Mental Health Services for Native Hawaiians: The Need for Culturally Relevant Services

Abstract

The fervor to increase institutional accountability has extended to human services. Accountability in the human services broadly refers to the efficiency of a system so that resources and services are allocated in an equitable manager to address identified needs. “Actions which are taken and decisions which are made must be justifiable in terms of the stated goals and objectives of the program” (Gelman, 1983:83). This definition is semantically different but not philosophically different from business which focuses on productivity as “achieving a desired benefit level with less costs” (Nagel, 1863:143). In both public organizations and the human services, it has become increasingly necessary to identify needs clearly, articulate goals and objectives, and provide services with desired outcomes which are cost-efficient. Critical to this process is the involvement and participation of the people who are recipients of services and consumers of products from public organizations or clients of human services. While the demand for institutional accountability will continue to be an issue for public organizations, it has only recently gained attention as an issue for the human services.

Mental health services for ethnic minorities of color is one area of the human services which has historically been remiss in accountability. The President’s Commission on Mental Health (1978) stated that the general delivery of mental health services to minorities, by and large, has been inappropriate and ineffective. The findings from this Commission report have subsequently been affirmed by the human services literature (Pedersen, Draguns, Lonner, and Trimble, 1981; Green, 1982; Lum, 1986; Devore and Schlesinger, 1987) which argues that the mental health system is organized around a noncultural set of assumptions. Essentially, the assumptions presume that there is similarity among all people regarding the origins and patterns of problems, help-seeking behaviors, and copying repertoires.

These assumptions are predicated on the White-European culture and imply that the values of the dominant culture should characterize the nature and scope of the mental health system. These assumptions are fallacious inasmuch as there is great variations among people because of differing historic origins, cultural values and traditions, and lifestyle practices. Therefore, the immediate implication is that groups who do maintain different and sometimes opposing values and beliefs are excluded and/or penalized in such mental health systems.

One particular minority group of color, which as traditionally been excluded as planners, providers, and clients of the mental health service system, are Native Hawaiians. The criticism that mainstream or western mental health services have failed to meet the needs of this group is becoming more and more evident (Alu Like, Inc., 1985; Mokuau, in press). One response to such criticisms has been the development of a demonstration program aimed at providing mental health services which are unique to Native Hawaiian culture. Native Hawaiians participated in the planning and implementation of this program.

This article presents the findings of a study which assesses clients’ perceptions of this special program. The major objectives of the study was to determine if Native Hawaiian clients found the program to be more helpful that western mental health programs in resolving their problems and concerns. Specifically, the study examines clients’ perceptions of the program’s staff services.