Phillip D. Akutsu

Clinical Problems That Initiate Professional Help-seeking Behaviors From Asian Americans

What are the types of clinical problems that motivate Asian Americans to overcome cultural and institutional barriers and decide to seek professional help? This study found there were both similarities and differences in the clinical problems that were reported to encourage 7 Asian American groups to seek out a mental health provider. Specific reasons for these ethnic differences in problem reporting were attributed to possible differences in level of acculturation or familiarity with Western concepts of mental illness, cultural scripts about mental health issues, and baseline epidemiological rates. Both clinicians and researchers may benefit from further examination of the cultural influence on problem reporting to improve their general understanding of the help-seeking behaviors and service needs of Asian American groups.

Predictors of Nonattendance of Intake Appointments Among Five Asian American Client Groups.

The authors examined the relationship of demographic, clinical, and service program factors with preintake attrition rates, or the nonattendance of intake appointments, among 5 Asian American groups at an ethnic-specific program. The results show that younger age, earlier appointment, Asian language match with the prescreening interviewer, and assignment of the prescreening interviewer as the intake therapist increased; however, gender match with prescreening interviewer decreased-the likelihood of intake attendance. As hypothesized, Southeast Asians (Cambodian, Iu Mien, and Vietnamese Americans to a lesser degree) reported higher intake attendance rates than more established East Asian groups (Chinese and Korean Americans). Specific implications of these results to program evaluation and to development and improvements in service delivery to Asian American groups are discussed.

Involuntary return to a psychiatric emergency service within twelve months

ABSTRACT Objective. Under managed care, there is pressure to shorten hospital stays. Yet, previous investigations have shown longer hospitalizations following a psychiatric emergency service (PES) evaluation reduce recidivism. This study examines the relationship between post-PES hospitalization, patient characteristics and involuntary PES return within 12 months. It is done in a context where average duration of post-PES hospitalizations are 6 days, approximately 1/4 the duration of previous studies reporting positive effects of such hospitalization. Method. Structured observations of PES evaluations of 417 patients were completed at 7 California county general hospitals. Follow-ups were conducted at 12 months after initial evaluation. Study objectives are evaluated using multivariate modeling. Results. Subsequent to the initial evaluation, 121 of the 417 patients (29.0%) were involuntarily returned to the PES. The likelihood of involuntary return was increased by a psychotic diagnosis and the seriousness of initial clinical presentations on the TRIAD dangerousness criterion measure. Having insurance also increased the likelihood of involuntary return. Conclusions. As the patients initial PES condition was found to be the best predictor of involuntary return and duration of post-PES hospi-talization seemed to lose its prophylactic effect, it seems we have gone too far in reducing lengths of inpatient stays. We may have lost sight of the crucial role of this setting in stopping the revolving door and insuring appropriate care.

Differential referral patterns to ethnic-specific and mainstream mental health programs for four asian american groups

This study examined the referral patterns of Chinese, Japanese, Filipino, and Korean Americans at ethnic-specific versus mainstream programs in a public mental health system. As predicted, social/ community-based services and family/friends to a lesser degree referred each Asian American group to ethnic-specific programs more than other referral sources (e.g., criminal justice and health services). Referrals by social/community-based programs to ethnic-specific versus mainstream programs were the most significant for Chinese Americans, followed by Japanese and Filipino Americans, and the least significant for Korean Americans. These findings suggest Asian American clients themselves and their social networks may view ethnic-specific programs as more culturally responsive than mainstream programs.

Prioritized assignment to intake appointments for Asian Americans at an ethnic-specific mental health program.

This study examined the relationship of demographic, clinical, and therapist factors to decisions about prioritized assignment to the earliest intake appointment for 983 Asian Americans who contacted an Asian-oriented, ethnic-specific mental health program. The logistic regression results showed that Asian language preference, ethnicity, suicidality, violent behavior, physical and sexual abuse, and psychotic symptoms increased the likelihood of a prioritized decision for the earliest intake appointment but that being female, being of an older age, and having somatic complaints decreased the likelihood. Given these findings, Asian American clinicians at an ethnic-specific program were found to consider clinical, demographic, and ethnically related factors in prioritized decisions about intake assignment, which could improve intake attendance.