Daryn Reicherter

Stressors and Barriers to Using Mental Health Services Among Diverse Groups of First-Generation Immigrants to the United States

This study examined stressors and barriers to using mental health services among first-generation immigrants in San Jose, California. Focus groups for 30 immigrants from Cambodia, Eastern Europe, Iran, Iraq, Africa, and Vietnam were audio-recorded, translated and transcribed. Two researchers coded the data and identified themes pertaining to mental health stressors and barriers. Six primary stressors were identified: economic, discrimination, acculturation due to language differences, enculturation, parenting differences, and finding suitable employment. Primary barriers included: stigma, lack of a perceived norm in country of origin for using mental health services, competing cultural practices, lack of information, language barriers, and cost. A conceptual model is presented that may be used to inform the design and implementation of mental health services for this population.

Coping with the challenges of living in an Indonesian residential institution.

OBJECTIVE The aim of this study was to describe challenges and strategies for coping with these challenges among individuals living in an institutional setting. METHOD This study used a qualitative approach to analyze the interviews of fourteen participants (11 males and 3 females) ages 10-24 residing in an Indonesian residential institution (orphanage and Muslim boarding school). RESULTS Insufficient access to educational resources and basic necessities were major concerns of the participants, as was the residential institutions unresponsiveness and the lack of connection experienced by residents. Individuals coped with these challenges by turning to others for social support and by trying to change the focus of their thoughts, such as to more pleasant thoughts or simply to mentally disengage. CONCLUSIONS Some youths and young adults residing in institutions such as a residential institution demonstrate resilience at the individual level by utilizing coping strategies to address problems in obtaining adequate educational, material and psychological support. However, because inadequacies in these kinds of support ultimately impede psychosocial development, it is imperative to develop solutions for addressing these problems at the institutional and societal level rather than at the level of individual youths and young adults.

Introduction to Ethics in Clinical Medicine

This chapter provides a general discussion of medical ethics and professionalism. The authors examine the development and history of Western ethical thinking in medicine as a mechanism to understand the roots of modern ethical guidelines. The authors define and explore core bioethical principles and ethical skills. Case studies of ethical situations are presented to challenge the learner’s critical thinking in regard to the complicated realities in today’s world of medical ethics and professionalism.

What Is the Role of Academic Departments of Psychiatry in Advancing Global Mental Health

In response to growing recognition of the importance of mental health in overall health in populations around the world, interest has surged recently in global mental health (GMH), from governments and academic institutions to nongovernmental organizations and foundations [2, 3]. Past articles in Academic Psychiatry have described GMH as the part of public mental health that includes prevention, intervention, education, and improvements in the identification and care provision for the mentally ill around the world [4]. Others have offered a perspective on global health training in US psychiatric training programs. Yet others have described specific curricula and thoughtfully constructed educational projects that advance understanding of GMH issues or training of international partners. Although there are several well-developed examples of GMH training in psychiatry residency programs, many programs that have interest struggle to prioritize formation of such training opportunities amid increasing curricular content and decreasing budgets. Previous authors have outlined the justification and guidelines for GMH training within a residency program [5]. Without a commitment from the department as a whole—including clear signals of support from its leadership and broad engagement by its faculty—it may be difficult to form and sustain GMH training experiences in isolation. To date we are not aware of specific recommendations for the organization of GMH programs within academic departments of psychiatry. The intent of this commentary is to offer a framework for a GMH program as an academic-community partnership, to outline the potential components of a GMH program, to illustrate these ideas with examples from our department, and to articulate a role for departments of psychiatry in addressing the global burden of disease [6].

Questions on Core Concepts

This chapter contains questions from across medical disciplines. The questions are designed to test the learner’s understanding of the core concepts of professionalism and ethics in medicine. Correct answers are listed at the end of the section. The learner may refer back to the relevant chapter in Part I for the conceptual framework.

Questions on Research and Education

This chapter contains questions from across medical disciplines. The questions are designed to test the learner’s understanding of the concepts of professionalism and ethics in medicine as they apply to research and training. Correct answers are listed at the end of the section. The learner may refer back to the relevant chapter in Part I for the conceptual framework.

Questions on Clinical Issues

This chapter contains questions from across medical disciplines. The questions are designed to test the learner’s understanding of the concepts of professionalism and ethics in medicine as they apply to clinical situations. Correct answers are listed at the end of the section. The learner may refer back to the relevant chapter in Part I for the conceptual framework.

Questions with Narrative Answers

This chapter contains questions from across medical disciplines. Each question is followed by five possible answers, a narrative explanation of the question, and the correct answer. The narrative explanations are intended to help the learner understand applications of the fundamental principles of professionalism and ethics in medicine set forth in Part I. The learner may refer back to the relevant chapter in Part I for the conceptual framework.

Multicultural and Ethical Considerations in American Medicine

The authors describe and examine models of culturally informed care, giving attention to the culture of the patient and of the provider and the context of care. Ethical issues in multicultural medical environments are discussed and articulated through the use of case studies with narrative explanation. Culturally astute communication skills are explored. The authors recommend effective methods to address ethical issues in multicultural environments.

The Cambodian Lotus Thrives Under a California Sun: How a Mental Health Clinic Partnered with a Khmer Buddhist Temple to Reach Killing Fields Refugees Living in California

Suffering and loss are universal elements of the human condition. But so are hope and healing. This narrative discusses the partnership between academic psychiatry, a community mental health program, and a local Khmer Buddhist temple in an effort to rebuild lives broken by the Cambodian war and genocide. The key elements of this partnership found their foundation in the personal stories of the individuals involved in the project as much as in the missions of the agencies that partnered together. In order to effectively work with Cambodian survivors of genocide, cultural sensitivity was so essential that this partnership used unorthodox methods by Western standards yet reached a population otherwise poorly receptive to mental health interventions. Mindfulness meditation, co-led by Khmer Buddhist monks and Khmer mental health professionals, bridged the gap between East and West to make this partnership blossom. Meanwhile the personal stories of the monks, the Khmer clinicians, and patients became a cornerstone of the program, creating a unique healing experience.