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Cross Cultural Comparisons in Mental Health

Exploring the Honors EXCEL Project of Nick Miller

By Stephanie Golden, Honors Student Ambassador

Nick Miller headshot

Nicholas Miller is a junior from Hedgesville, West Virginia who is majoring in immunology and medical microbiology and minoring in medical humanities and health studies. 

Nick is currently in the Honors EXCEL Program here at WVU. Honors EXCEL is a program that supports WVU undergraduate students in experiential and community-engaged learning. Students work to develop their skills in areas like leadership, project management, communication and collaborative scholarship. The experiential learning aspect of the program allows students to apply their knowledge and skills to projects that they are passionate about.

When thinking about his project, Nick thought about the impacts of poor mental health, both at home and abroad. He designed his project to examine mental health issues in resource-reduced communities in Latin America and Appalachia. 

As part of his project, this coming March Nick will travel to Honduras with the WVU Global Medical and Dental Brigades. There he will work with local medical professionals to assess the stigma, diagnostics and treatment of mental illnesses. He then plans to observe the same factors within Appalachia for cross-cultural comparison.

Poor mental health among children and young people has been described as an epidemic and an “escalating crisis.” Roughly 1-in-5 American adults live with mental illness in any given year. Moreover, Appalachians have disproportionately higher rates of mental health problems in comparison to the rest of the United States. Appalachian Medicare recipients reported feeling depressed at a rate16.7 percent, higher than the rate for the United States as a whole at 15.4 percent. 

Nick's Past Experiences Abroad

Nick Miller and other volunteers demonstrate for local children how to brush teeth on a dental model in a small community in Honduras.
Nick Miller and other volunteers demonstrate for local children how to brush teeth on a dental model in a small community in Honduras.

Nick Miller and the rest of the student leadership team with their faculty advisor and Nick's mentor, Daniel Brewster, during their Honduras brigade trip to Cantarranas, Honduras.

Nick Miller and the rest of the student leadership team with their faculty advisor and Nick's mentor, Daniel Brewster, during their Honduras brigade trip to Cantarranas, Honduras. 

Nick has already traveled to several countries through WVU’sGlobal Medical and Dental Brigades, traveling to Ghana, Nicaragua and Honduras. For Nick, Honduras was the most personally impactful experience with the Brigades so far because the trip included 55 students, and so they were able to accomplish a great deal.  

Nick said, “It's hard to compare the trips because of the different circumstances in each country. They’re all predisposed to different socioeconomic factors that determine what you actually see in the clinic.”

“Overall, I think the group of students we traveled with were excellent. Everyone was so dedicated to the work we were doing, and you could definitely feel a sense of productivity and accomplishment.”

During his time in Honduras, Nick learned a lot from the public health work. The students were split up into groups of roughly six students each and assigned to a family. They then had the opportunity to work with local masons and build sanitation stations for their assigned families. 

Nick Miller and the rest of his group help build a sanitation station at the home of a community member in rural Honduras in 2019.

Nick Miller and the rest of his group help build a sanitation station at the home of a community member in rural Honduras in 2019.

Nick Miller taking blood pressure for a community member in a small community in Ghana during one of their clinic days.

Nick Miller taking blood pressure for a community member in a small community in Ghana during one of their clinic days.

“The best part about it is that you feel like you’re really making a long-term impact when you’re doing the public health work because often times that’s the first time these families are getting access to a clean sanitation station,” Nick said.

Nick’s Honors EXCEL mentor is Daniel Brewster, an instructor in the Department of Sociology and Anthropology

Talking about Global Brigades and Nick's project, Brewster said, “I stress that West Virginia is very similar to the regions we work with Global Brigades while collaborating with our students. I think a lot of people focus too much on the differences between cultures and societies." 

"I was excited when Nick approached me with his idea because regardless of place or time, mental health is often overlooked and stigmatized. I am confident that we will find that Appalachia and Central America are very similar as it relates to mental health awareness, diagnosis, stigmatization and available resources,” Brewster said.

Nick’s Plans for his Upcoming Trip to Honduras

Nick is looking forward to returning to Honduras next month and starting his project comparing mental health issues in Latin America and in Appalachia. 

We asked Nick if he thought there would be more similarities or differences, and he replied, “It’s very hard to predict; since I’ve been traveling with Global Brigades, I’ve actually been able to see more similarities between our area and the areas we work with. For example, some of the medical conditions are very similar. They also have problems with obesity, high blood pressure and diabetes, and those are actually the most common conditions people go to the doctor for here." 

"I think that the main differences would be in terms of culture. For example, here we are more individualistic, while in Latin America and other countries we have worked in, they seem to be more collectivist. That means they are often looking out for their families and to support one another, whereas here people tend to do things for themselves a lot more. The differences in mental health would probably be seen in terms of the differences of culture,” Nick predicted.

We also spoke to Nick about why he specifically chose to zone-in on mental health of these populations. He said, “When I was working in the clinics and shadowing the physicians there, it’s not something that is often discussed. While here, you would probably see it in our clinics, like student health, for example. People will come in and talk about their mental health issues." 

"Where I've been in Latin America, it’s just something that patients don’t bring up; doctors don’t really bring it up. Is it the stigma associated with it? Are people afraid to admit that they’re upset or anxious about something or is it just that there are really no resources available? I’m interested to dive deeper and see what it is actually like.”

Even in the United States where more resources are available to people struggling with their mental health, people are still scared to seek help. In 2016, only 43 percent of people with mental illnesses received treatment (American Hospital Association, 2019). Untreated mental illnesses can lead to serious consequences like public health crises, drug overdoses, lost jobs and poor physical health.

“I think it all goes back to the stigma,” Nick said.

Nick attributes many of these statistics to the stigma that surrounds mental health both in America and around the world. 

Nick has a few ideas on how to improve mental health in Latin America and Appalachia. He thinks we need to increase awareness that these problems exist and reinforce the fact that mental health is just as important as physical health. He thinks we need to reduce the negative stigma associated with addressing one’s mental state and create an environment in which people feel like they can reach out and get the help they need.

When Nick isn’t in class or working with Honors EXCEL, he keeps busy! Nick volunteers with the Appalachian Prison Book Project, an organization that challenges mass incarceration with books, education and community engagement. Nick really enjoys it because it gives access to education to a vulnerable population. 

He also volunteers at Ruby Memorial Hospital, where he gained clinical experience in the emergency department, as well as the post-anesthesia care unit (PACU). 

Nick is also a testWELL tutor for theHonors College where he assists students in biology, chemistry, physics, Spanish and immunology-specific courses. In his spare time, he enjoys running, traveling and spending time with his family and friends.

Nick has some advice and reassuring words for those students on the fence about Honors EXCEL. 

He said, “When I was first considering Honors EXCEL, I was also nervous. I encourage them to persist and think of something they are really passionate about. Do not be afraid of failing. There is a bunch of support." 

"When I first applied, I did so with a different project. Then I switched it when I was enrolled in Honors 450 at the very beginning. I changed mentors. I changed everything, and it wasn’t a big deal because of all the support I had. I would really consider taking advantage of the resources the Honors College offers.” 

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