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A beneficial, yet challenging, factor of education today involves the increasing diversity in our schools. Because of the ever-growing demographics, teaching cultural competency has become a major focus in the classroom, especially for a public school system as vast and diverse as Montgomery County.

It’s not only students that are getting instruction on cultural competency. These lessons start at the top with administrators, curriculum writers, and educators all participating in this movement in favor of cultural awareness and appreciation.

Because culture involves a deeply personal, ingrained set of beliefs, behaviors, practices, and values, most people are at least somewhat unaware of cultures to which they do not prescribe. This is especially the case for young children who are just beginning to explore the world around them.

Culturally-responsive instruction truly begins with a look at one’s self through reflection—it isn’t until we truly understand ourselves that we can begin to understand others around us.

Build a classroom environment founded in cultural appreciation by abolishing the word “normal.”

Just because a behavior or characteristic might be our cultural norm, this does not mean that it is the “normal” or “right” way. Likewise, just because a behavior or trait may be unfamiliar to us, this does not mean that it is weird, wrong, or abnormal. Remind children that, just as we are all unique beings, our beliefs and values may cause us to speak, dress, and behave differently. Reinforce the mindset that cultural diversity provides learning opportunities that a culturally-homogeneous classroom would not necessarily have.

Because each student comes from a different upbringing, with different customs, traditions, family structures, etc., the perspectives that we can gain by embracing our peers’ cultures are limitless. If we hold one another’s culture in high esteem by valuing it as a chance to gain knowledge about something new, we no longer see our peers as “odd” or “different.” Instead, children learn to place the emphasis on the fact that a peer’s culture has provided them with information and knowledge that they would not have known otherwise.

Beef up the classroom library with culturally diverse options for students to explore.

Keep in mind that a culturally-relevant text does not receive its credit simply from the author’s culture. A novel about a child growing up during British imperialist India could provide plenty of opportunities for culturally-rich discussion—or it could oversimplify a culture or lack an important perspective all together. The key is to explore an abundance of different styles of texts, by many different authors, on a plethora of different subjects and themes. After doing plenty of research, and taking your students’ cultures into account, set up a culturally competent classroom library.  

Encourage courageous conversations surrounding cultural norms and where they originate.

For instance, when examining the protagonist throughout the course of a novel, prompt the class to ask analytical questions about the character’s motivations, thoughts, and decisions. What do we know about this character’s values, background, upbringing, family structure, etc.? How are our lives similar or different because of our own cultures? How might our own beliefs impact the way that we view or characterize the protagonist? What more would we need to know or discover about the main character in order to fully understand why she behaves a certain way?

If we take steps to expose students to diverse cultures and guide their exploration of different customs, traditions and perspectives, they will learn to embrace new ideas and better navigate our world.

Read more and watch a TED Talk on why cultural diversity matters on SocialWorkHelper.com.

Mental illnesses such as anxiety and depression are common among older adults in rural areas, affecting 10 to 25 percent of that population. But many of those people with them suffer in silence rather than seeking treatment.

Researchers at Wake Forest School of Medicine wanted to know why, so they questioned 478 adults aged 60 and older in rural North Carolina. The most common barrier to treatment, according to their study? The belief that “I should not need help.” Other commonly cited barriers: not knowing where to go, distance, mistrust of counselors or therapists, “not wanting to talk with a stranger about private matters” and stigma.

Stigma — the sense that something is shameful — may be felt more acutely in small rural towns because of the relative lack of anonymity there.

“We as a society have a hard time asking for help, so it’s hard enough to ask for help [without feeling] that everybody’s going to know it,” said Dennis Mohatt, vice president of the behavioral mental health program at the Western Interstate Commission for Higher Education (WICHE) and director of the WICHE Center for Rural Mental Health Research.

“Your neighbors don’t have a clue in a city if you’re going to go get some help. But everybody [in a small town] will know if your pickup truck is parked outside of the mental health provider’s office,” Mohatt said.

Nobody Wants to Be in ‘That Club’

Our negative opinions about those who struggle with mental illness are reflected in our language, experts said. “That makes people fearful — you don’t want to be in that club, right?” Mohatt said.

Adding to that for older adults is the stigma around aging itself, said Eve Byrd, director of the mental health program of the Carter Center.

“They’re doing their best to remain active and relevant and, with physical conditions and possibly some cognitive [conditions], are constantly fighting that stigma,” said Byrd, a former nurse practitioner in geriatric psychiatry. “Should they experience symptoms of a mental illness, such as depression or anxiety, they often feel that supports the greater notion that all older people somehow have less value or are less capable.”

It also contributes to the belief that there’s no use in seeking solutions, Byrd said. But “mental illnesses in older people are treatable… with supports, people can live happy, healthy, productive lives — and that includes older adults.”

Shortage of Mental Health Pros in Rural Areas

A discussion of stigma associated with seeing a mental health professional assumes “that there is somebody to go to to begin with,” said Paul Mackie, a social work professor at Minnesota State University, Mankato.

“Too often, when you can even find services, they’re going to be limited,” he said.

Mohatt agreed. “The likelihood that there is a mental health professional in your rural community or even a nearby rural community that has been specifically trained to treat older adults is slim to none,” he said.

Most mental health providers are generalists, Mohatt said.

“You wouldn’t go to a cardiologist for open heart surgery who had not been specifically trained in doing that procedure, but we’ve got a lot of mental health practitioners out there treating populations of people, whether it’s children or older adults, that have had no real training,” he added. “They may have gone to a weekend seminar at a Holiday Inn, but they have not gone through a specific academic program to prepare them.”

Access to telehealth appointments, in which patients can have a video therapy session with a medical professional elsewhere, can help. But finding a mental health provider who isn’t already booked solid is a challenge, too, Mohatt said.

The Stigma of Mental Illness for Older Adults

A 2014 study of 129 older adults in three counties of the southeastern United States found significant differences between the stigma about seeking help for mental conditions felt by those in isolated rural areas compared to urban dwellers.

“We often stigmatize what we don’t know,” said Lisa Curtin, a professor of psychology at Appalachian State University and, with Hannah Stewart and John Paul Jameson, an author of the study.

“Some of our older adults were raised in a very different time period, when people didn’t talk about mental illness,” she said. “If somebody was suffering from depression or psychosis, people didn’t talk about it as depression or psychosis. They didn’t even have that kind of language.”

Many older rural residents with mental illness associate seeking help with a sign of weakness or an inability to be self-reliant, she said.

A small study of rural veterans, half of whom were in their 60s, found that barriers to seeking mental health treatment included “the importance rural veterans place on independence and self-reliance.” The veterans also cited “an emphasis on stoicism” and concern about stigma as getting in the way of their seeking help.

Solving the Issues of Access and Stigma

Mackie said the answer to a lack of practitioners for older adults in rural areas lies partly in getting students interested in the field.

“If we don’t start doing a better job of preparing rural practitioners, then we’re not going to get rural practitioners,” he noted. Mackie’s research has shown that potential future rural mental health professionals are most likely going to be young people who grew up in small towns: half say they would not want to go back to “the farm,” but half are open to it — compared with only 10 percent of students from urban areas.

To combat a sense of stigma, older adults need to see images of people like them in public health campaigns on mental illness, Mohatt said.

“Seeing [material] that’s got middle-aged people or young people and their problems — that’s not psychologically accessible to them; it doesn’t apply to them,” he said. Neither would sending public service messages through Twitter. A better approach, said Mohatt, would be “having a talk at the local Rotary club or having a public information ad campaign that’s on local radio and local TV and pamphlets in the doctor’s office that people can read and take with them.”

Byrd, of the Carter Center, said that individuals experiencing anxiety or depression are less likely to reach out for help because of the nature of the illness. But if the need is evident, community support can work wonders.

Just as when a neighbor is diagnosed with cancer or breaks her hip, “the community could rally, visit, bring meals, help with transportation, all of these things,” Byrd said.

She also believes we need to tell more positive stories about mental illness, “not just the gloom and doom, but the stories of recovery, the stories of getting the supports and the care and the treatments that are needed, and what the outcomes are of those stories.”

Read more on NextAvenue.org.

It’s a truism that the mind and the body are connected, but the U.S. health care system has long treated them as separate—with separate doctors, separate hospitals, separate payment systems. That’s a major reason people with acute mental illnesses don’t get help. Ditto for chronic conditions like depression and anxiety. People may not seek help because of stigma. They may not find it because there are too few providers and they are too hard to locate. Or people don’t have health insurance, or can’t afford the co-pays, or lose interest when faced with a long wait.

The result is that many people who need mental health care aren’t getting it. According to a recent article published in the Journal of the American Medical Association, nearly 18 percent of adults surveyed in 2015 reported having a mental, behavioral or emotional disorder. And 20 percent of respondents said either they or a family member had needed mental health care but didn’t get it, either because they couldn’t afford it, their insurance wouldn’t cover it, they were afraid or embarrassed, or they had no idea where to go.

At the patient level, this means people with mental health issues suffer when they don’t need to. And at the policy level, there are huge reasons to fix this, primarily the high long-term cost of untreated mental illness. Mental health plays a big role in chronic conditions like hypertension, obesity and diabetes. “You can go ahead and give all the insulin you want,” says Donald Berwick, former head of the Centers for Medicare and Medicaid Services, founder of the Institute for Healthcare Improvement and a big proponent of behavioral health integration. “If you’re not addressing the attendant behavioral health issues, you’re not just missing the chance to reduce suffering, you’re reducing the chance to save a lot of money.”

In part because of their Alaska Native heritage, which puts a high value on spiritual health, the leaders of the Southcentral Foundation recognized decades ago that behavioral health is tightly linked with bodily health. So they became one of the early adopters of integrated care. They embedded treatment for mental and emotional ills in their primary care practices, and found that patient satisfaction rates skyrocketed and usage of medical care went down, saving millions of dollars while improving patient outcomes.

In the nearly 30 years since Southcentral hired its first psychologist, pretty much every study has shown that integrating mental health care into medical care results in better patient outcomes and lower costs. A few years ago, analysts at actuarial firm Milliman estimated that integrating medical and behavior heath care could shave $26 billion to $48 billion each year from the nation’s health care costs.

But adoption has been slow, in part because of the way much health insurance is structured. Mental health is often a separate benefit, if insurance pays anything at all. Doctors are paid more for procedures on sick people. They get less if they keep their patients healthy and out of the hospital.

Of all the structural problems in the U.S. health care system, the segregation of mental health care from the rest of medical care is arguably the most costly, both financially and in terms of patient health. With new pressure to find ways to bend the curve of health care costs, and the growing burden of chronic disease and worker disability, perhaps no policy could have as much bang for the buck as finally integrating mental and physical health care.

In the middle of the 20th century, mental illnesses weren’t considered illnesses per se; fully debilitating illnesses were seen as “insanities” and their sufferers often confined against their will in special mental hospitals. Illnesses that were less debilitating—milder depressions, say, or anxiety or substance abuse—were viewed as weaknesses of will, often ignored by medical professionals. Payment followed suit; for mental health providers it was low, for primary care providers it was essentially nonexistent.

People had to either figure out a way to live with their conditions, or suffer as their illnesses got more acute. The arrival of more effective medications for mental illnesses opened things up a bit—doctors could write a prescription, and patients could feel better without months or years of talk therapy. Still, several studies in the 1980s showed that many patients didn’t get treatment, with as many as one-half of patients saying no when their doctors suggested they get mental health care.

The search was on for something better. In the early 1990s, private foundations and the federal government, through the Substance Abuse and Mental Health Services Administration, began funding clinical studies around the country. Could primary care providers be trained to recognize depression, and get their patients treated? Would that make a difference? The studies showed the answers were yes and yes. In 1996, the Institute of Medicine published a suggestion—integrate primary and behavioral health care so that patients would get diagnosed and treated by their doctors or via direct referral to a behavioral health specialist as part of their routine medical care. Big health care systems like Kaiser Permanente and the Veterans Administration began experimenting with integrating behavioral health care in some locations.

Southcentral Foundation was ahead of the trend, having started thinking about integrating its care in 1985. CEO Katherine Gottlieb, an Alaska Native who won a MacArthur “genius” grant award for her work at Southcentral, says there was a simple reason: “We did a survey of our community.’’

Southcentral asked community members to rank their health care priorities among choices like cancer care, diabetes, obesity and behavioral health. The top five priorities, says Gottlieb, were all related to behavioral health—child sexual abuse, child neglect, domestic violence, behavioral health counseling and addictions.

So Southcentral forged forward with its goal of making patients with behavioral health issues feel welcome. It built an airy new primary care center that looks as much like a mountain lodge as it does a place to get medical care. Huge windows frame the snowcapped peaks of the nearby Chugach Mountains, and the halls are filled with Alaska Native art—beadwork, blankets, dolls, carvings and paintings of totem animals such as ravens, orcas and eagles. There’s an expansive lobby designed to host community gatherings. Foundation planners say the setting sends the message that the health of the community directly relates to the health of each of its members.

Today, a patient with a history of mental illness, like Vera, gets evaluated by her doctor whenever she comes in for a medical appointment. If Vera seems anxious or depressed, the doctor might talk to her about it, or call in the behavioral health consultant. But the same goes for patients without a history of behavioral problems. A diabetes patient who has stopped taking his pills, for instance, might find himself in a 20- or 30-minute discussion with his primary care doctor about ways to deal with anxiety or depression. The primary care doctor or the behaviorist on the team might suggest more formal counseling, or the request might come from the patient. When hospital care is needed, patients are sent by their care team, and they return to that care team when they get out.

The system puts mental illnesses into the realm of routine health care. “We know that for tons and tons of people, stigma is a really big deal in behavioral health,” says Douglas Eby, vice president of medical services at Southcentral and one of the many staffers who’ve been there since the beginning. “But getting behavioral health during your visit with your primary care provider, or by the guy down the hall, at the same place and maybe during the same visit—then it’s nothing different, and not likely to be stigmatized.” Your employer won’t find out, and your buddies won’t see your truck parked outside a mental health office. Integrating behavioral health care into a medical setting normalizes it, he says.

Southcentral takes things a step further, with several innovative group therapy programs, some of them building on Native American culture—“learning circles” where people talk about how they dealt with internal conflict and about how to resolve their feelings. Vera attended an intensive one-week group therapy session where people shared memories of domestic violence, abuse and neglect. “That was the week I figured out I could be happy,” she says. Family, faith and friends also helped, but what she learned at Southcentral was instrumental. “That was the start of not being a victim anymore, of seeing that there was light at the end of the tunnel and I wouldn’t always be depressed.”

Southcentral’s administrators credit integration for lowering hospital admissions and visits to the emergency room by more than a third between 2000 and 2015. In a recent survey, 97 percent of patients said they were satisfied with the care. In 2011, the foundation was awarded a Malcolm Baldrige National Quality Award for delivering top-quality care for less cost than the vast majority of U.S. providers.

The biggest challenge all along, says CEO Gottlieb, has been money.

Southcentral gets by on a combination of private insurers and government programs including Medicare, Medicaid and the Indian Health Service. But most of them don’t pay much for mental health care, and they don’t pay anything at all for some of the counseling and group sessions the foundation offers. So Southcentral subsidizes behavioral health care with savings from the medical side, and it gets grants as well.

Payment is a challenge across the country.

A landmark study of 113,452 patients in 102 group practices within the Intermountain Healthcare system in Utah and Idaho showed how much can be saved by integrating mental health care. Some practices included mental health care in a “medical home.” In other practices, patients were referred to outside therapists. Annual medical costs were $515 higher per year for patients who did not get mental health services through their primary providers.

While the benefit to patients was clear, the study had a second conclusion—that providers lost money by integrating mental health. As physician Thomas Schwenk noted in an accompanying editorial, during the 2010-13 study period the integrated practices received $115 less per patient per year than the traditional practices, because payment was based on procedures and office visits. Since patients in the integrated practices needed less medical care, the doctors made less money.

Such payment practices are common, and Schwenk wrote that it’s going to take “a profound change in the fundamental structure of the U.S. health care delivery system” to integrate behavioral health care into the primary care environment. That would take heavier reliance of payments going to groups of doctors caring for groups of patients, not piecemeal payments for individual services.

Solving these problems will take more than money; it will require changing the culture of medicine. Many groups are moving in that direction; the American Medical Association, the American College of Physicians, the American Psychiatric Association, the American Psychological Association and other groups have policies promoting integrated care and offer information to their members on how to adopt it.

Southcentral Foundation leaders are often invited to speak at conferences or to health care organizations in the Washington, D.C., area, and when they do, they usually stop by Capitol Hill or federal agencies to talk about the benefits of providing mental health care in a primary care setting. Douglas Eby’s trips have led him to believe that there will be more support in the future for fully integrated systems.

“We are popular with the whole political spectrum,” he says. “We cut costs like crazy and emphasize self, and family, so Republicans love us. Democrats love us because we’re all about community and social factors and reforming the pillars of society so that everyone has improved access to care. When we walk into different political offices, we emphasize different parts of the system so that they can hear our story in their words and values, but it is all very true and the truth is the same truth.”

Read more on Politico.com.

In the wake of the school shootings in Florida, therapy dogs have been used as a way to provide comfort and support for students returning to school. Research has shown therapy dogs can reduce stress and provide a sense of connection in difficult situations.

Given the impact therapy dogs can have on student well-being, schools and universities are increasingly adopting therapy dog programs as an inexpensive way of providing social and emotional support for students.

What are therapy dogs?

It’s important to note therapy dogs are not service dogs. A service dog is an assistance dog that focuses on its owner to the exclusion of all else. Service dogs are trained to provide specific support for individuals with disabilities such as visual or hearing difficulties, seizure disorders, mobility challenges, and/or diabetes.

The role of therapy dogs is to react and respond to people and their environment, under the guidance and direction of their owner. For example, an individual might be encouraged to gently pat or talk to a dog to teach sensitive touch and help them be calm.

Therapy dogs can also be used as part of animal-assisted therapy. This aims to improve a person’s social, cognitive and emotional functioning. A health care professional who uses a therapy dog in treatment may be viewed as less threatening, potentially increasing the connection between the client and professional.

There are also animal-assisted activities, which is an umbrella term covering many different ways animals can be used to help humans. One example is to facilitate emotional or physical mental health and wellbeing through pet therapy or the presence of therapy dogs. These activities aren’t necessarily overseen by a professional, nor are they specific psychological interventions.

Research suggests using therapy dogs in response to traumatic events can help reduce symptoms of depression, post traumatic stress disorder and anxiety.

So, what can happen psychologically for people using therapy dogs?

The human-animal bond

The human-animal bond can impact people and animals in positive ways. Research shows therapy dogs can reduce stress physiologically (cortisol levels) and increase attachment responses that trigger oxytocin – a hormone that increases trust in humans.

Dogs also react positively to animal-assisted activities. In response to the human-animal bond, dogs produce oxytocin and decrease their cortisol levels when connecting with their owner. Often dogs feel the same when engaging in animal-assisted activities as if they were at home, depending on the environmental context.

Benefits of therapy dogs

Animal assisted therapy can:

• teach empathy and appropriate interpersonal skills
• help individuals develop social skills
• be soothing and the presence of animals can more quickly build rapport between the professional and client
• improve individual’s skills to pick up social cues imperative to human relationships. Professionals can process that information and use it to help clients see how their behaviour affects others.

More recently, therapy dogs are being used as a form of engagement with students at school and university.

Benefits of therapy dogs at school

A recent report highlighted children working with therapy dogs experienced increased motivation for learning, resulting in improved outcomes.

Therapy dogs are being used to support children with social and emotional learning needs, which in turn can assist with literacy development.

Research into the effects of therapy dogs in schools is showing a range of benefits including:

• increase in school attendance
• gains in confidence
• decreases in learner anxiety behaviours resulting in improved learning outcomes, such as increases in reading and writing levels
• positive changes towards learning and improved motivation
• enhanced relationships with peers and teachers due to experiencing trust and unconditional love from a therapy dog. This in turn helps students learn how to express their feelings and enter into more trusting relationships.

Despite these known benefits, many schools choose not to have therapy dog programs due to perceived risks. These range from concerns about sanitation issues to the suitability of dog temperament when working with children. But therapy dogs and owners are carefully selected and put through a strict testing regime prior to acceptance into any program.

The main reason for the lack of take up has been linked to the limited research into the benefits of therapy dogs in schools.

Benefits of therapy dogs at university

Researchers have found university students reported significantly less stress and anxiety, and increased happiness and energy, immediately following spending time in a drop-in session with a dog present, when compared to a control group of students who didn’t spend any time with a therapy dog.

Read more on TheConversation.com

The 4 million residents of drought-stricken Cape Town, South Africa, have held Day Zero at bay. Their water-saving efforts appear to have kept the city’s taps from running dry just yet. But as Capetonians breathed a sigh of relief this month, some Americans left their homes in rural New Mexico, bucket in hand, to collect water from a nearby livestock trough. Those dirty two or three gallons would be all they had for drinking, cooking, cleaning and bathing that day. For these Americans, it is always Day Zero.

Water poverty affects nearly 1.6 million people in the United States, but it remains a stubbornly invisible crisis. Before widespread solutions can be rolled out, however, we need to know who exactly is getting by without the taps and the toilets the rest of us take for granted. But such granular data simply doesn’t exist.

Here’s a bit about what is known. Today, African Americans are twice as likely as whites to live without modern plumbing. In majority-black Lowndes County, Alabama, for instance, only 20% of the community is connected to the municipal sewer system. On the Navajo Nation, 40% of the nearly 170,000 residents still haul water home in bottles or buckets, often at great expense. Impoverished rural communities in Appalachia face water-borne diseases at rates rarely seen in developed nations. Even in California more than 1 million people rely on public drinking water systems that have violated state safety standards, threatening their health.

These observations, while shocking, are really just anecdotal.

The most comprehensive data we have on U.S. water poverty comes from the Census Bureau, but it is maddeningly unspecific and often inaccurate. The Census Bureau’s American Community Survey tells us there are about 1.6 million Americans living in housing that lacks “complete plumbing facilities.” That could mean they don’t have a flush toilet or a bathtub or shower. But it could also mean they don’t have piped water at all. Which one is it?

The census data does reveal this much: The problem is experienced most acutely by African Americans in the rural South, Latinos in the rural Southwest, Native Americans and Alaskan Natives, residents of deep Appalachia, and migrant and seasonal farmworkers. These are notoriously hard-to-count populations for the census, and data on them is often inaccurate. Even worse, the census’ big number — 1.6 million — doesn’t include the millions of Americans who have plumbing but unsafe tap water. Think of Flint, Michigan.

We are seeing only the broadest outline of the problem. Census data doesn’t tell us which communities are too remote to be served by traditional water lines, which are too poor to afford their own septic systems, or which live too close to water sources contaminated by agriculture or industry. It doesn’t tell us how communities cope with these challenges every day. Most important, census data doesn’t explain why these communities still don’t have access to water and sanitation when nearly every other American does. We need both qualitative and quantitative information from within these communities. Without it we can’t forge the right policy solutions, accelerate the implementation of essential water projects, or build the public and political will to end this problem once and for all.

Some important work is already being done to improve equity in U.S. water access, despite this lack of data. Some of the finest examples were recently outlined by the U.S. Water Alliance in its national briefing paper, An Equitable Water Future. San Francisco is addressing disparities in water cost and quality for low-income residents and using the billions of dollars they’re investing in system upgrades to create jobs in disadvantaged communities. In California’s Central Valley, the Community Water Center is organizing residents with poor water quality to give them a voice in policymaking. This month, DigDeep will finish a project to bring clean water to the St. Michael’s Association for Special Education, the only special-needs school on the Navajo Nation. Each of these achievements creates prosperity, health and joy.

For this work to reach a national scale, we need more specificity from the census plumbing data, and a commitment from state and local governments in affected areas to examine the root causes of local water poverty. Universities and NGOs can help by gathering and synthesizing existing national data and by embedding our own researchers in affected communities. They should also convene stakeholders — human rights organizations, the water sector, the private sector, philanthropy and affected communities themselves — to arm them with knowledge.

Every American needs access to the basics — water, food, shelter — to participate fully in society. When these conditions are met, our communities and our economy thrive. Instead of waiting for the next Cape Town or California water crisis to wonder, “Will we still have water tomorrow?” we should be asking right now, “Who needs water today?”

Read more on LATimes.com.

The impact of prejudice and racial bias on health shouldn’t be underestimated, a new study affirms. 

Researchers looked at the relationship between discrimination and suicide ideation, or suicidal thoughts, among older Chinese-Americans. The results, published in August in the The American Journal of Geriatric Psychiatry, showed that those who reported experiencing prejudicial treatment or racial bias were twice as likely to have suicidal thoughts as those who didn’t.

The findings show that the effects of discrimination shouldn’t be taken lightly, Lydia Li, associate professor at the University of Michigan School of Social Work and a co-author of the study, told HuffPost.

“It’s a serious matter. It’s not something you can just forget ― that you can just brush off. It’s lingering. It cuts into peoples’ thoughts about their place on this planet,” Li told HuffPost. “[Race] might be a social construct, but discrimination really does affect peoples’ lives.”

The study examined more than 3,000 Chinese-American seniors (ages 60 and older) in the greater Chicago area and found that more than 4 percent had experienced suicidal thoughts within a 30-day period.

Those who reported facing discrimination were significantly more likely to do so.

According to the Centers for Disease Control and Prevention, the percentage of suicide ideation for the general older U.S. adult population is under 3 percent over a yearlong period ― a much longer period than in the new study.

The elders in the recent study said they most often suffered prejudicial treatment in public spaces and on the street, Li explained. Many also mentioned they experienced discrimination at work. 

Li speculates that difficult immigrant experiences coupled with certain values in Chinese culture could potentially account for the higher rates of suicidal thoughts among Chinese-American elders who have faced discrimination. Many are immigrants and don’t have the support networks they’re typically used to in their home countries, she explained. When encountering bigotry or intolerance, they may feel alienated and start to second-guess whether moving to the United States was the right choice for them. 

“This experience with discrimination can make people think, ‘Maybe I just don’t belong here.’” she said. “There’s a sense of that they’re not welcome here.”

And because older immigrants may not have had to grapple with discrimination in China, processing these hurtful experiences may be particularly difficult for them. 

“It’s not something they’ve been trained to deal with,” Li said. “They didn’t have this experience in the first half of their lives. They didn’t have to cope with that.”

Li added that the concept of “losing face” or bringing shame to families and loved ones can also make it more difficult to deal with discrimination. When Chinese-American seniors experience a racially charged event, like being told to go back to their country, it’s possible they could internalize the bigotry, Li said. They could question whether they did anything wrong and could even end up blaming themselves for the incident. 

What’s more, when Chinese-American elders find themselves distressed by these experiences, they often won’t seek out mental health help, Li said, which could ultimately contribute to the occurrence of suicidal thoughts. She explained that the seniors may avoid treatment or solutions due to pride, or simply because the proper language resources don’t exist for them. Many others just don’t know what kinds of services exist or where to go for help. And without getting the assistance they need, suicide may start to feel like a viable alternative for them, Li said. 

Li also noted that Chinese studies also showed higher rates of suicide ideation among seniors compared to studies of seniors in the U.S. It’s possible that suicide may be relatively permissible in Chinese culture and therefore contribute to the higher rates of suicidal thoughts in Chinese-American seniors. 

She also notes that rates of suicide ideation among older Chinese-Americans could look different in rural regions, since participants in this study all lived in the Chicago area. She also mentioned that the discrepancy in the rate of suicidal ideation in Chinese-American seniors versus that of the general U.S. adult population could be partially due to difference in methodology.

However, the study’s results are still startling, Li said, and shouldn’t be discounted. They point to a serious need to recognize the harmful consequences of bigotry and prejudice. To start, Li feels that the public needs to gain awareness about the very real health effects of discriminatory behavior. And ultimately, advancing civil rights could actually be a form of suicide prevention.

People who have suffered prejudicial treatment and racial bias must be empowered to properly cope with these situations, Li added. She suggested helping new immigrants in particular by stressing that they aren’t alone and that these hateful instances aren’t their fault. 

“People aren’t being oversensitive,” she said. “This is a real experience.”

Read more on HuffingtonPost.com.