Immigrants Face Mental Health Stigma

http://www.kfmb.com/stories/story.72345.html

SAN FRANCISCO -- Omeed Popal's parents knew their son wasn't well. He heard voices, believed people were trying to kill him and falsely confessed to his boss that he'd stabbed someone.

His family, refugees who fled Afghanistan in the 1980s, kept close watch over Popal for years. They got him emergency help when he seemed to need it and even arranged a wedding, hoping marriage would prompt the 29-year-old to settle down.

But in August, Popal swept through the streets of San Francisco in his sport utility vehicle, smashing into 18 people after killing a pedestrian in Fremont. He now faces a variety of charges, including attempted murder and evading police.

Like many low-income immigrant families, the difficulty Popal's relatives faced getting health care was compounded by a language barrier and a deep cultural divide. What set Popal's case apart is the tragedy that ensued when he went untreated.

Doctors and others who work with immigrants say being in a new country, without the support of family and surrounded by a foreign culture, can be a real psychological hardship.

The National Latino and Asian American Study, concluded in December 2003 with funding from the National Institute of Mental Health, suggested that recent Hispanic and Asian immigrants had a lower incidence of mental disorders than Americans but accessed help far less often.

Not speaking English or having health insurance presented the most obvious stumbling blocks, according to "Mental Health: Culture, Race, Ethnicity _ Supplement," a report issued by the Office of the Surgeon General five years ago.

Studies reviewed in the report suggested that fewer than one in 20 Hispanics with mental disorders used the services of specialists, while Asians-Pacific Islanders were far less likely than whites to seek care for a mental disorder, or even to mention their problems to friends and family.

Refugees like Popal's family might arrive suffering post traumatic stress disorder, depression or anxiety. Those conditions require long-term care, and can make it particularly difficult to meet new people and hold down a job _ the very things that might anchor lives in flux, said Khalil Rahmany, a clinical psychologist who works primarily with Afghan immigrants.

"Very often, they've left their home, their hearts, their belongings," Rahmany said. "And often family members left without knowing if their relatives were even living or dead."

Many cultures also harbor beliefs about psychological problems that keep people from seeking help even when they know it's available.

In Afghanistan, "it's seen as an emotional weakness, a deficit in personality," Rahmany said. "People with mental health problems were taken to the mullah or to holy sites, not to doctors."

Family members may even refrain from getting help for a relative because they don't want to shame them by exposing their illness to strangers, he said.

Popal's relatives tried to manage him as best they could, keeping watch and taking him to emergency rooms when he seemed out of control, said cousin Hamid Nekrawesh.

"If there was follow-up (to the emergency room visits) this whole situation could have been prevented," Nekrawesh said. "But the doctors didn't think he would be harmful to society."

Even for those open to Western-style counseling, finding a doctor who understands a patient's language and background and is willing to work with his belief system is difficult, said Sarita Kohli, director of mental health programs at Asian Americans for Community Involvement, which offers counseling for immigrants, refugees and torture survivors.

"There just aren't enough resources out there that are appropriate for our clients," Kohli said. "We can't refer them out because there isn't any place to refer them to."

Without care, Popal lashed out, impacting people like Susan Rajic, who became paralyzed from the neck down when struck by his car. Nearly three months later, Rajic struggles to regain control of her arms and hopes to be able to feed herself again, said Debra Bogaards, her attorney.

The shock of the events has led Popal's father, who suffered from similar mental health problems but hadn't sought treatment, to start seeing a therapist that Popal's cousin found.

In jail, Popal is under the constant supervision of doctors who are addressing his mental disorder with therapy and a drug regimen. At his latest court hearing, he smiled and greeted family and friends, and responded to the judge's questions without difficulty.

With medical care, Popal was finally doing well enough for court-appointed psychologists to declare him mentally fit to stand trial.

But even with care, his well-being is uncertain. Last week, a sheriff's deputy became suspicious of noises coming from the area where Popal was being held and found him trying to hang himself from a pipe.