Perceived Barriers to Mental Health Care for American Indian and Hispanic Veterans: Reports by 100 VA Staff

Abstract

This study aimed to identify perceived barriers that might prevent American Indian (AI) and Hispanic American (HA) veterans from seeking mental health services at U.S. Veterans Administration Medical Centers (VAMCs), as reported by 100 VA mental-behavioral health staff members. A total of 100 volunteer mental-behavioral health workers were questioned, 50 from Albuquerque VAMC and 50 from Minneapolis VAMC. Participants responded to public announcements and e-mail invitations; facilitated, open-ended interviewing produced the barrier responses, which were then coded. Mental healthcare workers in both sites reported most perceived barriers as occurring in the VA system, among AI/HA veterans, and within themselves and/or their colleagues. Less commonly, they perceived barriers as occurring in the AI/HA families and communities. Mental healthcare workers at the Minneapolis VAMC reported more barriers than workers at the Albuquerque VAMC. A coding protocol derived from interviews among ethnic AI and HA staff members in the two VAMC’s was applicable to mental health workers. Mental health workers agreed with AI and HA workers in perceiving most barriers as existing in the VA system, with family and community barriers being least often reported. Mental health workers perceived veterans as posing the second most common barrier category, followed by VA staff members.

Keywords

American Indians barriers ethnicity mental health veterans

Get full access to this article

View all access options for this article.

References

Amaya-Jackson, L. , Davidson, J. R. , Hughes, D. C. , Swartz, M. , Reynolds, V. , George, L. K. , & Blazer, D. G. (1999). Functional impairment and utilization of services with posttraumatic stress in the community. Journal of Traumatic Stress, 12(4), 709–724.

Amering, M. , & Katschnig, H. (1990). Panic attacks and panic disorder in crosscultural perspective. Psychiatric Annals, 20(9), 511–516.

Caetano, R. , & Clark, C.L. (1998). Trends in alcohol consumption patterns among Whites, Blacks, and Hispanics: 1984 and 1995. Journal of Studies on Alcohol, 59, 659–668.

Cross, T. L. , Bazron, B. J. , Dennis, K. W. , & Issacs, M. R. (1989). Toward a culturally competent system of care. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.

Egeland, J. (1986). Cultural factors and stigma for manic depression: The Amish study. AmericanJournal of Social Psychiatry, 14, 279–286.

Fabrega, H. (1991). The culture and history of psychiatric stigma in early modern and modern Western societies: A review of recent literature. Comprehensive Psychiatry, 32, 97–119.

Fava, G. , Kellner, R. , Perrini, G. I. et al. (1983). Italian validation of the Symptom Rating Test (SRT) and Symptom questionnaire (SQ). Canadian Journal of Psychiatry, 28, 117–123.

Frances, R. J. , & Miller, S. I. (Eds.). (1998). Clinical textbook of addictive disorder. New York: Guilford Press.

Friedman, M. J. , Ashcraft, M. L. , Beals, J. L. , Keane, T. , Manson, S. M. , & Marsella, A. J. (1997). Matsunaga Vietnam Veterans Project, National Center for Posttraumatic Stress Disorder and National Center for American Indian and Alaska Mental Health Research.

10.

Gold, M. , & Stevens, B. (1998). Synopsis and priorities for future research. HSR: Health Services Research, 33(3), 611–624.

11.

Gurley, D. , Novins, D. K. , Jones, M. C. , Beals, J. , Shore, J. H. , & Manson, S. M. (2001). Comparative use of biomedical services and traditional healing options by American Indian veterans. Psychiatric Services, 52, 68–74.

12.

Karno, M. , Golding, J. M. , Burnam, A. , Hough, R. L. , Escobar, J. I. , Wells, K. M. , & Boyer, R. (1989). Anxiety disorders among Mexican Americans and non- Hispanic Whites in Los Angeles. Journal of Nervous Mental Disease, 177, 202–209.

13.

Lepkowski, J. M. (1991). Sampling the difficult-to-sample. Nutritional assessment and intervention: Interface of science and policy. Washington, DC: Federation of American Societies for Experimental Biology.

14.

Leung, P. K. , Kinzie, J. D. , Boehnlein, J. K. , & Shore, J. H. (1993). A prospective study of the natural course of alcoholism in a Native American village. Journal of Studies on Alcohol, 54, 733–738.

15.

Lunsford, T. ,& Lunsford, B. (1995). The research sample; Part I: Sampling. Journal of Prosthetics and Orthotics, 7(3), 105–112.

16.

Malgady, R. G. , Rogler, L. H. , & Constantino, G. (1987). Ethnocultural and linguistic bias in mental health evaluation of Hispanics. American Psychologist, 42, 228–234.

17.

Noren, J. , Kindig, D. , & Sprenger, A. (1998). Challenges to Native American health care. Public Health, 113(1): 34–35.

18.

Ortiz, V. , & Arce, C. H. (1984). Language orientation and mental health status among persons of Mexican descent. Hispanic Journal of Behavioral Sciences, 6, 127–143.

19.

Silk-Walker, P. , Walker, R. D. , & Kivlahan, D. (1988). Alcoholism, alcohol abuse, and health in American Indians and Alaska Natives. American Indian and Alaska Native Mental Health Research, 1(Mono 1), 65–83.

20.

Szapocznik, J. , Kurtines, W. M. , & Fernandez, T. (1980). Bicultural involvement and adjustment in Hispanic-American youths. Internal Journal of Intercultural Relations, 4, 355–365.

21.

Walker, R. D. , Benjamin, G. A. , Kivlahan, D. , & Walker, P. S. (1985). American Indian alcohol misuse and treatment outcome [Monograph]. Alcohol Use Among U.S. Ethnic Minorities, 18, 301–311.

22.

Waters, J. K. , & Biernaski, P. (1989). Targeted sampling: Options for the study of hidden populations. Social Problems, 36(4), 416–430.

23.

Westermeyer, J. (1989). Research of stigmatised conditions: Dilemma for the sociocultural psychiatrist. American Indian and Alaska Native Mental Health Research, 2(3): 41–45.

24.

Westermeyer, J. (1992). Cultural perspectives: Native Americans, Asians and new immigrants. In J. H. Lowinson , P. Ruiz , R. B. Millman , & J. G. Langrod (Eds.), Comprehensive handbook of drug and alcohol(pp. 890–896). New York: Mercel Dekker.