Why Pacific Islanders in Utah have trouble connecting with mental health care

Story and photo by ALEXANDRA OGILVIE

Most Pacific Islanders live in a clan-based family society, where the family unit as a whole is viewed as more important than the individual, said Susi Feltch-Malohifo’ou, the executive director of Pacific Island Knowledge 2 Action Resources (PIK2AR) in Salt Lake City. Family is so important that many Pacific Island languages don’t distinguish between “brother” and “cousin.”

However, this family-based support system often prevents Pacific Islanders from getting professional help with mental illnesses and domestic abuse.

Karson Kinikini, a Pacific Islander and a licensed professional counselor of mental health, said in an email interview, “As a tribal/family based culture, they may more naturally seek support from within their family system in non-clinical ways. Often times, the concept of counseling (going to talk to a stranger about personal things) seems like a foreign concept to a people who have learned to rely on each other. Polynesians are often LDS in Utah, and so they have another support system of the Church, who they will often talk to before reaching out to a stranger.”

While having a strong support system is key to good mental health, family members and clergy often aren’t trained to give mental health advice. This is generally OK when the problems are about having an unrequited crush, but can become problematic when a family member has an undiagnosed serious mental illness, Kinikini said.

One example of mental illness is depression. Depression can present in many ways other than feeling sad all of the time. In men, it can often show itself as aggression. “All types of mental health problems were positively associated with aggression perpetration,” according to a study in the Journal of Family Violence.

This is certainly not unique to the Polynesian community, but the Organisation for Economic Co-operation and Development reports that Polynesian women are at the same risk for spousal abuse as are women in Somalia and Afghanistan.

Line drawing of sad people

A bipolar woman’s visual description of her illness. Used with permission.

One of the programs that PIK2AR offers is an anti-domestic abuse Pacific Island initiative. Feltch-Malohifo’ou said domestic abuse doesn’t end when families leave the islands and come to Utah. She said the family clan system also contributes to women not seeking help. “Women are expected to carry their share of the family burden.”

According to the Office of the Surgeon General, racism is a major barrier when it comes to getting mental health help. “Ethnic and racial minorities in the United States face a social and economic environment of inequality that includes greater exposure to racism and discrimination, violence, and poverty, all of which take a toll on mental health,” it stated. And for good reason, the office reported, “Their concerns are reinforced by evidence, both direct and indirect, of clinician bias and stereotyping.”

Along with overt racism, racial minorities tend to occupy the lower socio-economic echelons. Kaati Tarr, a Pacific Islander who is a licensed clinical social worker in Salt Lake City, said in an email interview, “In my opinion, it’s a combination of culture and socioeconomic status. Having insurance coverage helps, but still, the co-pay might be considered excessive, especially if paid weekly. $25 x 4 visits a month is $100 dollars that could be used to pay for food and higher priority basic needs.”

According to The Utah Health Department, “16.3% of PIs (Pacific Islanders) reported that someone in their household had been unable to receive needed medical care, tests, or treatments during the past year, usually due to financial barriers.”

Kinikini, the counselor of mental health, said money isn’t the only missing resource — mental health professionals often don’t have translators. “Services available in a native Polynesian language is very difficult to find access to. I, for example, am of Tongan descent but I do not speak Tongan. I have struggled to find native language speaking therapists to refer native language speaking clients to. Consequently, often the solution is to have a family member or friend translate. This can limit the effectiveness of the counseling process.”

Studies have been done on bridging this gap for other racial minorities, such as Latino and black communities. But, few data exist on Pacific Islander communities, so many families and mental health professionals are left on their own to determine best practices.

“The overall rates of mental disorder for many smaller racial and ethnic groups, most notably American Indians, Alaska Natives, Asian Americans and Pacific Islanders are not sufficiently studied to permit definitive conclusions,” the NIH reports.

Tarr, the local clinical social worker, said, “Unfortunately, I don’t have any additional resources to provide you with … that’s part of the issue, I think.”

But local Pacific Islanders like Kinikini and Feltch-Malohifo’ou are working toward closing that gap.