Defining Mental

Health Within a
Transcultural
Nursing
Perspective

Presented To:
Ms. Rhea B. Bucog
LEARNING OUTCOMES

01 02 03 04 05
Recognize the Examine best practice Understand the Recognize the Evaluate strategies to
importance of treatment options in influence of culture on importance of provide competent
cultural values, caring for decisions about evidence-based transcultural
beliefs, culturally diverse mental health care. transcultural mental mental health nursing
and practices when mental health clients. health nursing care.
planning and research in caring
implementing mental for clients seeking
health nursing care. mental health care in
a culturally
congruent and
competent manner.
Defining Mental Health Within a
Transcultural Nursing Perspective
The World Health
Organization (WHO)
(2014a) indicated that :
 “over 450 million
people suffer from mental
disorders.” WHO further
postulated: “Mental health is an
integral
part of health; indeed, there is
no health without mental
health” (WHO, retrieved 2-14).
Interestingly, the definition
of mental health, by WHO, has
not been
changed since 1948.
WHO included mental well-
being in their definition of
health:
 “Health is a state of complete
physical, mental and social
well-being and not merely the
absence of disease or
infirmity.” .
 Included in this definition is
the implication that “mental
health is more than the absence
of mental disorders or
disabilities
 is “a state of well-being in
which the individual realizes
his or her own abilities, can
cope with the normal stresses
of life, can work productively
and fruitfully, and is able to
make a contribution to his or
her community” and that this
understanding of mental health
can be interpreted “across
cultures”
According to the National
Alliance on Mental Illness
(NAMI) (2014):
 mental illness is a condition
that “disrupts a
person's thinking, feeling, mood,
ability to relate to others and
daily functioning.” NAMI
identified some of the most
serious mental illnesses include
“major depression,
schizophrenia, bipolar disorder,
obsessive compulsive
disorder (OCD), panic disorder,
posttraumatic stress disorder
(PTSD), and borderline
personality disorder.”
Leininger (Leininger, 1991a;
Leininger & McFarland,
2002), in Culture Care
Diversity and Universality
Nursing, theorized the
importance of identifying what is
common and universal among
cultures, while at the same
time understanding there is
individual diversity within
cultures. Diversity for
transcultural mental health
nurses
encompasses not only culture and
ethnicity but also gender, sexual
orientation, socioeconomic status,
age,
physical abilities or disabilities,
religious beliefs, and political
beliefs or other ideologies.
.
Mental Health Care
for Immigrants
The term culture shock was coined
by the anthropologist Kalervo
Oberg to describe individuals, such
as immigrants, who enter a new
culture. Culture shock is
“precipitated by the anxiety that
results from losing all our familiar
signs and symbols of social
intercourse”. Oberg suggested that
the “signs” or “cues” that people use
within a culture— such as the words
people speak—customs people
follow, and even nonverbal
communication such as gestures and
facial expressions are not recognized
by those who are new to the culture.
The concept of acculturation was
initially defined by Redfield, Linton,
and Herskovits as “those phenomena
which result when groups of
individuals having different cultures
come into continuous first-hand
contact, with subsequent changes in the
original cultural patterns of either or
both groups”. Acculturation
can be a stressful and complex process,
particularly for immigrants who
experience difficulty adjusting to the
new culture. Ho conducted a systematic
review of research on implications of
acculturation on Chinese immigrants.
Some individuals may find themselves
unable to work through the stress of
acculturation and have great
difficulty in modifying their cultural
values, beliefs, or practices and feel
isolated from their new culture or
even from their culture of origin.
Depression is the most common
mental health problem among
immigrants in the United States and
has been associated with the process
of acculturation. Immigrants and
refugees may be fleeing war and other
traumatic political environments and
may exhibits symptoms of
posttraumatic stress disorder as well
as depression.
Cultural
Concepts Of
Distress
Cultural Bound Syndromes
Cultural
Bound
Syndrome
 Cultural
Bound
Syndrome
 Cultural Values,
Beliefs, and Practices
of Specific Cultural
Groups as They Relate
to Mental Health
Cultural Values, Beliefs, and Practices of Specific Cultural
Groups as They Relate to Mental Health

Nurses have always cared for
diverse populations of clients,
and community-based nurses
have focused in
particular on newly arrived
immigrant populations. A
century ago, nurses and other
health professionals were
concerned about contagious
diseases and malnutrition in
caring for immigrant
populations.
Currently, there is a great deal of
research being conducted to better
understand nursing care for
culturally
diverse immigrant clients and their
family members who are seeking
care. Many of these studies focus
specifically
on mental health care, particularly
helping immigrant clients, families,
and communities adjust to life in
their new
country.
In addition, health care services
for immigrant communities also
place an emphasis on mental
health, particularly
since many recent immigrants
have experienced war,
displacement, and other
associated traumas.
 AFRICAN
AMERICAN
CULTURE:
AN OVERVIEW OF
MENTAL HEALTH
CONCERNS
 African American Culture: An Overview of Mental Health
Concerns
Numerous health Black men cannot be African American Prevention of The Black church is a
disparities are of great suicidal. It is one of the men, as in other depression and major institution in the
concern in the African most pervasive and diverse cultural suicide is community and pastors
American population, and damaging falsehoods can be trained to
groups, often extremely
mental health issues within and outside of the recognize signs of
have often gone African American express their important, and depression among
unnoticed, taking a back community. Some depression education is the parishioners and to
seat to other health studies have shown that through bodily key to early refer troubled
concerns. Many in the some African Americans symptoms like prevention. individuals to the
Black community, believe that depression is headaches, Although the proper professionals
especially a stomach aches, African American (Taliaferro, 2006).
young Black males, may personal weakness and pains, and so on. church has Depression in African
believe that depression is the result of improper Within the Black traditionally American individuals
not really an illness or lifestyles (e.g., too much can be overlooked;
that it is a sign of worry, working too community, there viewed suicide as a unfortunately, it is
weakness, so they hard, not being can be sin, many religious sometimes cultural
tend not to seek help. religious enough) considerable organizations are insensitivity
There is a notion that is (Shellman & Mokel, stigma about now starting to that leads health care
prevalent among young 2010). mental illnesses. create mental providers to overlook
Black men (as well as health programs. symptoms of
others) that because depression.
of machismo, being macho
or tough,
NATIVE AMERICAN
CULTURE:
AN OVERVIEW OF
MENTAL HEALTH
CONCERNS
Native American Culture: An Overview of Mental Health
Concerns
Holism is a belief that the
physical, mental, emotional,
and spiritual dimensions of
an individual are
perceived as one. Native
Americans, as a cultural
group, are also perceived as
one, although each tribe may
have unique characteristics.
The mind–body separation
of Western health care is not
present in the Native
American culture
Alcohol has had an Native Americans “These layers of
overwhelming impact on have repeatedly present losses in
the mental health of Native suffered losses of addition to the
Americans. Forced into a
family and major traumas of
harsh
reservation system, Native community the past fuel the
Americans were forced to members to alcohol anguish, psychologic
give up their native lands related accidents, numbing, and
and ways of life. Yellow homicides, and destructive coping
Horse suicide. Abuse, such mechanisms related
Brave Heart and DeBruyn as domestic violence to disenfranchised
(1998) utilized the (DV) and child grief and historical
literature on Jewish abuse, is a leading trauma” suffered by
Holocaust survivors to
develop the construct of mental health Native Americans
historical trauma. concern among
Native American
communities
throughout the
country.
 ASIAN/PACIFIC
ISLANDER
CULTURE: AN
OVERVIEW OF
MENTAL HEALTH
CONCERNS
 Asian/Pacific Islander Culture: An Overview of Mental
Health Concerns
For some Asian Americans and
newly arrived immigrants from
China and Japan, stigma
related to mental health
problems can be a stumbling
block in seeking appropriate
care.
A study by Gilbert et al. (2007)
identified three (3) components
of shame: external, internal,
and reflected.
 EXTERNAL SHAME: a belief
that an individual will be viewed
negatively for mental health
problems.
 INTERNAL SHAME:
evaluating oneself negatively.
 REFLECTED SHAME: a
belief that having mental health
problems could bring shame to
an individual’s family or
community.
Asian Americans’ core cultural
values of honor and pride and
patriarchal obligations,
particularly with elders, are
important to understanding
Asian American culture.
Collective group harmony,
including family and kin,
rather
than individual concerns, are
significant cultural values
(Leininger, 1995).
Understanding core cultural
values of
the Asian American culture,
particularly the importance of
maintaining harmony, will
help transcultural nurses plan
care for clients with mental
health problems in a culturally
competent manner.
Cultural values and beliefs
of older Korean Americans
seemed to have a major
influence on whether or
not they viewed mental
health
services in a negative
manner. Those individuals
who identified mental
illness with personal
weakness or shame
held more negative
attitudes about using
mental health services.
However, if the individual
associated depression
as a health condition, then
he or she had a more
positive attitude about
mental health services.
HISPANIC/LATINO
CULTURE: AN
OVERVIEW OF
MENTAL HEALTH
CONCERNS
 Hispanic/Latino Culture: An Overview of Mental Health
Concerns
For many Hispanic
immigrants, use of mental
health services in the United
States is low when
compared to use of health
care services for general
health concerns. According
to a report by the U.S.
Department of Health and
Human Services (2009), less
than 1 in 11 Hispanic
Americans with a mental
health illness contacts a
mental health care provider
while less than 1 in 5
contacts a health care
provider for a general health
concern. For
Hispanic immigrants with a
mental health illness, less
than 1 in 20 contacts a
mental health care provider
while 1
in 10 contacts a health care
provider for general health
concerns.
 According to the Although intimate The Latino culture also Many Hispanic Americans
American Psychiatric partner violence holds strong are Roman Catholics, and
Association (2015), (IPV)and family violence expectations for women, faith and church activities
many Hispanic associated with male with an emphasis on are an influential part of
individuals rely on their dominance in the submissiveness and their daily life activities
extended family, the Mexican reverence (Kemp, 2005). Some
community, traditional American culture may be toward men. The female studies have identified
folk healers known as prevalent, as in other role has its roots with the religious and cultural
curanderos or herbalistas, cultural groups, it is Virgin Mary and is barriers to professional
and churches for help frequently referred to as mental health care as
during a health crisis. underreported. Dietrich marianismo, indicating some Hispanic Americans
 Consequently, many and Schuett (2013) women should be pure report that they trust in
Hispanic individuals identified that using even and self-sacrificing and God, and “if I am sick, it
with mental illness often the most conservative devote their lives to their is his will” . These
go without seeking prevalence estimates family. The traditional attitudes often delay
professional help for about IPV in the Latino Hispanic cultural appropriate preventative
mental health treatment. culture calls for values for females may care as well as
One of the main reasons immediate attention to lead to a higher treatment of mental health
for failure to seek this serious problem. incidence of IPV, where illnesses.
professional mental women are encouraged
health care services is to be submissive and
Hispanics are the largest “obey” their husbands.
uninsured population in
the United States.
 ARAB MUSLIM
CULTURE:
AN OVERVIEW OF
MENTAL HEALTH
CONCERNS
 Arab Muslim Culture: An Overview of Mental Health
Concerns

Seventy to 80% of mental
health clients in Arab
countries tend to present with
somatic symptoms for
psychological issues. There is
a stigma about mental health
problems, and the client who
presents with somatic
complaints is protected from
the stigma of being diagnosed
with a mental health illness.
Nurses and other health care
providers in emergency
departments need to be aware
of this phenomenon and assess
the client for any mental health
concerns. The subordinate
position of Arab women places
them at risk for developing
mental health disorders such as
depression, anxiety, and
suicidal behaviors
For individuals from Arab There is evidence to suggest
communities, stigma that the experience of
associated with mental prejudice, intolerance, and
hostility toward Arab
illness is considered a Americans
major barrier to has increased in the United
accessing mental health States following the terrorist
services related to the attacks on 9/11. Arab
shame associated with Americans have been victims
disclosing personal and of
family issues to racism, aggression, insulting
speech, and discrimination on
outsiders the basis of their cultural
religious beliefs and
practices and national origin
LAUDERES, FRANCES KEI S.
LORO, RIJEKA CHARLOTTE C.
MAAGHOP, RHANDZ RHAVEN .
MADRANGCA, IRISH V.
MADULA, KATHLYN V.
MAGNAYE, MA. THERESA B.
MANANGUITE, ALLIAH JOYCE B.