Presented by: Patti Kressly MA Pro-Crisis LLC

1. CIT: Responding to multicultural incidents Patti Kressly MA Pro-Crisis LLC Co-authored: Dr. Kathy Harowski Ph.D., Special Agent Leah Billings, Amy Berg and Katie Kornder

2. Goals Current CIT cultural responses. Demographics of Cultures in the United States What is mental illness – culturally speaking CIT response

3. Does you current CIT curriculum include cultural influences? What does it include?

4. Dominic Kavaventi Immigrated from Zimbabwe when his citizenship was taken away. Was jailed for writing and performing plays that depicted the social injustices of Zimbabwe at the time.

5. Refugee Arrivals by Country of Nationality (Department of State)

6. States of Residence for Refugee in United States 2009 (Department of State) California(15 percent) Texas (11 percent) New York (5.9 percent) Arizona (5.8 percent) Florida (5.6 percent) Michigan (4.7 percent) Nearly one-half of all refugees settled in one of these six states.

7. Arrivals by Asylum (Department of State) The total number of persons granted asylum in the United States decreased slightly from 22,838 in 2008 to 22,119 in 2009. The number of persons who were granted asylum affirmatively through USCIS(U.S. Citizenship and Immigration Services – through judicial process) decreased from 12,095 in 2008 to 11,933 in 2009.

8. Unauthorized Entries into the US(Department of Homeland Security) Between January 2008 and January 2009, the number of unauthorized immigrants living in the United States decreased seven percent from 11.6 million to 10.8 million. An estimated 8.5 million of the total 10.8 million unauthorized immigrants living in the United States in 2009 were from the North America region, including Canada, Mexico, the Caribbean, and Central America.

9. The next leading regions of origin were Asia (980,000) and South America (740,000). Mexico continued to be the leading source of unauthorized immigration to the United States. There were 6.7 million unauthorized immigrants from Mexico in 2009, representing 62 percent of the unauthorized population. El Salvador (530,000), Guatemala (480,000), Honduras (320,000), and the Philippines (270,000).

10. What is Mental Illness? The notions of health and illness are not clearly defined concepts. Perceptions vary. Some cultural anthropologists believe that mental disorders are culturally created evaluations. They are dysfunctional deviations from the normative patterns of social behavior.

11. Western societies believe that the concept of mental illness is based in the medical model. The training for psychiatry was and still is based on medicine. The diagnosis and treatment of mental disorders still remains predominately in the hands of psychiatrists.

12. Cultural Aspects of Mental Illness The belief is that mental illness is present cross culturally. Studies strongly suggest that culture can influence the expression of mental illness. Most immigrants come from cultures in which interpersonal reliance and dependence are considered healthy cultural norms. Families, clans, healers are the first step in dealing with mental illness.

13. Some immigrants are coming from their countries of origin with complex stressors. Death and loss of family members Victims of torture Witnessing years of war. Some coming from refugee camps.

14. CIT Cross culturally Multidisciplinary practitioners in a multicultural setting. Encourage awareness and sensitivity to verbal and nonverbal aspects of communication across cultures and across our teams. Our biases and typical reactions contribute to the reactions often heard from those in diverse communities about our efforts and tactics.

15. Mental illness across a multicultural community: racial or ethnic group, with worldview differences; additional factors might include generational, socioeconomic, and language differences. Assimilation – melting pot or tossed salad Awareness that a person who has limited use or understanding of English is not necessarily an immigrant or not assimilated History of the cultural group with authority figures/government

16. On the job Nonverbal issues related to being impatient, misjudgment about motives, understanding that certain gestures and even facial expressions have different meanings across cultures. Provide background or a reason for your need for information; consider this part of rapport building- those who are marginalized might need more time and information to place your request in context and to give them time to process if there are language barriers

18. Respect the cultural story telling style- is it linear, more circular, how do details emerge, understand some will go in to more detail than necessary. Memory may be changing/change, be difficult, uncertain

20. Crisis Intervention with the Hmong Population

22. Hmong population in Minnesota/ Demographics

23. Cultural shifts

24. World view

25. Cognitive and behavior processes

26. Health issues (mental and westernization)

28. Hmong cultural history- Midwest and Twin Cities Hmong immigration to the United States began in 1975 and consisted first of the soldiers and their extended families, followed by other Hmong who felt persecuted by the Vietnamese. In the US, now in the second and third generation of this process; even with ongoing immigration, the majority of individuals of this cultural group have now been born in the US.

29. Cultural shifts Tradition versus assimilation Hmong in Laos were/are farmers living in poverty. Hmong born in America (second generation) enjoy educational, professional, and political opportunities that their elders did not. These successes have made Hmong people susceptible to discrimination from other ethnic minority groups.

33. Hmong live in a closed society where they initiate consultation for guidance.

34. They are not keen on unsolicited advice, intrusion, or having outside influences impressed upon them.

37. Following the teachings of elders is expected.

38. Fitting in to the Hmong culture and society is more important than cultivating individual differences.

40. Extended family members are in close proximity, often with multiple generations in the same household.

41. The society is closed to non-Hmong.

43. General health Common Diagnoses: Depression, anxiety (religious focus), PTSD (older immigrants) Social Problems: Gangs, domestic abuse Use herbs and herb cocktails in lieu of pharmaceuticals for treatment(baggie of herb may resemble baggie of marijuana). When western, more mainstream medical care or law enforcement becomes involved, it is due to escalated symptomatology.

45. In collaboration with Shamans, western medicine is slowly being more widely used.

46. Health care focus is on an emergency basis, not preventative or sustained care.

48. For more traditional Hmong, treatment includes the sacrifice of an animal

50. Avoid shaking hands, especially with Hmong woman.

51. Avoid making positive or negative comments about Hmong children (e.g. you have a strong boy).

52. Avoid pressing Hmong to look at you or make eye contact.

54. You may not get an immediate “yes” or “no”. Hmong people are often introspective and do not want to answer too quickly or overpromise.

56. Be respectful when dealing with traditional and religious jewelry and clothes.

59. Somali population in Minnesota/ Demographics

60. Somali culture

61. Cultural views on mental illness

62. Communication issues

63. Successful Crisis intervention

66. 10,000-60,000 in Minnesota

67. Most live in Minneapolis, but also in Rochester and Owatonna

68. Most are refugees

71. Crossing legs

72. Putting hands in pockets during conversation

73. Showing bottom of feet/shoes

74. Using “thumbs-up”

75. Eating with or using left hand

76. Pointing with index finger

78. Communication Somali language was only oral until 1972; Somalis are not universally fluent in writing as their culture relies on oral communication Decision making is primarily based on discussion/consultation with family, clan, tribe, religious elders, religious teachings

80. Very negative stigma

81. Either waali (crazy) or not crazy

83. High levels of empathy/sympathy work well

84. Observe and respect cultural differences

85. Work with local/community resources to obtain solutions

87. Religion and culture are key Group counseling works best Rapport, rapport, rapport

88. Native American crisis intervention

89. Definitions: Native American/American Indians/Alaska Natives: includes many racial, ethnic, and cultural groups. Indian Tribe: Body of people that: 1) Blood ties that are socially, politically, and religiously organized. 2) Live together in a specific territory. 3) Speak a common language. Reservation: Land reserved by the federal government for a tribe that relinquished other land areas through treaties.

90. Sovereign nation Result of Cherokee Nation v. Georgia in 1831. Govern own affairs, including authority to structure governments Regulate membership Maintain justice Provide for public safety and welfare Develop tribal economies and regulate businesses Tax

92. Minnesota has 11 tribes.

93. 211 Federally recognized Alaskan Entities

94. Of these, 224 operate gaming facilities. (40%)

95. Minnesota has 19 casinos.

96. As of 2006 only 73 tribes distributed direct payments to individual members.

99. Cultural identity varies from “traditional” to little knowledge or interest in traditional

100. Elders tend to be traditional, younger generations tend to be either multicultural or non-traditional.

102. Traditional, Christian, or combination of both

103. Community oriented

104. Specific practices vary among communities.

105. Ask versus assume. Many beliefs and practices are sacred and are not to be shared publicly or with outsiders.

107. Others identify mental health problems as shameful.

108. Mental illness may be viewed as a form of spiritual possession or as an imbalance with the natural world.

110. Healing comes from identifying stress in the community

111. Illness is resolved through community ceremonies and traditional practices.

112. Many different plants and animals are used for medicine.Medicine Stick

114. Avoid intrusive questions early in conversation

116. Pointing with your finger may be interpreted as rude in many tribes

117. Do not stand too close, talk too loud, or talk too fast.

119. Conclusion What is your cultural population? What information will best serve your CIT officers? Open the dialogue with cultural leaders to obtain recourses and education for your CIT officers.

120. Patti KresslyPro-Crisis LLCprocrisis@hughes.net651-210-8036