Black Mental Health Perspectives THEWOOZY.COM

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Black Mental HealthPerspectivesTHEWOOZY.COM
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Program Introduction

• 2003 City County awarded 2-yr. CA. Dept. of
  Mental Health grant to develop alternatives for
  institutions for mental disease treatment.
• 2 counties awarded Grants
• Our Primary focus African-American males.

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African-American Focus?

• 2002 report
• Identifying factors that contribute to longer
  term community tenure for L-facility discharged
  clients (2002)
• 2001-2002 Census figures show African-Americans
  are
• 7 of population is African-American
• 23 of Adult System of Care
• 28 of residents in IMDs
• Stay 20 (152 days) longer than non-Af-am
• More likely to return 6 months post discharge

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Program Foundation

• Bottom Line Rarely is anyone in an inpt. or a
  locked facility because of their mental illness.
  Rather, its their behavior.
• Mission all of our programmatic elements need to
  be structured as innovations to target/change/and
  resocialize individuals and support their
  positive behavioral changes We will discover
  Black culture
• Admin. Agenda Meet all requirements, get a
  budget have enough left over to make it work.
• Recruitment Do not rely on system choice/Dumping

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Conglomeration of Risk Factors

• Primary issue is 80-95 due to social
  service/family failures, disparity, inequality
  ineffective responses. (for all race clients).
• Risk Factors When You interview, you will find
• Foster Care Sexual Abuse Homelessness Drug
  Addiction Family Separation Incarceration
  Trauma/Violence/Physical Injury Medical
  Complications Homelessness Abandonment
  Temporal Impairment (no future) Dysfunctional
  Communities Incompetent Families Learning
  Disabled Environmental Hazards Unemployment

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Clients

• Engagement, Successes, Setbacks
• B.w. (Housing,Weight Loss, Blackhawk, 290 Reg.)
• E.C. (Engagement, Vallejo, Housing, Residential
  tx. SHA)
• D.M.i (DM Zyprexa, Africa, Crack, Money Mgmt.
  Meal Purchase))
• A.N. (cant hear , crack)
• L.A. (met couple at airport, College Committee,
  Program Housing)
• E.B. (Zyprexa,Child Molester, Zillionaire)
• B.B. (bro at SFGH, hygiene, meth iv)
• J.C. (crack baby, lies, drawing, Aspergers)
• M.E.(songwriter, , housing, haldol, ran off)
• A.P. (haircut resistance, field trips, sense of
  humor)
• I.M. (attacked police car, crack, seroquel,
  arrested)
• W.P, (Wig, 40k a Cadillac, Soledad Brothers,
  married.kids, etc)
• H.T. (knocked over old man did anything come
  through?)
• C.V.W.(stable, wheelchair, brain damage (dog))
• D.T.(would wander off, family didnt want in PES,
  cats have sharp teeth, rat delusion)

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Group Types Cultural Advantages

• 7 types of groups special event per month
• Pre-vocational/Vocational Group
• Black History Group
• Medication/Health Group
• Spirituality Group
• Black Culture Field Trips
• Health Fitness
• Group Therapy Advantages with African-Americans
• Milieu
• Mentorship
• Informal Style (worker client disclosure)
• Direct Observation of clients
• Relationship building among group members
• Semblance to African culture (family, group,
  clan)

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Program Innovations 1

• Mentorship
• Breakfast M-F Meals, (2-3 a week)
• Black History Library
• Open Door Policy
• Vocational Program
• Health Nutrition Initiative/Weight Loss
• Integration with Primary Care
• Food Bank
• Housing (every possible way) SRO, TLC, SC, SHA,
  BC, Family, Girlfriends, etc
• IMDs
• Primary Assessment Criteria Do they look
  normal-ish
• Primary Discharge Criteria Do you want to work
  with us?
• Interview them, interview staff, contact family
  and begin integration pre-discharge.

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Program Innovations 2

• Vocational Program modification
• No actual budget for the program
• Vocational monies used for
• Subsidized bus pass program (disabled passes)
• Field Trips, Movie Tickets, Admission, Barbering,
  Fresh Produce
• Pre-vocational training (6 sessions 5/hr.)
  Vocational
• CVE Previous relationship was 12,000 to get our
  clients to 2nd step(contract in existence)
• Cultural Celebrations Kwanzaa, MLK day, Black
  History Month, Juneteenth, etc
• Cooperation with law enforcement for
  decompensation
• Contact and release preparation work in IMDs
  (Cooperation)

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I.D.E.A. Consulting Findings

• I.D.E.A.
• Both programs have been highly effective at
  reducing the total cost of services to these
  individuals. (other program male/female, all
  races)
• In comparing seven months of services prior to
  enrollment into the program with seven months
  following enrollment San Francisco saved over
  450,000 ( at 1 yr. 13 clients).

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Medications Af-Ams

• ALL medications have side-effects. Sometimes the
  side-effect is the medication. (Antipsychotics)
• African Americans have
• Higher risk for disease, injury, death
  disability
• Older population, longer exposure to
  typicals/primary care complications
• 1.7 times as likely to have DM, death rate 27
  higher, and more likely to experience greater
  disability
• 60 more likely to become obese (higher BMI at
  baseline)
• twice as likely to develop TD than Caucasians
• Increased risk of hypertension, stroke, heart
  failure, and kidney disease.

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What is Schizophrenia? Psychosis?

• Problematic Dx. Of Schizophrenia
• Freud - Dementia Praecox
• Etiology
• Shared Symptoms?
• Objective Diagnostic Criterion?
• Schizophrenias
• Lack of inclusion of effect of social
  disparities
• Cultural/Social/Economic Impacts Over Mis
  Diagnosis
• Extinct DSM Debate
• Multiple formats existed. Other formats perhaps
  more culturally relevant.
• Stigma described vs. defined.
• Ambiguity has been (falsely) eliminated.

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Race,Ethnicity PowerE. Pinderhughes, MSW

• Client/Worker commonality
• Due diligence vs. Teaching
• Advantages Disadvantages of same race therapist
• Dimensions of Trust (competence racism)
• Af-Am Clients Tendencies
• May Push Boundaries
• Require an Informal Stance
• Ask for therapist Values, Backgrounds or Opinions
• Attempt to Discern Competence
• Will not engage if Judged or Viewed Negatively
• Continuum of Culture Denial-Acceptance-Embracing

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Counseling Therapy Approach

• Directive Approach
• Agenda setting, advice, opinions (sensitive and
  well-timed)
• Focus on Problematic Behaviors
• Maintain Community Living
• Direct Confrontation
• Crisis Response/Outreach
• Search for Meaning and Metaphor
• Poetically Camouflaged Language
• Believe it, Dont act on it. (delusions,
  fantasies, psychosis, narcissism,etc)
• Underlying themes
• Groups elicit material on various subjects

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A Brief History of Pharmacology

• Mood Stabilizers March 28, 1948 Lithium
  Treatment Began
• Antipsychotics discovered developed in 30s,
  40s 50s as antihistamines. (noted depressant
  side effects)
• Thorazine 1950-51 Henri Laborit (France) first
  used Chlorpromazine
• The patients seemed to become totally
  indifferent to their surroundings
• Anti-Depressant 1950 first anti-depressant
  (tricyclics)
• Economic Impact By 1955 smith klein made
  75,000,000 on Thorazine.
• Pharmaceutical - DSM-IV link Mad Science

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Black History/Esteem Group Topics

• Over 200 black themed groups, 90min.
• Politics, Culture, History, Biographies, Current
  Events, etc, etc
• What did we talk about?

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U.S. Institutional Racism 1619-1865

• 1441-1492-1528-1619 first Slaves Arrive in
  America
• 157 years later, Declaration of Independence.
  Jeffersons condemnation of British participation
  in the slave trade. All men created equal. ?
• 1787 U.S. Constitution. 3/5ths clause 20 yr. Ban
  on congress fugitive slave clause govt. power
  to put down slave insurrections
• 1791 Bill of Rights ( Blacks Excluded, not
  citizens)
• 1857 Dred Scott blacks are not citizens, so they
  can not sue in court.
• 1865 Black Codes employed, movement, speaking,
  virtual slavery
• Reconstruction Tunis Campbell, 40 acres/mule
• Civil rights Act of 1866 1875 desegregation.
  (overturned in 1883 (Harlan dissent). Power given
  to states, Whites had the right to discriminate)

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Institutional Racism 1866-1991

• 13th 1865 (freedom), 14th 1868 (citizenship),
  15th amendment 1870 (vote)
• 1870-71 Enforcement Acts protected blacks' right
  to vote, hold office, serve on juries, and
  receive equal protection of laws.
• 1880 Strouder v. West (Juries axe murder)
• Plessy v. Ferguson 1896 (street car), separate
  but equal (Justice Harlan)
• Gaines (1938, U. Missouri)
• Sweat v. Painter (1950 U. Texas)
• 1954 Brown v. Board of Ed (I II) with all
  deliberate speed
• Civil rights Act of 1964 Outlawed Segregation
  (for the 5th time) renewed
• Civil rights Act of 1991 (re-affirmed
  strengthened) right of recovery

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Institutional RacismFrom Slavery to the P.I.C.

• Prior to 1865, blacks constituted the minority of
  inmates, after 1865, they were the vast majority
  with convict leasing. 25-45 yearly death rate.
  1878, 92 of leased in Georgia were black.
• Black are 12 of the population and 13 of drug
  users. In 2001, comprised 38 arrested for drug
  offenses, 44 prosecuted, 59 convicted,
  sentences 49 longer (than whites).
• 500 rise in incarcerations in last 30 years, 41
  are Black
• Black rate of incarceration more than 6 xs of
  whites nation-wide
• 1 in 3 Black males destined for prison
• Black youth receive life without parole 10xs
  over White youth
• Powder Cocaine 5 grams 5 yrs mandatory vs. 500
  grams powder (over 1 lb.)
• Strategic targeting of street level crack use to
  ensnare blacks
• Whites vs, Blacks 5xs cannabis, 4 xs cocaine,
  3xs crack 80 vs. 33

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Institutional RacismPropaganda Conspiracy

• Slavery Profit 500 Millionaires/Mansions in
  Natchez, Mississippi
• Felony Disenfranchisement voting, Grants, Ed.
  Loans, Weapons, Jobs.
• Racial Profiling 1996, New York Superior Court,
  Blacks 5 xs as likely
• Ghetto Creation 1930s Redlining, Little
  Harlem equity
• Suspensions/Expulsions Nationwide, 35 of black
  students, grade 7-12 had been suspended or
  expelled, vs.15 of whites equal offenses
• Gifted Yale University showed that Black
  students 40 less likely to be placed in
  Accelerated classes, and 2.5 times more likely
  remedial
• Dropouts to Prison In New York City 90 of all
  male prisoners dropouts.
• Cointelpro Polictical Assasination, Illegal
  Wiretaps, Frame-ups, Domestic Black Ops.

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Institutional Racism contdGovernment Academic

• Social Security Discrimination (domestic and
  agricultural exclusion, Benefits age)
• 2005 NBFA EWG Report National Black Farm
  Workers USDA 1997 settlement USDA admission of
  denied loand 1982-1996. Black Farm Ownership
  decreased from 54,367-29,090. 2.3 Billion Award
  but as of 2005, 81,000 of 94,000 claims denied,
  (64,000 filed after deadline)only 25 funds
  distributed. New 20.5 billion suit currently
  pending.
• 2003 NAACP Report Normal Af-am boys dx. With
  mental disorders 11 times more likely to be
  placed on adhd, psychosis, depression meds 32
  of mild retardation are Af-am netherlands
  report, 62 significant improvement in diet
  change within 3 weeks.
• GRE, ACT, SAT GPA Gratz Grutter Decision No
  challenge to lower scoring White Students

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Recommended

• ROBERT F. WILLIAMS Radio Free Dixie, -Tyson
• OLAUDAH EQUIANO The Interesting Narrative of the
  life of Olaudah Equiano
• MALCOLM X The Autobiography of Malcolm X -Alex
  Haley
• FREDERICK DOUGLASS My Bondage, My Freedom
• SOLOMON NORTHRUP Twelve Years A Slave