DEARBORN — President Trump’s proposed fiscal year 2018 budget cuts dealt a huge blow to mental health and substance abuse prevention, with funding to face projected cuts by almost $400 million.

Michigan is no stranger to debilitating cuts to areas such as education or health care, with cuts to these programs a routine practice of conservative governors from John Engler to Rick Snyder.

Just last year, Gov. Snyder’s proposed 2017 budget moved to privatize the $2.4 billion public mental health system, turning over a state-funded entity to private insurance companies.

The anxieties among the recipients, beneficiaries and dependents of these programs naturally became most salient among vulnerable patients, including those that are low-income.

Naturally, immigrants and refugees have a lot at stake through their own unique challenges in obtaining these services.

Organizations such as ACCESS or the Arab American and Chaldean Council (ACC) face a plethora of challenges, whose breadth ranges from cultural to institutional, all the while struggling to reconcile the multidimensional demands that these challenges wage upon multiple fronts of their organizations’ ability to provide for their unique clientele.

Unfortunately, the abundance of challenges can exacerbate deficiencies in these organizations that otherwise, through their vision, do important and highly transformative work.

In a 2013 testimony to the Mental Health Commission of Michigan, Mark Reinstein, CEO of the Mental Health Association in Michigan, addressed Michigan’s “treatment gap.”

“There are thousands, if not tens of thousands, of persons with severe mental health illnesses whom we can’t identify and reach out to,” he said. “Or if we can, we’re unable to get them to enter and stick with treatment that meets their clinical needs.”

The stigma

Many Arab Americans agree that the stigma against seeking mental health is a primary barrier for professionals to be able to provide their clientele with care.

Sally Attia, a social worker for the Arab American Counseling Services, a subprogram of the Mental Health Association in Passaic County, New Jersey, identified the “shame factor” that afflicts those “involved in seeking therapy.”

“Many Arabs think that if you’re going to the therapist, then that means you’re crazy or something,” she told The AANews. “We’ve done our best to minimize the stigma and educate through extensive outreach in local mosques and different community centers that Arab Americans are involved with.”

Walid Gammouh, MSW and consultant with the ACC, discussed the challenges a lack of “manpower and money” alike pose to organizations tasked with serving constituencies like this.

Yet, the veteran of 32 years in his field also cites stigma as the primary impediment.

“Stigma is an issue,” Gammouh told The AANews. “And creating safety and building relationships are the foundations for seeking help.”

Prioritizing

Awareness campaigns have not only been useful in helping refugees and immigrants find the resources and break the shame associated with seeking care, but also with recognizing that they need care in the first place.

Carmen Sarafa, director of behavioral health at the ACC, identifies post-traumatic stress disorder (PTSD), major depression and generalized anxiety disorders as the most prevalent issues refugees and immigrants seeking care face.

“My general feeling over the years is that new immigrants, most coming from war-torn countries, are not provided with enough information when they enter the U.S. and they do not have long term supports that help them navigate the system,” she told The AANews, adding that, “Not all new immigrants seek mental health services.”

Between adjusting to life in the United States and having immediate needs met outside of mental wellbeing, identifying and admitting to needing help falls to the wayside.

“[Dealing with] PTSD is pushed aside because they are more busy with survival,” Gammouh said. “It takes about one to three years for mental health issues to start showing up after [residents] have settled down and sort of adjusted.”

Funding issues

“As of July 1, we’ll be taking Medicaid and cash, whereas before we took [clients] free of charge, Attia said.

The Arab American Counseling Services faces new difficulties with being able to provide low cost, affordable and accessible services to clientele without the resources to put towards more expensive avenues of care is an apparent consequence of federal budget cuts towards such services.

Gammouh agreed that there are “not enough financial resources,” adding that “pretty much everybody is facing these kind of issues” across fields such as education and other social services.

“Even though ACC has been in existence since 1979, it has been creative to seek funding throughout,” he said.

The search for the right provider

Many professionals also agree that recruitment of Arab professionals who demonstrate a trifecta of extensive, clinical experience, a culturally sensitive understanding of mental health care across discourses and a strong command of Arabic as well as English are hard to find.

As a result, many organizations struggle to match the challenges faced by clientele with an inadequate number of health professionals that can meet and exceed these demands.

“We don’t have enough bilingual and trilingual social workers in our community,” Gammouh said, adding that, “mainstream treatment modalities in American cultures is [often] not culturally sensitive.”

He reiterated the importance of passion in the pursuit; an additional unspoken prerequisite that makes the search for the perfect social worker, psychologist or psychiatrist all the more difficult.

“It’s not a punch-in job,” he said. “You have to develop relationships which will change behaviors. We have to be genuine about reaching people. [There is] a very high calling working for people in this field.”

Attia reiterated the same need in her clinic, which serves Arab American clientele.

“We only have two Arabic speaking clinicians, so we’d love to have more,” she said. “There’s a waiting list [of clients.] It’s not terribly long, but there is a waiting list.”