EASING TROUBLED MINDS

AS A CULTURAL PSYCHOLOGIST working among the estimated 24,000 East African immigrants and refugees in the San Diego area, Dr. Gebaynesh Gashaw- Gant understands that the last thing she should do is ask her clients about "mental health issues." "There is a high stigma for mental health in all these communities," says Gashaw-Gant. "People with mental illness are viewed as individuals who cannot be whole or functional. We wanted to break the stigma," she says resolutely, "while respecting our culture."

BREAKING DOWN BARRIERS TO SERVICE
In 2004, Project ESSEA was one of the 46 mental health programs in 15 counties profiled in a monograph, "Breaking Down the Barriers to Service," published by The California Endowment. The programs were funded under The California Endowment's $24-million Special Opportunities in Mental Health Funding Initiative in 2001. The three-year mental health initiative helped The Endowment gain greater understanding of the barriers that limit access to effective mental health care services and find ways to break through those barriers.

According to The California Endowment's Senior Program Officer Gwen Foster, who coordinated the Special Opportunity in Mental Health Funding Initiative, "Each grantee has contributed to the field's collective knowledge of how to more effectively promote mental health and provide mental health services to populations that have been described as 'hard to reach.' We found that these populations will accept and effectively use services when the services are flexible, culturally and linguistically responsive, and when providers are open to learning from consumers and the community."

CULTURAL RESPONSIVENESS IN ACTION
Dr. Gashaw-Gant started Project ESSEA — Ethiopia, Somalia, Sudan and Eritrea to America — in 2001 to provide mental health services to refugees and immigrants. A native of Ethiopia herself, she understood the depression and stress caused by adapting to life in a new country and new cultures. She also knew that to address the mental health needs of the population meant addressing these issues in a culturally relevant way.

Instead of directly asking about psychological issues, Project ESSEA first guides refugees and immigrants through a basic needs assessment and helps them through the labyrinth of the American system, including ESL classes, day care options and housing. The project also helps coordinate medical services and medication monitoring for their clients.

Many East Africans follow Muslim or Christian Orthodox traditions and believe that religion is a source of healing. Project ESSEA works with churches and mosques to erase some of the stigma associated with mental health treatment.

"We have satellite offices at several places of worship," Gashaw-Gant explains. "Our clients are not used to psychologists or psychiatrists; they are accustomed to treatment from their religious organizations. We work with the priests, imams and pastors because religion is important in treatment, and services need to be integrated with spiritual practices."

According to the findings in "Breaking Down the Barriers to Service," Project ESSEA is an example of how groundbreaking partnerships improve mental health outcomes among underserved individuals in California.