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Cultural Competence in Mental Health Care

In 1999, the Surgeon General released Mental Health: A Report of the Surgeon General. This report acknowledged that not all Americans, especially minorities, receive equal mental health treatment, a finding that prompted the Surgeon General to release a supplemental report on disparities in mental health care for people of color. The supplement, which was published in 2001, sends one clear message: culture counts.

Culture—a person’s beliefs, norms, values, and language—plays a key role in how people perceive and experience mental illness, whether or not they seek help, what type of help they seek, what coping styles and supports they have, what treatments might work, and more. To effectively serve America’s diverse populations, mental health systems need to understand and respect cultural differences.

Cultural competence is the ability to work effectively and sensitively within various cultural contexts. The U.S. Department of Health and Human Services (DHHS) defines it as "a set of values, behaviors, attitudes, and practices within a system that enables people to work effectively across cultures" and says the term "refers to the ability to honor and respect the beliefs, language, interpersonal styles, and behaviors of individuals and families receiving services, as well as staff who are providing such services."

For consumers of color, access to mental health services and the quality of the services they receive are negatively affected by the lack of cultural competence in service delivery. Many research studies have shown that because of the lack of cultural competence, people of color may not seek services in the formal system, cannot access treatment, drop out of care, are misdiagnosed, or seek care only when their illness is at an advanced stage.

The final report issued in 2003 by the President’s New Freedom Commission on Mental Health (NFC) stated that "culturally competent services are essential to improve the mental health system" and recommended improving access to quality care that is culturally competent in Goal 3.

Recommended Reforms:

• Fully fund and implement Goal 3 of the NFC report and its recommendations.
• Put increased education, mandates, and enforcement measures in place so that all agencies that receive federal assistance fully understand and comply with their obligations to provide quality and equal treatment.
• Ensure that systems of care integrate the consumer’s culture in the treatment process.
• Ensure that mental health systems adapt to meet the needs of people of color.
• Make cultural competence education mandatory in clinical training programs and in continuing professional education in medicine, social work, and clinical psychology.
• Increase the number of states that have operational mental health plans that address cultural competence.
• Ensure that government and private providers of mental health services perform a cultural self-assessment, adopt cultural competence standards, embrace diversity, and adapt their services to address the needs of diverse populations.
• Enhance and adequately fund culture-specific research needs.
• Create readily accessible financial assistance programs, scholarship programs, and loan-forgiveness programs for graduate mental health education for people of color to pursue a mental health profession at the graduate level.

Statistics and Facts:

• According to U.S. Census Bureau projections, African Americans, American Indians, Asian Americans, and Latinos will make up roughly 50 percent of the total U.S. population by 2050.
• According to the Commonwealth Fund 2001 Health Care Quality Survey, One of three Hispanics and one of four Asian Americans have problems communicating with their doctors, and
• Fifteen percent of African Americans, 13 percent of Hispanics, and 11 percent of Asian Americans said there had been a time when they felt they would have received better care if they had been of a different race or ethnicity.
• Access to language interpreters is limited. Among non-English speakers who said they needed an interpreter during a health care visit, fewer than one-half (48 percent) said they always or usually had one.

Quotes:

"The mental health system has not kept pace with the diverse needs of racial and ethnic minorities, often underserving or inappropriately serving them. Specifically, the system has neglected to incorporate respect or understanding of the histories, traditions, beliefs, languages, and value systems of culturally diverse groups."

 —Final Report of the President’s New Freedom Commission for Mental Health, 2003

"Because State and local governments have primary oversight of public mental health spending, they have a clear and important role in assuring equal access to high-quality mental health services for racial and ethnic minoritie

—Surgeon General’s Report on Culture, Race, and Ethnicity, 2001

Resources:

NAMI Fact Sheet: Cultural Competence, A Key for Success

Barriers to Mental Health Care Treatment for People of Color

From Good to Great: NAMI’s Cultural Competence Self-Assessment Project

Cultural Competence Now Law in New Jersey, American Medical News (AMNews) 4/25/05.

Cultural Competence on the Web

For more information about cultural competence:

Georgetown University National Center for Cultural Competence

Hogg Foundation for Mental Health

National Alliance of Multi-Ethnic Behavioral Health Associations

Cultural Competence Online

Cultural Competence Standards in Managed Mental Health Care Services: Four Underserved/Underrepresented Racial/Ethnic Groups

Mental Health: Culture, Race, and Ethnicity (DHHS, 2001); A Supplement to Mental Health: A Report of the Surgeon General

The President’s New Freedom Commission on Mental Health

 

 

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