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Koko Nishi learned gaman from her grandmother. Gaman describes the act of persevering through challenging times, the seemingly unbearable, with patience and poise. It’s a mindset by which many Japanese people ― including Nishi, a third-generation Chinese Japanese born in the U.S. ― live their lives. It’s also one of the reasons Nishi didn’t seek therapy in college, at a time she needed it the most. Nishi had failed her first class, an undergraduate organic chemistry course that was part of her plan to someday go to medical school, and it left her feeling emotionally wrecked.

“I thought there was something wrong with me,” Nishi, who is now a psychologist, told HuffPost. “I think that’s one of the times when I realized I was holding in so much, and it was really unhealthy…[Gaman] taught me resilience and helped me overcome a lot of challenges, but at the same time, I internalized a lot of my emotions,” Nishi explained. “I didn’t get to process what was happening or understand how I was feeling, or communicate what I needed.”

Asians, which make up the fastest-growing minority group in the U.S., are three times less likely than any other ethnic group to seek help, though that doesn’t mean they’re not suffering. According to Mental Health America, 13% of Asian Americans and Pacific Islanders had a diagnosable mental illness in 2016.

HuffPost talked to several psychologists, including Nishi, to break down what stops Asian Americans from getting the mental health services they need ― and it begins with a complicated version of shame. The shame to seek help comes from many sources, including the model minority myth.

Nishi now provides therapy to students at San Diego State University and hosts an organization that helps students with Asian and Pacific Islander backgrounds. Many Asian cultures have a concept similar to gaman, which Nishi said “loosely translates to ‘suck it up,’” and it makes students hesitant to seek help because they’re ashamed of not seeming emotionally tough.

The Substance Abuse and Mental Health Services Administration, a federal agency, provides funding for organization and programs that tackle these problems, including the National Network to Eliminate Disparities in Behavioral Health. Nishi co-created a workshop where people can share their stories about what it’s like to grow up as Asian or Pacific Islander in the U.S. and talk openly about the problems they face. She sees it as a way for the community to understand they’re not alone in their struggles.

“I think we [Asians] tend to feel like we’re invisible,” Nishi said. “It’s a space for folks to get their story heard, have their voices heard and validated.”

Read more on HuffPost.com.

For homeless people incapacitated by mental illness in Hawaii, years go by and ― for many ― nothing changes. They’re trapped. And their families struggle to get them help, despite a law passed five years ago that was supposed to offer a way out.

Cheryl Sasaki knows firsthand how hard it is to see a loved one on the streets ― and be able to do nothing about it. Her younger sister, Jeanette Serikaku, was homeless for decades. For 35 years, she was lost in a disease that manipulates how she thinks, feels and acts. “I’d see her at the K-Mart. By 7-11 on Dillingham,” said Sasaki. “I’d always stop by to see how she’s doing. And it was never an eye contact. She’d always look away from me.” As time passed, her condition manifested. Doctors diagnosed Serikaku with bipolar disorder shortly after graduating from Kalani High School. Sasaki said the whole family went to see the state psychiatrist for help. That was in the 1970s. And he had a discouraging message: “He couldn’t do anything because she was not hurting herself and she’s not hurting anybody,” Sasaki said.

Mental health advocates say despite changes in the law since then, that same explanation has kept Serikaku ― and others like her ― trapped on the streets. It used to be the only way a person could be forced to take psychiatric medication in Hawaii is if they committed a crime or had a legal guardian. But in 2014, the state Legislature passed a law called Assisted Community Treatment. It allows the courts to order a person to take medication if they’re proven to be an imminent danger to themselves or others. The problem: That threshold is so high the majority of Hawaii’s homeless suffering from mental illness don’t reach it, despite advocates and family members petitioning the court in a number of cases.

“As I work with many of these people, you don’t think that they have any family involved. Or any family who have tried to help. But it’s actually quite the opposite,” said Dr. Chad Koyanagi, who heads up the Institute for Human Services’ psychiatric street medicine team.

It was Koyanagi who diagnosed Serikaku with schizophrenia, a chronic and severe mental disorder that can include hallucinations, delusions and extremely disordered thinking.The doctor started trying to convince Serikaku to accept treatment when he first encountered her ― as a student in medical school. Perseverance of Koyanagi and her sister eventually found there happy ending.

Not long ago, Sasaki had lost all hope that days like this would ever come. To be sure, there are still times when not everything her sister says makes sense. It’s to be expected in this stage of her recovery. Still, Sasaki is proud to say her sister has improved “1000%” compared to a year ago.

“A thousand percent meaning she has medication. She has housing,” said Sasaki.

“Mentally-wise I think she’s better. She smiles. She says thank you. She’s starting to take care of herself too. It’s good to see her back in society.”

It took 35 years, but Serikaku is finally free ― no longer a hostage of her paranoia but a survivor who managed to escape the filth of the street. She’ll tell you how it happened: “Help is inside that needle,” she said.

Read more on HawaiiNewsNow.com

The U.S. Department of Veterans Affairs (VA) recently began partnering with the Corporation for National and Community Service (CNCS) to engage Senior Corps volunteers in support of VA’s Choose Home Initiative, enabling older Veterans to receive needed homemaker and daily living support in their homes, rather than move into health care institutions.

“VA supports Veterans who choose to remain home while receiving the care and services they need,” said VA Secretary Robert Wilkie. “This partnership will help improve Veterans’ health and physical and mental well-being and will aid their families and caregivers through in-home assistance.”

CNCS is the federal agency that leads national volunteering and service efforts. Senior Corps volunteers are a nationwide network of service programs for volunteers age 55 or older who commit their time to a wide range of community needs. CNCS mobilizes Senior Corps volunteers to provide homemaker and in-home respite care services to eligible Veterans, so those Veterans can remain in their own homes, live more independently and stay close to their families, caregivers and support services.

Homemakers assist with activities of daily living, such as light housekeeping and preparing meals. Respite care services temporarily relieve caregivers of their duties, so they may rest and return refreshed.

Through this interagency collaboration, which was formally agreed to in May, CNCS is providing volunteer support services in the following five communities that are part of the Senior Care Choose Home Program: Colorado Springs, Colorado; Las Vegas, Nevada; Missoula, Montana; Pittsburgh; and San Antonio.

Senior Corps volunteers will receive training about Veteran-specific concerns, including suicide awareness and prevention, before providing services in Veterans’ homes. Those participating in the partnership will also receive ongoing training on a variety of Veteran-related topics.

“Through national service, our commitment to Veterans is twofold: We serve them and we invite them to serve with us,” said Barbara Stewart, CEO of CNCS. “This new Senior Corps project is a unique opportunity to do both, helping aging Veterans to ‘choose home’ while providing others with a second opportunity to serve.”

Read more on VA.gov.

In order to highlight pockets of excellence across the country, the NNED selects a partner organization to highlight once a month. Great Plains Tribal Chairmen’s Health Board has been selected as the Partner of the Month for November in celebration of National Native American Heritage Month.

Established in 1986, the Great Plains Tribal Chairmen’s Health Board (GPTCHB) is an organization representing the 18 tribal communities in the four-state region of South Dakota, North Dakota, Nebraska and Iowa.

Through public health practices and the formation of tribal partnerships, they work to improve the health of the American Indian peoples they serve by providing public health support and health care advocacy.

Serving as a liaison between the Great Plains Tribes and the various Health and Human Services divisions including the Great Plains Area Indian Health Service, GPTCHB works to reduce public health disparities and improve the health and wellness of the American Indian peoples who are members of the 18 Great Plains tribal nations and communities.

GPTCHB’s vision is that all tribal nations and communities in the Great Plains will reach optimum health and wellness through lasting partnerships with health organizations and embrace culturally significant values that are empowered by tribal sovereignty.

United under the GPTCHB umbrella, the tribal constituents are able to compete for population-based grants and resources that may not otherwise be available to them. Through GPTCHB, tribes are empowering themselves to address their individual health resource needs in an effective way.

Some of the services and programs that are offered:

• Great Plains Native Connections Program
• Honor Every Woman
• Great Plains Good Health and Wellness Program
• Northern Plains Healthy Start
• Great Plains Tribal Epidemiology Center
• Native American Healthcare Scholars Program
• Training and Education

Learn more about Great Plains Tribal Chairmen’s Health Board and their work to support 18 tribes and tribal communities across four states.

View a list of previous NNED Partners of the Month.

Yvette Enrique knows what it’s like to struggle with “hiya,” or shame. She also understands what it’s like to feel the other side of “hiya,” known as “sayang” — in other words, feeling like a waste. Both of these concepts play a big role in Filipino culture: To be on the wrong side is akin to being ostracized in the community.

Growing up, however, Enrique looked like she was living the Filipino American dream. She attended private Catholic schools and took piano and dance classes. Shortly after high school, she became a nurse — a profession highly glorified among Filipinos across the diaspora. Internally, though, she was struggling. She lived in a household of domestic violence, and her parents got divorced when she was young. But it wasn’t something she felt like she could open up about.

Enrique started drinking alcohol and using cocaine when she was a teenager. Her family found out she was using cocaine and sent her to a short-term recovery program. But she kept using, which eventually became a gateway to methamphetamines. She was able to keep it under wraps from her family until it started affecting her work. At around 26 years old, she quit her job, not realizing at the time that she would eventually lose her license and quit nursing altogether.

Studies often suggest that Asian Americans have lower rates of substance abuse than people of other races, but mental health advocates say this belies the dark reality for the fastest-growing ethnic group in the United States.

“Cultural stigma and shame and the lack of knowledge exacerbates the hidden nature of mental health,” said Diane Ujiiye, an activist and former substance abuse counselor. “So if you don’t access psychotherapy or counseling, certain kinds of medication — and I’m not a proponent to medicate quickly — then you’re going to seek other ways to cope, to numb the pain, to escape and to function.”

This erasure largely stems from the way data on substance abuse has been historically gathered to begin with. In fact, Asian Americans weren’t a category of data collection for various state agencies until the 1990s, Ujiiye said.

“If you don’t have the data, you don’t have the basis to advocate for federal, state, county funds for treatment services, so there’s the cycle,” she said. “No data, no services — ergo, no data, no services.”

It’s something that Enrique, who is now reunited with her family and working at AADAP as a case manager, wishes more people understood about dealing with addiction in Asian communities. She explained that enabling goes hand in hand with “hiya” because encouraging someone to go to treatment means something was wrong.

“That’s not something you want to admit to for your family, that there’s a problem, ’cause there should never be problems,” Enrique said. ”[But] it’s OK. It’s OK to get treatment. It’s OK to save your family, you know?”

Read more on HuffPost.com.

Tracing the history of how the mental health of African Americans was characterized during slavery sheds light on why disparities in psychiatric care still exist.

Historically, concepts of race and mental illness have been intimately linked in American psychiatry, policies, and public opinion. Starting in the 1700s, two diametrically opposed medical views were alternatively used to predict vulnerability of black populations. From 1700 to 1840, enslaved blacks were described as immune to mental illness. John Galt, M.D., medical director at Eastern Lunatic Asylum in Williamsburg, Va., hypothesized that enslaved Africans were immune from the risk of mental illness because they did not own property, engage in commerce, or participate in such civic affairs as voting or holding public office. The immunity hypothesis assumed that the risk of “lunacy” would be highest in those populations who were emotionally exposed to the stresses of profit making—principally wealthy white men.

Blacks could receive care until the “immunity hypothesis” was displaced. Regrettably, the exaggerated risk hypothesis predicted excess mental illness, dependency, and dangerousness of black people if slavery were abolished. From 1860 into the 20th century, free blacks were seen at the greatest risk of mental illness. The causes included poverty, urban living, adverse family structures, and migration. The exaggerated risk hypothesis supported increased hospitalization of blacks as a means of control and safety.

In 2020, the Commonwealth of Virginia will acknowledge the 150th anniversary of the first mental institution for blacks in America and the theoretical and political roots that marked its segregationist origins.

Read more on PsychNews.org.