Eighteen years ago, when Anya Stepanova immigrated to Tennessee from the small town of Dimitrovgrad, Russia, she participated in adjustment support groups aimed at people resettling after leaving Eastern Europe.
“Coming here and participating in the adjustment groups was a great help because that just gave me that sense of community right from the very beginning,” she said.
The groups helped her make connections with people. Although it was difficult adjusting to a new culture, she knew she was not alone.
Stepanova now provides one-on-one mental health counseling at Lutheran Community Services Northwest in Vancouver, which looks to start its own adjustment support groups for the Russian-speaking community this spring. Its existing services include immigrant counseling and advocacy and refugee resettlement.
Russian-speaking Counselors Who Accept Medicaid
Lutheran Community Services Northwest, 3600 Main St., Suite 200, 360-787-4708.
Columbia River Mental Health Services, 6926 N.E. Fourth Plain Blvd., 360-993-3000.
Sea Mar Vancouver Behavioral Health Clinic, 5501 N.E. 109th Court, Suite A1, 360-566-4432.
Search for providers online via Amerigroup: www.myamerigroup.com/Pages/welcome.aspx
Seeking Private Local Mental Health Services?
Visit https://www.psychologytoday.com/us to search by county or city for a therapist or psychiatrist. Results can be filtered by the ethnicity and language spoken by the provider, such as Russian or Ukrainian, as well as their treatment approach.
The SeaTac-headquartered nonprofit developed the refugee health screener, called the RHS-15, a tool that detects possible mental health issues among new refugees. Those who test positively are referred to mental health services. Overall, between 2015 and 2017, about one in five refugees from former Soviet Union countries tested positive for emotional distress and could benefit from mental health services, according to the Washington State Department of Health. The rates are higher among female and elderly refugees.
Refugees from countries such as Syria and Iraq indicate higher rates of emotional distress. However, they are more likely to accept referrals to mental health services than those from the former Soviet Union. In 73 percent of cases, people primarily from Ukraine, Russia and Moldova declined services, according to the state Department of Health.
More than 12,000 Clark County residents were born in Eastern Europe, according to 2017 American Community Survey estimates.
“We recognize that there is a huge population in Clark County of Russian-speaking people who need or who would benefit from some behavioral health services,” said Cheryl Hamilton-Jefferson, Lutheran Community Services’ clinical supervisor. “But we can’t present it to them or offer it to them in the way that we do the dominant culture. So therein is where we begin to explore how we can reach that community that is falling through the gap. How would we reach them and in what way would benefit the culture?”
Lutheran Community Services Northwest received a $12,650 grant from Premera Blue Cross and $54,800 from Clark County Community Services to launch adjustment support groups.
Stepanova facilitated similar groups at Lutheran Community Services’ Portland office. She said most of the people who attended the group were older.
“They brought things to share from the week,” she said, whether that was cultural barriers they faced or questions they had about marriage, parenting or interpersonal relationships. “They just learned so much from one another.”
It was a safe place where they could speak among peers who understood what they were going through. Hamilton-Jefferson said it’s powerful when people of like cultures come together and connect around their experiences.”
The job of the facilitator was to provide resources and weave in mental health. It’s a tricky topic to address directly in Slavic culture, Stepanova said. Mental health could be talked about in terms of mental wellness or self care. Depression may be described as feeling sad or having the blues. Diagnosis sounds like a harsh word in English, but “when I say it in Russian language it sounds even more so,” she said.
Stepanova’s memory of living in Russia was that there wasn’t a mental health system. A family member who was struggling wasn’t able to find help.
“It was sort of like kept inside, no one talked about it, there was no help, there was no education about it. Community was a big component. People were just there for each other,” she said.
The mental health system was the neighborhood, the family and friends surrounding people.
Reaching out
In addition to hiring a group facilitator, Lutheran Community Services plans to eventually hire a peer support person. Joe Asbridge, operations manager, said the Portland office spent years developing its Eastern European mental health specialty program. Reaching out to elders, community leaders and churches was a major component of growing the program because they’re trusted referrals.
“We’re going to try and replicate that model,” he said. “The traditional medical model of the United States around mental health services doesn’t work for people from the Russian, Ukrainian, Slavic community.”
Hamilton-Jefferson said the only way to shift the stigma around mental health is for people to have a positive, beneficial experience.
“It’s one thing to hand them a piece of paper to read about mental health. It’s another thing to watch something on a video. But if they can come and have the experience, have the emotions, the feelings, find the language of their heart, that can shift their understanding. That’s when change can happen,” she said.
Sometimes, a diagnosis can be a barrier to participation, but people don’t need to have a diagnosis to participate in adjustment support groups.
“While we may not be successful at getting individuals to come into individual therapy, it’s still therapeutic and contributes to their mental wellness to just be part of the group. For some people it’s more effective for them to be in group therapy than individual therapy,” Hamilton-Jefferson said.
The support group can be a starting point and may open some people up to the idea of one-on-one therapy, Asbridge said.
Breaking conceptions
Ilya Kuzkin, business change advisor with Medicaid-managed care organization Amerigroup Washington, is excited to hear about Lutheran Community Services’ new service.
“When my family immigrated to Vancouver in the late ’90s, adjustment support groups were not formally available. There were other services that we participated in, but adjustment support groups seemed to be an informal occurrence through social circles or churches,” he said in an email.
Slavic people take pride in being independent and strong, and seeking help may be perceived as a sign of dependence or weakness, he said.
“While many understand that seeking mental health services doesn’t make somebody less independent or weak, it is important to have open conversations about it and educate people to promote acceptance and utilization,” Kuzkin wrote.
Behavioral and physical health are integrated in Washington’s Medicaid program, so more providers and coordinators, like Amerigroup, are discussing this.
“I’m looking forward to seeing more of my Slavic community engaging in these conversations and becoming more accepting of the positive difference that mental health services can have on lives,” Kuzkin said in an email.
Trust issues
Julia Anderson, a Vancouver social worker and Russian immigrant, said the stigma around seeking mental health services stems from a fear of government and not trusting people of authority because it wasn’t safe. That trauma is passed down through generations and the stigma reinforced.
Back home, people may have been institutionalized for having a mental health issue, so people associate mental health with being locked up.
“They have a really hard time trusting this system,” said Olga Boltenkov, a therapist at Rainier Springs in Vancouver. “Therefore, they just don’t seek the support that’s available.”
Anderson said there is also a lack of local resources. Even if somebody tells their primary care physician that they or one of their children is having a mental health issue, who would the physician refer them to? It’s difficult to find a master’s level therapist who speaks Russian, is culturally competent, understands the depth of immigrant trauma and contracts with Medicaid, Anderson said.
Kuzkin personally experienced that challenge.
“When I was young, I had to be an interpreter for my parents. Imagine an eight year old interpreting medical information and forms for their parents or grandparents,” he wrote in an email. “Even today, this is reality in many people’s lives.”
Cultural cues
While many service providers offer translation services, things can get lost in translation. A patient saying ‘my head is heavy’ may be diagnosed as just having a headache when they’re actually describing symptoms of depressions. An interpreter has to know how a culture expresses the bodily symptoms of a specific illness.
“They come in and talk about chest pains. They feel scared. That’s anxiety,” said Boltenkov, who was born and raised in Ukraine and used to work in the intercultural psychiatric program at OSHU. “It definitely gets lost in translation.”
Without being able to speak and be understood in their native tongue, it can be hard to trust providers.
“It’s hard to talk to someone who doesn’t understand your culture,” Boltenkov said.
To build trust within the Russian-speaking community, she said, there has to be money invested in appropriate resources and outreach to churches and other groups so the community knows about those resources.
Translation services are expanding and companies like Amerigroup are taking steps to remove language barriers and hire providers who speak the language of their members, Kuzkin said.
