Why mental health services fail Pacific Islanders

Story and photo by ANTHONY SCOMA

You are in a foreign country and you need help with an urgent problem. You may seek help but the stark differences in language, customs and values renders any assistance frustrating and ultimately useless.

That is the reality for many Pacific Islanders seeking mental health services in Utah.

The disconnect between Pacific Islanders and mental health services starts at the fundamental contrast between western culture and Pacific Islander culture. Oreta Tupola, a community health worker coordinator at Utah Public Health Association, said, “The differences in our culture is that individualistic perspective and [the] collectivist perspective.” She continued, “That community and family perspective is everything we’re about, and you can understand … all these issues that we’re facing. It surrounds how it impacts the family and how it impacts my family name and my lineage and my genealogy.”

The conception of the self and its relation to the world outside the self is important to mental health and informs how one deals with conflict. In a collective perspective, several sources said, the actions of the individual reflect the family or group as a whole. This is particularly important for immigrants from the Pacific Islands whose view of family connection extends far beyond the nuclear norm in the U.S.

Within this framework, the accountability to the family makes shame a powerful tool for social control. Lani Taholo, director and owner of Child and Family Empowerment Services, said in a phone interview that these feelings of shame also work as a deterrent to seeking mental health services.

Story1Assetv2

Lani Taholo in her Child and Family Empowerment Services office in the Glendale neighborhood of Salt Lake City.

“When it comes to shame, if we’ve done something wrong to lose face in our community it’s a big deal because we don’t want to bring shame to our family or our family name,” she said. “Then the poor family starts to feel judged and can easily feel … shamed by that so that just pushes it down further — to repress it and suppress it — and unless they have services that they can relate to they just don’t go.”

Taholo is currently working on her Ph.D. in Social Work at the University of Utah. Her research is on the underutilization of mental health services by Pacific Islanders and how to make those services more inclusive of their experiences and culture.

Taholo said that even when Pacific Islanders are required to use mental health services, the cultural differences are still an obstacle. In cases where violent behavior calls for intervention by mental health professionals, the established model does not seem to work for Pacific Islander participants. They either don’t attend or barely participate to avoid punishment. Taholo says that these approaches fail to relate to Pacific Islanders culture.

“There is no change, there is no healing, there is no recognition and acknowledgment of what’s really happening because it’s not even relatable,” she said. Taholo described instances when judges from the West Valley Justice Court called her to help out in cases involving Pacific Islanders because of their shared culture. “They already know they aren’t going to finish the other program,” she said.

The contrasting cultural perspectives also have consequences for communicating thoughts and feelings across generational divides in Pacific Islander communities. In the cases of first-generation immigrants, there is a separation of experience between those raised on the islands and those raised in the U.S.

Those experiences also represent a clash in cultural ideology for the new Americanized generation. They learn a collective perspective from their families, while school and peer interactions instill a more individualistic mentality.

Fisi Moleni, a licensed clinical therapist in Salt Lake City, said in a phone interview that the move to America introduced a lot of mental health issues that were not as prevalent in the islands.

“In that transition to America, the complexity of living here and all the different stimulus and exposure to society … it seems to have been quite a challenge,” he said. “The Polynesian parents, the Pacific Island parents, are trying to utilize to some degree their old methods of parenting, of conditioning … the core values of respect and loyalty and all those things.”

Moleni also links this change in geography and culture to the rise in various forms of addiction and has observed a disconnect between the first generation of immigrant parents and their American-raised children.

“Children are … leaving the home and being influenced by so many other entities that when it comes time to connect, there is a disconnect,” he said. “They don’t feel comfortable … communicating with parents and expressing difficulty with certain challenges at school, with friends, with … the more extreme addictive behavior.”

While this disconnect might lead to children being influenced more by friends and cultural norms, Moleni also acknowledged the potential of the Pacific Islander family to achieve positive mental health. When parents have the tools to communicate and connect with their children, the loyalty to name and family creates a robust, adaptable social network.

“Our people were the greatest navigators, the greatest seafarers that history … has seen,” Moleni said. “They adapted, they were able to use their navigational skills to extend themselves to other islands and to survive and began to thrive. … I thoroughly believe that we can adapt even here and not just survive but thrive within this society.”