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Cultural Competence in Mental Health

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Saunji Fyffe
August 27, 2018

This Photo by Unknown Author is licensed under CC BY-ND

Despite the increased attention being paid to mental health, it continues to be an area that is under-researched, underfunded and inequitable. An under-researched mental health system makes the diagnosis and treatment of mental illnesses less precise than other health conditions. An underfunded mental health system means that only a small fraction of people who need mental health services actually receive them. An inequitable mental health system results in the mental health needs of people of color remaining largely unmet. Therefore, it is no surprise that mental health systems across the country are struggling, especially when it comes to treating people, families and communities of color.

According to the American Psychiatric Association, rates of mental illness among people of color are generally similar to rates for whites. Yet, when compared to whites, people of color tend to experience greater burden and long-lasting consequences of mental illness. This is often due to misdiagnoses or underdiagnoses; systemic and structural barriers to treatment; limited access to quality, culturally competent care; inappropriate care and more. Plus, research shows that racial and ethnic minorities can face mental health disparities despite income, age and insurance status.

Over the past decade there have been numerous articles, blogs and conversations about the need to eliminate mental health disparities, yet progress has been slow. To strengthen the programs, institutions and resources that enhance the well-being of all people, it is critical that policymakers and public administrators collaborate to take steps to advance mental health research along with culturally competent mental health services and programs.

Advancing mental health research that includes communities of color

Despite gains in our knowledge about mental illness, there is still much to learn. Without improved, increased robust research, there will be little to no progress in understanding mental health. To offer more effective services, innovative, cutting-edge research is necessary to test treatments and medications and better understand how they work, especially for people of color.

Reducing mental health disparities will require robust research that includes persons of various races and ethnicities. Mental health research often disproportionately excludes people of color. This underrepresentation is especially important as genetic differences associated with race can lessen the effect of prescribed medications and determine what resources are made available for communities of color. Further, the exclusion and underrepresentation of people of color in mental health research means that it does not generalize as well to people of certain races and ethnicities as it does to non-minority populations. As a result, people of color continue to be misdiagnosed and experience systemic barriers that prevent them from being prescribed appropriate medication and treatment.

Advancing culturally competent mental health services and programs

Reducing mental health disparities will require tailoring programs, services and resources in ways that respond to the needs of and are culturally sensitive to communities of color. Across the country mental health providers are too few and inaccessible. However, people of color face further roadblocks to their care when seeking culturally competent providers that are trained to understand the differences and different needs between and within racial and ethnic groups.

One size does not fit all. Communities of color have different behavioral health needs and experience different rates of mental and/or substance use disorders and treatment access. Often, providers apply the same cultural lens to racial and ethnic minorities as they do to their non-minority patients. If mental health providers are not trained to identify and treat issues for the populations they serve it can result in negative health outcomes.

It is important that mental health providers be aware of how stereotypes and stigma influence their own thoughts and behaviors. Cultural competence training can be the best avenue to address these biases, but only if the training is comprehensive, ongoing and intensive. In other words, it must go beyond a two-hour session that simply discusses superficial topics like tolerance and acceptance. While some may argue that intensive competency training is too expensive and difficult to implement, the argument also can be made that training is less expensive than the financial and social costs associated with not acting.

The lack of attention to the mental and behavioral health needs of racial and ethnic minorities and the inadequate provision of culturally competent mental health care demonstrates a clear need for change. While advancing mental health research along with culturally competent mental health services and programs are important ways to address the disparities, these are not the only challenges contributing to the issue. The complexity of mental health disparities is a public health matter requiring collective action and strategies. While public administrators at all levels must work together to address this issue, it is not likely that government alone can achieve transformative change and reduce disparities. Effective and strategic partnerships with nonprofit organizations, mental and behavioral health providers, hospitals, community leaders, academic institutions are critical.


Author: Saunji D. Fyffe, Ph.D., is a nonprofit professional and a former researcher at the Urban Institute’s Center on Nonprofits and Philanthropy where she authored several briefs on nonprofit performance. This article is based on her experience working with nonprofits to build capacity and implement performance measurement and management. For additional information, contact Saunji Fyffe at [email protected]

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