Clinical Case Management with Severely Mentally Ill African Americans
Though the etiology of mental illness may be a mysterious consequence of genetic disorder and/or early life trauma., it has been firmly established that episodes of the illness are precipitated by stressful life events. Thus, it is all the more regrettable that persons with mental illness have more than their share of problems in living. Many of the psychiatrically disabled do not have the personal resources to maintain independent living. The inability to provide for basic needs such as food, shelter, and urgent health care can be stressful for anyone. For those less able to cope, it is often a disaster. It is typical to utilize support systems in times of crisis. However, several studies have shown that characteristics of personal networks are problematic among chronically mentally ill individuals. For example, the size of their personal networks are only half of that which is normal for the general population (13 for the psychiatric as compared to 25 for the general population). This study by Tolsdorf (1976) showed that for psychiatric patients, twice as many of their ties are with kin than is the case with chronic medical patients. Consequently, hospitalization is often used as compensation for these deficits in the patient's support network rather than for its unique therapeutic functions (Cutler and Tatum, 1983). Methods of disengaging hospitals from this role are a challenge for community mental health (CMH) systems. For Mrican Americans, this challenge is particularly great. African Americans are overrepresented
among those involuntarily hospitalized, yet underserved in community care. This, as well as the chronic shortage of acute and subacute beds in the CMH system, has been the impetus for increased focus on the use of the client's social networks. For African Americans, the community should be particularly well utilized. A ramification of racism and its attendant issues-poverty, dearth of resources, and the strong Mrican value of the community pulling together to support its members-the use of informal networks is a relatively rich recourse for African Americans who suffer from a psychiatric disability (Lawson, 1985). This chapter explores the unique cultural features of African environments in the U.S., and how they can best be employed to help persons with psychiatric illnesses live in the community. How racism has influenced mental health care to Mrican Americans will also be considered, as well as how non-Africans can best provide culturally competent care.