July 19, 2019

By Revella H. Nesbit, M.Ed., LPC-S, ODCP

Mental illness affects every age group, gender, socio-economic status and culture, yet not all Americans have the same access to proper care. For example, only 20% of Asian Americans with mental illness receive treatment compared to 48% of white adults. And only 56% of African Americans and Latinx adults with serious mental illness receive treatment compared to 71% of white adults. 

That’s why National Minority Mental Health Awareness Month was established in 2008: to help increase awareness of the barriers to mental health care for minority populations. The issue is not only the ability to access care but also the ability to obtain effective care. Far too often, people don’t remain in treatment once they begin. 

Why Do People Stop Going to Treatment? 

As we confront the stigma around mental health and as people are increasingly seeking mental health care, the challenge becomes keeping them engaged in that care. One of the reasons people from minority groups leave treatment is due to a lack of understanding from doctors. That lack of awareness can contribute to a lack of trust from the individual. 
Care providers should be trained to ask questions and seek to understand each patient on their own terms. And a patient should feel free to share about their culture and how that might impact treatment for them. That includes: family dynamics, traditions and expectations (spoken and unspoken) and gender roles, among other factors. 
A care provider has a responsibility to create a safe environment so that the individual feels comfortable. When a person is uncomfortable bringing their whole self into treatment, the treatment most likely won’t be as effective. 
One of the most important ways we can help improve mental health treatment for minority populations and keep them engaged in their care is by increasing cultural competency. 

What Is Cultural Competency?

Cultural competency is when health care professionals understand the cultural influences that might contribute to someone’s health outcomes. That includes things such as language barriers, stigma and even the way a specific culture describes or presents symptoms. 

Cultural competency—and the delivery of culturally competent interventions–can play a key role in ensuring that mental health professionals understand how someone’s background may contextually influence their mental health issue.The aim is to provide services that respect an individual’s cultural background such as their race, ethnicity, religion, geographical origin, health beliefs and practices. 

While it may sound complex, the approach is pretty simple: The more a doctor knows about someone, the better they can treat the whole person. A genuine desire to build bridges and trust can go a long way toward engaging patients and making sure they continue to get the care they need.

What Does Cultural Competency Look Like

When treating individuals from the southern U.S. or those with Caribbean heritage, a provider may hear the patient describe the symptom of “falling out” or “blacking out.” The term is used to describe a sudden collapse without warning, where a patient’s eyes remain open, and they can hear and understand what’s going on around them. 
According to the Diagnostic and Statistical Manual of Associative Disorders, this may correspond to conversion disorder or associative disorder. Learning that in cultural competency training gives the provider guidance and context to explore the symptoms with their patients further and increases their ability to provide the correct diagnosis. 

Many situations would require a mental health professional to understand the unique needs of different populations. A few include: needing to consult family members prior to making medical decisions, needing an interpreter or not being comfortable providing their medical history. Cultural competency is having the sensitivity and awareness of how best to accommodate any of these possible scenarios.

What Can You Do? 

Unfortunately, there are times when a patient may encounter a care provider who may not be aware of the influence of culture in the treatment process. However, you can share information that you think is important and relevant with your provider. It’s important for patients and their families to feel empowered to advocate for their own needs while giving their care provider the opportunity to get it right. 
Maybe that approach seems daunting or uncomfortable. In that case, a patient seeking mental health treatment also may find it useful to find a health care advocate. An advocate is someone who helps patients navigate the health care system. They can find local providers who work to understand patients. Typically, these local providers are already professionally trained in cultural competency or involved in the local community, and understand the impact of historical context on perceptions and interactions. The advocate can provide examples of people who have received excellent treatment and share the positive impact of treatment on their mental health. 
Additionally, education and training is available to help care providers improve their ability to recognize the signs and symptoms unique to specific populations. And you can encourage or even ask your mental health professional to receive that type of training.
Helping minority populations seek out mental health treatment and stay engaged in their mental health care is a responsibility that rests with all of us—clinicians, community members and friends. Together, we can ensure that all people have access to effective care. 
Revella H. Nesbit, M.Ed., LPC-S, ODCPis Director of Diversity & Inclusion at Cardinal Innovations Healthcare.


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