The patient was suffering from severe depression. He had immigrated to the United States from an Asian country, and his adjustment had been very difficult.
In the old country, men had worked and women had stayed at home. But in the United States, it was financially necessary, as well as socially acceptable, that women work too. The man's wife got a job and learned English rapidly. He had more trouble with the language. He earned minimum wage while she was soon earning twice that. Ultimately, he felt she was looking down on him, and they began to quarrel frequently. She couldn't understand why he didn't adapt to the new culture. Two years ago, they divorced.
Recently the man's depression reached such depths that he needed hospitalization, and that's where the good news comes in: There was a place for him to go.
Metropolitan State Hospital, California's largest public mental hospital, had just opened an Asian-Pacific ward to meet the needs of Asian immigrants requiring hospitalization.
Steven Shon first saw a need for such a program when he was working as a psychiatrist at a community mental health clinic in San Francisco. Most of his patients were Asian, and occasionally they needed to be hospitalized for mental illness. "When they needed inpatient care, I had no place to send them," Shon recalled. "The (hospital) staffs often couldn't speak the patient's language and had little understanding of the patient's culture, so patient experiences were frequently very negative, and treatment needs were not met."
Special Ward Proposed
So when Shon, a Korean-American, became clinical deputy director of the California Department of Mental Health, he decided to take action. The first step, he decided, should be in Los Angeles County where more than 800,000 Asians reside. He proposed to his boss that a special Asian-Pacific ward be set up at Metropolitan State Hospital in Norwalk.
That was in February. Last Thursday, Shon saw the official dedication of Ward 108, which state officials say is the only inpatient facility aimed at Asians in any state mental hospital in the United States. There is one other such ward, at San Francisco General Hospital, but that facility is run by the City and County of San Francisco.
A Japanese-style archway has been constructed over the entrance to the ward, which can accommodate 25 patients. The walls are decorated with pictures of Asian countries and Pacific Islands. Colors on the ward are bright and warm. Patients get rice and tea with their lunches and dinner and once a week are allowed to cook dishes from their native countries.
But most important is the type of treatment they receive. "The field of psychiatry relies on communication much more than any other specialty," Shon said. "If somebody's blood pressure is high, it doesn't matter what language they speak, the high blood pressure will show up on a test. But in psychiatry, if a patient can't communicate, we can't make a diagnosis and the patient doesn't get the kind of help he deserves."
Culturally Diverse Staff
Nearly a dozen languages are spoken by the unit's staff, which consists of 18 nurses, a psychiatrist, a doctor, a social worker and a rehabilitation therapist. All but one member of the staff are of Asian or of Pacific Island descent, with roots in Hawaii, Vietnam, China, Korea, Cambodia, Singapore, India, Pakistan or the Philippines.
Shon says the staff's cultural diversity is also important to effective treatment. "The staff is trained in Western mental health techniques, but they also understand the values of other cultures," Shon said. "Immigrants are really in a high-risk group in terms of mental health because of the stresses and changes they've gone through in life."
Dr. Ton-That Niem, chief of medical services at Metropolitan, understands very well the stresses Asian immigrants face. He still gets teary when discussing the circumstances of his own emigration.
Niem headed the South Vietnamese Department of Health. He was forced to flee the country for the United States at 8 p.m. on the night the North Vietnamese took over Saigon in 1975. "In one day I lost my social status, my profession, my culture--everything," Niem recalled. Although he was one of the lucky ones who was eventually able to continue working in his chosen profession, Niem has not forgotten the pain that accompanied his transition. "Sometimes I still feel the depression," he said, adding that it is much worse for "an engineer who must take work as a busboy."
Lessening Culture Shock
Dr. Byung Chung, Ward 108's psychiatrist and a Korean immigrant, said that in addition to understanding psychological problems, the staff attempts to make patients' hospital stays less of a cultural shock. "We had one patient who complained of hunger pains all the time," Chung said. "Then we noticed that he wasn't eating because he didn't like the food. Now his father visits him every day and brings him the kind of food he is used to."
Chung says it is too early to tell what kinds of problems will be most common in the ward, although he said that so far, they are seeing a greater percentage of depression cases than the hospital as a whole and a smaller percentage of schizophrenia.
The Asian-Pacific unit at San Francisco General Hospital, believed to be the only other mental hospital ward specifically for Asian patients, has been operating since 1980. Dr. Francis Lu, one of the unit's founders, says that staff on his unit sees a higher percentage of depression cases and lower percentage of personality disorders, substance-abuse cases and organic brain disorders than the hospital at large.
The unit also sees a number of post-traumatic stress disorder cases, Lu said. "It is often not the presenting problem," he noted, "but we definitely see it."
One Laotian patient, for example, was referred to the San Francisco unit after neurologists could find no medical explanation for a severe weakness in the man's limbs. During interviews under a mild sedative, the man revealed traumatic war experiences in his native country. He described his helplessness as his friends were killed all around him and also described the nightmares and flashbacks associated with the disorder. After hospitalization, during which he discussed his war experiences, the patient expressed relief and said his depression was less severe.
In both the San Francisco and Norwalk programs, aftercare is an important part of treatment. Most patients are referred to the Metropolitan program through one of five county clinics set up to treat Asian-Pacific patients. As soon as a patient is admitted to the hospital, the therapist from the referring clinic begins planning with hospital staff for continuing treatment after the patient is discharged.
Hospital and state officials say Ward 108 required no additional money, that it took only a reallocation of existing resources and staff. The ward was previously not used and another ward was shut down when Ward 108 was opened. "We drew interested staff from other units in the hospital," said Don Z. Miller, executive director of the hospital. "We hired no new people."
Priority for admission to the co-educational unit will be given to patients of Asian or Pacific heritage who need short-term treatment and who have difficulty communicating in English. Currently the ward has 15 such patients. The other 10 beds are filled by Caucasians and blacks.
The program was developed by the state in cooperation with the Asian-Pacific Planning Council, and the Los Angeles County Department of Mental Health. Metropolitan State Hospital has an existing program for Latinos.