Identity and Cultural Dimensions


Our culture, beliefs, sexual identity, values, race and language all affect how we perceive and experience mental health conditions. In fact, cultural differences can influence what treatments, coping mechanisms and supports work for us. It is therefore essential for culture and identity to be a part of the conversation as we discuss both mental health and mental health care.

The Importance of Cultural Competence 

The shared beliefs, values and experiences of any social or racial group can result in different worldviews, and have a significant impact on how someone perceives and understands symptoms. For example, a person who has experienced discrimination due to their identity may experience depression symptoms as anger more than sadness. 

Terminology and understanding of mental illness may differ in communities as well. For example, one study found that white Americans focused on biomedical perspectives of mental illness while Latinx and African American participants tended to connect mental illness to spiritual, moral and social explanations.
 
A person must feel comfortable and understood by their mental health professional for a therapeutic relationship to be effective. This includes feeling their mental health professional understands their identity and being comfortable addressing it openly. 
 
When a mental health professional understands the role that cultural differences play in the diagnosis of a condition, and incorporates cultural needs and differences into a person’s care, it significantly improves outcomes. This is why mental health care must be tailored to the individual — to their identity, culture and experience.

Disparities in Accessing Care  

We live in a racialized society, where the perception of race matters profoundly regarding relationships, opportunities and access to housing, employment and services. Therefore, members of racial groups face additional barriers when it comes to receiving care. Some of these include higher levels of stigma within a community, fewer mental health professionals in their immediate area and fewer providers with a similar background or who speak the same language. 
 
There is also a lack of covered mental health care for members of racialized groups who are overrepresented in professions that do not offer health insurance. Often, even when they have insurance, they face discrimination or disparate treatment when trying to access care. They may receive poorer quality care due to lack of cultural competence, language barriers, bias and inadequate resources. This can result in misdiagnosis, dropping out of treatment and delayed recovery. 

This needs to change. 
 
As an individual or caregiver, don’t be afraid to advocate for yourself or the needs of your loved one. While it’s not always possible, finding the right provider is essential to ensure the dimensions of culture and language do not get in the way of healing or recovery. Instead, those shared community values and experiences, along with dimensions of faith and spirituality, resiliency, key relationships, family bonds and pride in where you came from — your culture — becomes a source of strength and support.

Promoting a Culture of Equity and Inclusion

  • Be an advocate when there is an opportunity to speak out on behalf of mental health for underrepresented groups and communities.
  • Share information you’ve learned about what forms quality care from a cultural and equity lens. 
  • Show compassion and seek to understand the experience of individuals with identities different from your own. 
    • Do not assume that a low treatment rates by members of a cultural or social group is due to a lack of effort in seeking care. Instead, consider any underlying challenges — individuals are less likely to seek help or engage in treatment if they cannot find a provider they can trust, who understands their identity and will treat them with dignity and respect.
 

Providing Culturally and Linguistically Appropriate Care

  • Follow the Culturally and Linguistically Appropriate Services Standards developed by the U.S. Department of Health and Human Services.  
  • Provide equitable and respectful quality care and services that are inclusive of the cultural health beliefs and practices of the community you serve.
  • Offer free language assistance and other needed assistance to individuals with limited English proficiency. 
  • Hire diverse, bilingual staff that are representative of the community served.
 

Advocating for Change

Write, call or talk to legislators — both local and federal — to support efforts to:

  • Improve access to and the quality of mental health services for those who are underserved.
  • Ensure providers are trained on cultural competence.
  • Make linguistic services (interpretation and translation) available in treatment settings.
  • Provide mental health services that are holistic and offer many modalities of care (inclusive of trauma-informed care, psychiatry, psychology, faith-based care, community-based care and low cost alternatives to care). 
 

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