The Asian/Pacific Islander Focus Unit at San Francisco General Hospital (SFGH) was the first culturally focused psychiatric unit in the United States. Founded by Francis G. Lu, M.D., in March 1980, the unit is now one of four culturally competent focus units at SFGH. The others are the African-American Focus Unit, the Latino/Latina and Women’s Issues Focus Unit, and the Lesbian/Gay/Bisexual/Transgender and HIV/AIDS Focus Unit.

As the director of the Cultural Competence and Diversity Program for the department of psychiatry at SFGH, Lu has overseen 20 years of work in building the psychiatry department’s award-winning programs.

The rationale for starting the Asian focus unit, according to Lu, began with then President Jimmy Carter’s Commission on Mental Health. The commission’s Asian subpanel recommended that units or teams be created that could provide certain services across catchment areas to provide greater visibility to services and to pool scarce resources.

More recently, in 1997, mandates were developed by the California State Department of Mental Health, requiring each county to provide culturally competent services to underserved populations. According to the California mandates, inpatient psychiatric services must be available in the four threshold languages found in the San Francisco area: Cantonese, Vietnamese, Spanish, and Russian. Services must be provided either directly in these four languages or through interpreters.

"Its not just about language," Lu told Psychiatric News. "It also involves cultural, spiritual, and societal issues, like acculturation, knowledge of stressors, support systems, family structure and dynamics, how expression of illness differs from culture to culture, and, therefore, how treatment pathways must differ.

"There’s a realization, especially for the medical profession," he continued, "that you’re dealing with large ethnic minority populations. It becomes blatantly obvious that these issues must be incorporated."

It has taken Lu 20 years to recruit and retain the culturally diverse staff necessary to

make each of the four focus units work. "Like well-disciplined surgical teams," observed Lu, "the multidisciplinary staff on the units provide essential facets of patient care together, on the unit, in the patients’ primary language."

The staff includes psychiatrists, psychologists, nursing staff, psychiatric social workers, and occupational therapists. They are trained to understand the particular aspects of the focus culture they work with.

Ethnic immigrants, according to Lu, pose a particular challenge to psychiatry. Many immigrants often do not perceive mental illness as a disease, are not inclined to discuss emotions and feelings, and are loath to seek any outside help for what they view as a family shame.

Other focus populations face societal and cultural stigmas that impact their mental health as well as their physical well-being. Knowledge and understanding of these issues are necessary for culturally competent psychiatric care.

Formal recognition of the psychiatry department’s efforts has only reinforced the importance of the staff’s work. SFGH’s focus units were awarded APA’s Certificate of Significant Achievement in 1987 "for an innovative model program caring for underserved populations." In 1991 three of the faculty members, including Lu, were awarded the UCSF Martin Luther King Jr. Award for work in developing the units. In 1999 the American College of Psychiatrists awarded the units the Creativity in Psychiatric Education Award, "in official recognition of creativity in addressing significant educational issues and commitment to excellence in psychiatric education that can serve as a model for other programs."