Mental Health in the Asian-American Community
An Interview with Dr. Rhigel (Jay) A. Tan, DNP, APRN, PMHNP, GNP, ANP
August 3rd, 2017
Dr. Tan, tell us a little about your background.
I grew up on the Filipino island of Cebu and graduated cum laude from the Cebu State College – Cebu City Medical Center College of Nursing. After relocating to the United States, I furthered my education becoming an Adult Nurse Practitioner (ANP), a Geriatric Nurse Practitioner (GNP), and a Psychiatric and Mental Health Nurse Practitioner (PMHNP). I later received my doctorate in nursing (DNP) from Rocky Mountain University of Health Professions. I have an immense interest in education and was previously the tenured professor of nursing at the College of Southern Nevada. Currently, I am an Assistant Professor of Nursing at UNLV and run my own clinic, iCarePsychiatry. Additionally, I was elected as the first Filipino American President of the Nevada State Board of Nursing which I continue to serve as President.
What are some of your medical interests?
I have a passion for working with patients with mental health and psychiatric disorders, specifically ADHD and ADD, alcoholism, anxiety, schizophrenia, autism, bipolar disorder, borderline personality disorder (BPD), depression, substance abuse and teen depression. I also specialize in pharmacogenetics, which is the study of how genes affect a person’s response to drugs. This relatively new field allows us to combine pharmacology and genomics to develop effective and safe medication dosages which are specific to a person’s DNA makeup!
What would you say is a big concern regarding Asian-Americans and mental health?
Asian-American patients are a minority when it comes to mental health treatment. In my own clinic, less than 5% of all patients I treat are Asian-American. There seems to be this social stigma surrounding Asian-Americans that mental disorders are frowned upon in their culture and are rather a “Wrath of God” instead of a real-life medical condition. They feel that there is nothing they can do to treat their disorders but pray and hope that it will get better someday. Families with mental health children or parents tend to isolate themselves from society and not discuss what is troubling them. They find it to be an embarrassment and a punishment. Some even seek treatment from fake uneducated “Quack Doctors” that promise healing. The reality is, that simply hope, religious prayer and home remedies are not enough.
Why do you think that Asian-Americans, in particular, are not comfortable with discussing or receiving treatment for their mental health disorders?
I think we need to look back at the Asian culture altogether. Asian-Americans are considered to be the “model community” — they are educated, have white-collared jobs, higher income, value education and try to live healthier lives. In that regard, accepting the fate that they suffer from a mental disorder is simply troublesome and unacceptable. They hide their symptoms for years and even decades as to not break from their “perfect” lives. When and if they do finally decide to receive treatment, usually their symptoms are so much more severe than if they had come in years earlier. Asian-American women have a higher rate of suicide and this stems from having to keep their feelings and troubles inside of them until they can no longer hold on to the burdens.
What are some signs and symptoms you look for to determine if an individual may have a mental health disorder?
It is important to understand that although the exact cause of most mental illnesses is not known, it is becoming clearer through research that many of these conditions are caused by a combination of biological, psychological and environmental factors.
Some of the more common signs of mental health disorders in adults and older children include: confused thinking, prolonged depression (sadness or irritability), feelings of extreme highs and lows, excessive fears, worries and anxieties, social withdrawal, dramatic changes in eating or sleeping habits, strong feelings of anger, strange thoughts (delusions), seeing or hearing things that are not there (hallucinations), growing inability to cope with daily problems and activities, suicidal thoughts, numerous unexplained physical ailments and substance use.
In younger children, signs of mental disorders may include: changes in school performance, poor grades despite strong efforts, changes in sleeping and/or eating habits, excessive worry or anxiety (i.e. refusing to go to bed or school), hyperactivity, persistent nightmares, persistent disobedience or aggression and frequent temper tantrums.
What is your approach to treating patients with mental health disorders?
My first step in assessing a patient with a possible mental health disorder is to run a genetic test lab sample done by a quick cheek swab. After receiving the results of the patient’s specific gene structure, I am able to better understand how that gene interacts with certain medications. Thus, I can prescribe medications to the patient that will more likely benefit and treat their disorder. It is important to understand that as medical providers, we cannot take a “shotgun” approach to treatment – meaning to simply test different mediations out using trial and error until one finally seems to work for the patient.
What is happening in healthcare now is that mental health specialists are prescribing one medication to treat a mental disorder, but then having to prescribe two or three other medications just to treat the side effects of the original medication! This way of treatment is called “polypharmacy” and causes unpleasant long-term effects.
We also need to take into account that the “standard” dosage of a medication cannot apply to each and every patient the same way. If a recommended dose of a medication is 5 mg, for some patients with a fast metabolism, that amount will provide no benefit in their condition as the body will quickly metabolize it and get rid of it, while others with a slower metabolism, the same dosage may provide them with unpleasant side effects. Every patient needs to be treated based on their unique makeup. I call this process of treating each patient individually and uniquely “Personalized Medicine.”
What are the costs involved in receiving this genetic test to identify specific genes and how they react to certain medications?
Depending on a patient’s insurance or lack thereof, these tests can cost anywhere from $1,000-$3,000. However, I have even seen some tests cost as low as $200. Do not let cost discourage you from receiving adequate treatment! What I have found is that by being able to identify which specific gene and the medication that treats it, is that the patient can now come off the other medications they were previously on, thus reducing their overall medical bills.
If a person feels that they he or she may have a mental disorder, what can they do right now?
The first and most important thing to do is take a breath and know that help is available. You may consult with your primary care physician regarding your concerns and they may refer you to a specialist for further treatment. Speaking to counselors, joining church groups and other organizations is also a great support method. They may also contact the Philippine Nurses Association of Nevada at (702) 807-4634, the Filipino American Advanced Practice Registered Nurses Association of Nevada, or iCarePsychiatry at www.iCardPsychiatry.com to find a professional.
What are you most proud of?
I am deeply proud of the fact that in my home Filipino island of Cebu, I have been working diligently with government officials to pass new city ordinances and legislation that will allow mental health clinics to be opened — something that has never been done before! This will hopefully shine a light that mental health is not a sin or Wrath of God, but instead a very manageable and treatable condition in the Asian community with proper treatment and guidance. I cannot wait to see what will happen in the years to come!