Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Cultural Diversity and Mental Health Services
Family and Community as Resources
Ties to family and community, especially strong in African, Latino, Asian, and
Native American communities, are forged by cultural tradition and by the current
and historical need to assist arriving immigrants, to provide a sanctuary
against discrimination practiced by the larger society, and to provide a sense
of belonging and affirming a centrally held cultural or ethnic identity.
Among Mexican-Americans (del Pinal & Singer, 1997) and Asian Americans (Lee,
1998) relatively high rates of marriage and low rates of divorce, along with a
greater tendency to live in extended family households, indicate an orientation
toward family. Family solidarity has been invoked to explain relatively low
rates among minority groups of placing older people in nursing homes (Short et
al., 1994).
The relative economic success of Chinese, Japanese, and Korean Americans has
been attributed to family and communal bonds of association (Fukuyama, 1995).
Community organizations and networks established in the United States include
rotating credit associations based on lineage, surname, or region of origin.
These organizations and networks facilitate the startup of small businesses.
There is evidence of an African American tradition of voluntary organizations
and clubs often having political, economic, and social functions and affiliation
with religious organizations (Milburn & Bowman, 1991). African Americans and
other racial and ethnic minority groups have drawn upon an extended family
tradition in which material and emotional resources are brought to bear from a
number of linked households. According to this literature, there is “(a) a high
degree of geographical propinquity; (b) a strong sense of family and familial
obligation; (c) fluidity of household boundaries, with greater willingness to
absorb relatives, both real and fictive, adult and minor, if need arises; (d)
frequent interaction with relatives; (e) frequent extended family get-togethers
for special occasions and holidays; and (f) a system of mutual aid” (Hatchett &
Jackson, 1993, p. 92).
Families play an important role in providing support to individuals with mental
health problems. A strong sense of family loyalty means that, despite feelings
of stigma and shame, families are an early and important source of assistance in
efforts to cope, and that minority families may expect to continue to be
involved in the treatment of a mentally ill member (Uba, 1994). Among Mexican
American families, researchers have found lower levels of expressed emotion and
lower levels of relapse (Karno et al., 1987). Other investigators have
demonstrated an association between family warmth and a reduced likelihood of
relapse (Lopez et al., in press).
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