodbyes, writing goodbye letters and verbalizing suicidal thoughts or a plan. The patient’s family was advised to call suicidal hotline or psychiatrist immediately if having signs or symptoms. Patient’s family was also advised on the importance of family therapy for coping and managing with the patient’s illness. The nurse discussed with the patient’s family the worsening symptoms of bipolar disorder such as inflated self-esteem, decreased need for sleep for example feeling rested after only 3 hours of sleep, delusions of things that are not really there, suicidal thoughts, racing thoughts, an increased energy, hopelessness/ helplessness, and increase in impulsivity. The nurse discussed signs to look for when feeling frustrated such as irritability, clenched fist, and impatience for others, and if experiencing these symptoms to call psychiatrist. Triggers and consequences to aggressivity such as yelling by others or getting hurt were identified. Management for aggression were reviewed with the patient such as walking away, listening to her Ipod, playing her DS, hitting a pillow, deep breathing, and counting to ten.

Reference Citation
American Psychiatric Association. (2010). Healthy minds. Healthy lives. Retrieved February12, 2011, from http://www.healthyminds.org/More-Info-For/African-Americans.aspx
Heidrich, S.M. & Ward, E.C. (November, 2009). African American women's beliefs About mental illness, stigma, and preferred coping behaviors. Qualitative Health research, Vol. 19 Issue 11, p1589-1601, 13 p, 3. Retrieved February 12, 2011, from PubMed database.
National Alliance on Mental Illness. (2011). Multicultural action center. Retrieved February 12, 2011,from http://www.nami.org/Template.cfm?Section=Resources&Template=/ContentManag ement/ContentDisplay.cfm&ContentID=21024
National Alliance on Mental Illness. (2011). Multicultural action center. Retrieved February 12, 2011,from http://www.nami.org/Template.cfm?Section=Outreach_Manuals&Template=/ Content Management/ContentDisplay.cfm&ContentID=20986