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Success Of Sheba In New York Demonstrates Need For Ethnic Mental Health Programs

Aparna Narayanan in New York

Mali, a 25-year-old South Asian immigrant, endured an arranged marriage for five years to a man who sexually abused her and forced her to tolerate his brother's inappropriate advances. When he finally abandoned her and their 4-year-old daughter, she turned to Asian Outreach, an Elmhurst-based mental health clinic, for counseling and support.

Soon she became an active participant of Asian Outreach's domestic violence support group, and found a job as a waitress to support herself and her daughter. Unlike her, many South Asians remain caught in the net of cultural stigma and feelings of shame surrounding mental illness.

Mali, whose real name is undisclosed at her request, is among the small but growing number of South Asian immigrants who are shedding their reservations about visiting a therapist or a psychiatrist. The Asian Outreach is among a growing number of Indian and other South Asian organizations that offer help to immigrants who battle emotional problems. Women's support groups such as Manavi, Sakhi and Maitri also offer the services of voluntary therapists and psychiatrists. And in New York, Nav Nirman offers counseling to men and women for depression, substance abuse and a slew of other problems. The response for Sheba (Self Help for Each Bangladeshi American) at Bellevue Hospital in New York has been overwhelming, with more than a 100 patients visiting it since its inception last year, according to Dr Abdullah Hasan, its program director.

Hasan knows, as Dr George Coelho and other Indian American mental health experts do, that organizations aimed at ethnic minorities and run by people familiar with the psyche of a particular ethnic group, are important because often mainstream American therapists and psychiatrists do not understand the problems of ethnic patients. And patients who do not speak English are even at a bigger disadvantage.

"Our language and culture do not have basic terms that distinguish feelings of depression, frustration, or anger," Hasan says. "My patients strike their chests to show me where they feel upset, and tell me 'I don't feel good.' But in Western psychiatry, the difference between being upset and depressed is significant. It is essential that we provide culturally sensitive mental health programs."

Dr David Nardacci, director of community psychiatry at Bellevue Hospital, says mental illnesses frequently have a cultural specificity that require special understanding and skills.

"Patients get better quickly and are more comfortable with a doctor who speaks their language and understands the cultural nuances of their problems," he says.

South Asian immigrants are a fast growing population in New York City, comprising six per cent of the population of eight million, yet several studies have shown that South Asians under-utilize mental health services much more than any other population group. Data from Bellevue Hospital's psychiatric emergency room confirms this, with South Asians comprising one per cent of patients seen in 1998. At many universities, foreign student advisers affirm that South Asian students are among the last to seek counseling and therapy.

"Acknowledging the existence of mental illness in the family and seeking treatment for it is a fairly recent phenomenon even in the West, but especially among Asian families," says Dr Ranu Bopanna, staff psychiatrist at Asian Outreach.

Dr Nyapati Rao, director of residency training in the department of psychiatry at Brookdale Hospital, says, "South Asian communities are close knit, cohesive groups, and culturally there is an attitude of not seeking help because of fear of what people might say."

According to the 1990 census, the largest concentration of Asian Indians in the country is in New York City, with 60 per cent of the city's 94,590 Asian Indians living in Queens. Asian Outreach is active in neighborhoods with large South Asian concentrations such as Richwood, Forest Hills, and Jackson Heights.

However, patients come from as far away as Jersey City and Westchester because the clinic has trained psychiatrists and caseworkers who speak Hindi, Urdu and other Indian languages, says Agnelo Diaz, administrator of the clinic. An 118 per cent increase in the number of patients seen between 1993 and 1997 testifies to the popularity of its programs.

The major influx of South Asian immigrants into the country occurred after the passing of the Immigration and Nationality Act of 1965, which favored professionals and graduate students. This was followed by a second wave of immigration in the 1980s, mainly of working and lower middle class South Asians.

In 1998, Asian Outreach served more than 1,200 families, of whom the majority were poor or working class, including many new immigrants. "Stress about immigration documents and language difficulties is acute among the lower middle class South Asians, including cab drivers, news-stand owners and security guards," says Diaz.

About 50 per cent of the Asian Outreach patients have an income of less than $ 10,000 per annum, and over 75 per cent has an income of less than $ 20,000 per annum, according to statistics supplied by the clinic. The outreach program offers multilingual and bicultural counseling to help adults and children who are coping with emotional traumas, physical or sexual abuse, substance abuse, and behavioral or academic problems.

In addition to child and family therapy, the clinic offers support groups, school site counseling, and home-based crisis interventions.

"The level of misery among recent immigrants is tremendous, especially due to struggles between parents and kids," says Dr Hasan.

"The messages the children get from home and school are completely different, which makes the acculturation process very difficult."

Hasan conceived the idea of a Bengali clinic after observing a rapid surge in the number of Bangladeshi patients at Bellevue during his four-year residency training at New York University, which he completed in 1998.

Sheba caters mainly to poor patients, including Bengali-speaking waiters and cabdrivers, who are often without insurance, or cannot qualify for Medicaid because of their illegal status, or earn just a little more than required to be eligible for Medicaid.

Sheba is the only city-sponsored mental health clinic for South Asians, and integrates medication treatment and therapeutic treatment. Patients pay $ 20 per visit and receive services worth approximately ten times that amount, Hasan says, adding, "Bellevue is doing a tremendous service to our community because no doubt it runs into a huge deficit to run this program."

The American Association of Physicians of Indian Origin is seeking funds from the federal government to study depression among Indians, says Dr Rajam Ramamurthy, a San Antonio physician. The organization wants to determine the extent of depression and concomitant problems, even as it plans to offer counselling in major cities, she adds.

"Emotional problems are often not diagnosed in our community," she says. "In some cases, even when we know someone is suffering from depression, we try to overlook the problem because some of us still carry the stigma attached to counseling and therapy we find in India."

Her feelings are echoed by Dr Sesu Sarma, who is involved in a number of community organizations in Atlanta, and has helped many Indian families to seek counseling.

"Many of us look beautiful on the outside," she says with a sigh. "But the moment there is a serious breakdown or a suicide, our tortured interiors are exposed."

"Our lives need not be that painful," she says.

"Often it is a matter of one phone call," she adds. "Call up a friend, call up an Indian cultural or social group, call up an Indian medical association. Take the first step. You could be saving your own life -- and those of others."

Asian Outreach, 87-08 Justice Avenue, Elmhurst, NY 11373; (718) 899-9810; Sheba Clinic, Bellevue Hospital, First Avenue at 27th Street, (212) 562-8152

Arthur J Pais contributed to this story

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