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Beyond Just a “Phase:” Acknowledging the Role of Diversity and Culture in Mental Health

August 11, 2016 Tara Earl, PhD, MSW

O verall, my childhood wasn’t terribly remarkable. I have four older siblings from my dad’s first marriage. Technically, they are my half- brothers and sisters, but those descriptions were not used in our home. Family is family. I spent the most time with my twin brothers, mostly because we are the closest in age. My summers were equally filled with sibling play, love, and rivalry.

However, things changed in my early 20’s. One of my brothers started telling us that he “didn’t feel right.” He became withdrawn and got into more trouble than what was “normal” for him. I didn’t understand this at the time, but his behavior was the onset of what we now know—many years later—as schizophrenia. In our eyes, he was just a young adult going through a “phase.” I recall my grandmother saying that he was “smelling himself.” The concept of mental illness was as foreign to my family as “half-brother or half-sister.” We simply did not understand what was going on; and we certainly didn’t know what we were supposed to do.

My family’s response—or lack thereof—stayed with me for many years. In fact, when my colleagues and I published an article in 2015 (see Earl, Fortuna, Gao, Williams, Takeuchi, Neighbors, and Alegría, 2015[1]), my brother’s experience influenced much of my thinking and motivation. I had questions that I couldn’t find in the extant literature. In general, I wanted to know how my family’s experience related to others. I wanted to better understand what people experience, and how that information could be (mis)understood. In the article, we explored how psychotic-like symptoms were experienced, endorsed, and understood by a sample of African Americans, Asians, Caribbean Blacks, and Latinos.

While reviewing the data and reading several articles, I quickly realized that “abnormal” symptom presentation of mental illness was just as destructive for an individual as delayed treatment or limited access to care. As found in our work, attributions of psychotic-like symptoms varied significantly by race and ethnicity, and were commonly associated with culturally-bound beliefs, practices or personal or familial distress (e.g., death). Diagnostic criteria for psychosis that are based on Western standards may not account for the potential depth and breadth of the ways in which race, ethnicity, and culture can mediate and/or sanction the expression of what might otherwise be considered psychotic-like experiences.

Despite mental health parity, remarkable progress in expanding mental health coverage, and a rise in global awareness, we are still challenged with understanding and accurately assessing this class of disorders. Each year, approximately 1 in 5, or 44 million, Americans are affected by mental illness. Mental disorders like schizophrenia affect about 100,000 people per year. They can be debilitating and often alter a person’s ability to think, communicate, and function properly. As I think about my own family’s experience, I still try to imagine what it’s like for others. Although my brother was eventually diagnosed with schizophrenia, for many others, that may not be accurate or appropriate.

As we move towards building a holistic Culture of Health, we must not forget to include mental health. We must also intentionally acknowledge the role of diversity and culture. In order to be successful in this endeavor, we need to have a shared understanding about what is required to deliver the right type of care to the right people at the right time. We should also be realistic about the shortcomings, committed to establishing favorable population-wide strategies for improvement, and steadfast in our plan to create a society where everyone, regardless of their culture and background, is equipped with the knowledge, services, and support to lead healthy lives.

[1] Earl, T.R., Fortuna, L.R., Gao, S., Williams, D.R., Takeuchi, D.T., Neighbors, H.W., Alegría, M.A. (2015). An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life, Ethnicity and Health, 20(3), 273-292. doi: 10.1080/13557858.2014.921888.

Tara Earl, PhD, MSW, is an Associate with Abt Associates.

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A poor understanding of legacy code is the #1 cause of failure in modernization projects.
A Mainframe Assessment is a method of understanding existing program and script components of a mainframe environment before deciding whether to perform a modernization (Automated Conversion, Replatforming, Tool-Assisted Reengineering, or Portfolio Optimization) project. A Mainframe Assessment includes full definition of the goals and areas of concentration prior to data collection. Modern Systems uses DB-Shuttle® automation technology to perform a very detailed, targeted assessment of the entire mainframe application environment. This assessment provides the ability to fully define a modernization project plan including assignments, responsibilities, timeframes, and costs. This service:

Mainframe Assessment Overview

Mainframe components are classified and listed in detail and notes are attached to components requiring special attention during the conversion process. All application components are inventoried, classified by language, and cross-referenced. Missing components are collected and added to the inventory, while duplicate components residing in multiple customer repositories are eliminated from the inventory. The Assessment results in a complete understanding of the current processing environment.

Modern Systems designed and developed its DB-Shuttle automation technology to allow preliminary conversion of the database design and application software during the Assessment. This preliminary conversion further defines areas of concentration and is used in preparation of the project plan for the full conversion. It also proves the conversion concept and identifies any special requirements for a successful conversion. No converted code is delivered as part of the Assessment. All of the collected source code is parsed down to the line and field level and stored as metadata in the DB-Shuttle database. Portions of this source code metadata can be packaged and made available to the customer teams for additional analysis if desired.

Areas of Concentration

During the Mainframe Assessment, Modern Systems will define a set of topics that must be addressed prior to modernization. Once these Areas of Concentration are identified, customer teams and Modern Systems will address the areas about which they are most knowledgeable and for which they are best suited to implement a solution. Any additional Areas of Concentration that are identified during the course of the Assessment will be addressed and assigned in the same manner, to the most appropriate team.

Mainframe Assessment Process

A Mainframe Assessment has a well-defined process that includes automated collection and inventory, analysis, and measurement of all software and database components in the current customer environment. The assessment begins with a question-and-answer session and ends with the presentation of findings and plans for the modernization effort. Iterations of re-collection and re-assessment may be required and performed as additional components are identified and brought into the assessment scope. The DB-Shuttle assessment process is 100% automated, so it is fast, simple and comprehensive.

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