Cultural Competence In Healthcare: Reducing Disparities And Supporting Mental Health
Systemic disparities in the US affect not only racial and ethnic minority health but also the well-being of sexual minority groups, individuals with disabilities, and those in lower socioeconomic brackets. Among the disparities experienced by marginalized groups are those within the healthcare system. Bias towards cisgender, white, able-bodied men has historically led to skewed research, ineffective treatments, and poorer therapeutic outcomes for all other groups.
To address these disparities, a movement is underway within the healthcare sector to ensure that healthcare providers and administrators are trained in cultural competence. Here, we’ll examine the concept of cultural competence in healthcare and its impact on the health disparities experienced by various communities. We’ll also offer some suggestions for finding a culturally sensitive mental health professional.
What is cultural competence in healthcare?
It involves understanding, respecting, and adapting to the unique values, beliefs, and needs of individuals and communities. This includes recognizing how cultural factors can influence health behaviors, communication styles, and treatment needs and preferences.
Why does cultural competence matter?
Cultural competence has wide-reaching impacts. It can influence research accuracy, quality of care, and health outcomes as well as affect how individuals navigate their own care and wellness. Research on racial and ethnic disparities in health care organizations may offer more concrete examples of why cultural competence matters on multiple levels. For instance:
- A study of US hospitals suggests that Latino children who speak little to no English may be at a higher risk for experiencing safety issues during hospitalization than their white counterparts.
- A 2024 report published indicates that Black, Hispanic, and Asian adults are less likely to seek help for mental health challenges, with trouble finding providers who understand their background as one of the frequently cited reasons.
- A study cited by Nature suggests that when patients don't feel understood by or trust their health care providers, they are less likely to share relevant information, which can negatively impact diagnosis and treatment outcomes.
Lack of cultural competence in healthcare also affects society as a whole in various ways. For example, one 2024 Deloitte-Meharry analysis indicates that mental health disparities cost the US $478 billion annually in avoidable expenses. Those costs are expected to rise to around $1.3 trillion by 2040 if left unaddressed.
Cultural competence, diagnostic accuracy, and therapeutic outcomes
Understanding and recognizing cultural differences in symptom presentation is integral for correct diagnosis and effective treatment. One symptom or coping mechanism that causes concern in one culture might be standard in another. For example, ways of showing grief can differ across societies, with certain ways being concerning in one culture but not in another.
Cultural competence enables healthcare providers to create treatment plans that respect a patient's cultural background and beliefs, ultimately leading to improved care and better therapeutic outcomes. When patients feel understood and respected, they might also be more likely to participate in their treatment and follow recommendations.
Culture and the therapeutic relationship
Cultural competence plays a key role in enhancing the client-therapist relationship (also called the therapeutic relationship) and, by extension, efficacy of care. When a therapist demonstrates cultural sensitivity, clients are more likely to feel respected, understood, and comfortable sharing their thoughts and feelings. Additionally, maintaining ethical boundaries is fundamental to positive therapeutic relationships. Cultural sensitivity can help ensure that these boundaries are understood and respected.
The role of culture in mental health and public health
For example, some cultures may emphasize emotional expression while others discourage it, which can impact an individual’s comfort level and how they report symptoms. Some cultures stigmatize mental illnesses, affecting how (or if) an individual reaches out for support. Additionally, people from certain cultures may inherently mistrust the healthcare system due to historical experiences of mistreatment and exploitation as well as instances of discrimination that still take place today.
Examples of cultural competence in mental health care
Culturally competent healthcare organizations may offer professional interpretation services to bridge communication gaps or use translated materials and resources that are culturally relevant. They may also recruit and retain health care professionals from diverse backgrounds to improve understanding and better reflect the communities they serve.
Providing competent care may involve tailoring treatment approaches to each individual's cultural beliefs and traditions. For example, a provider might offer to include family in healthcare decisions when a client comes from a family-centric culture. When developing treatment plans, culturally sensitive mental health professionals may consider the impact of historical and ongoing discrimination on mental health and address those in treatment.
APA guidelines for cultural competence in healthcare
Fostering cultural humility is a cornerstone of providing competent care and creating a safe therapeutic space for individuals from diverse backgrounds. The American Psychological Association (APA) encourages mental health professionals torecognize and understand:
- Their own cultural biases and assumptions
- How intersectionality and cultural differences shape an individual’s sense of self and, by extension, their mental health
- The role of language and communication in the therapeutic relationship
- The role of ongoing education and training to deepen cultural knowledge and understanding
- How development and life transitions are affected by biosociocultural factors
- How to assess and diagnose disorders with a culturally informed perspective
- How experiences with power, privilege, and oppression can create systematic barriers and disparities
Cultural barriers and mental health disparities
Culture-related barriers to receiving quality mental health care may stem from factors like differing perceptions of mental illness, systemic issues, physical challenges, and miscommunication. Such factors and others may create disparities that significantly contribute to the rising mental health crisis in the US. Understanding cross-cultural barriers to treatment can be integral to overcoming these and promoting health equity.
Culture and stigma
Cultural norms can sometimes prevent individuals from utilizing mental health services or completing treatment. For instance, for various reasons, some cultures stigmatize mental health conditions more than others, often resulting in shame, fear, and reluctance to seek help. As an example, some Asian cultures place great importance on social image or familial reputation. This emphasis on familial and social obligations can sometimes deter individuals from getting help to avoid “loss of face,” according to some older research on the topic.
That said, because each culture is unique and each individual has their own experiences, it’s still important for healthcare providers to avoid making assumptions about a client and their beliefs.
Mistrust of the public health system
Some populations encounter racism and inequalities in the system that cause distrust and deter them from seeking care. These experiences may be based on historical occurrences, but some are also continuous and ongoing. For example, research suggests that African American adults experience higher rates of medical mistrust compared to their white counterparts, rooted in historical persecution and exploitation as well as present-day experiences of discrimination within healthcare systems.
Language disparities contributing to health disparities
Communication difficulties caused by language differences and a lack of accommodation for diverse languages may cause significant obstacles to receiving mental health care. Language barriers can lead to misdiagnosis, ineffective treatment, and poorer therapeutic adherence and outcomes. To overcome disparities caused by communication obstacles, organizations may prioritize professional interpretation services or hire multilingual therapists.
Lack of provider diversity or inadequate cultural competence training
Many individuals prefer to speak with a mental health professional who shares their culture, language, and traditions. As such, a lack of cultural diversity among available therapists can deter people from seeking help.
More widespread cultural competency training is also needed to provide more equitable care. In some cases, a lack of this training can lead to misunderstandings, mistrust, and poor therapeutic relationships. This may lead to biased assessments, inappropriate treatment approaches, and unfavorable outcomes.
Systemic and structural barriers
Systemic barriers such as a lack of mental health education and resources may delay or prevent individuals from seeking help in some communities. Challenges with finding childcare, transportation, and nearby therapists can disproportionately affect certain groups and create considerable obstacles to treatment. Additionally, some experience systemic financial difficulties or insurance issues that may prevent them from receiving mental health care.
Finding culturally sensitive therapy
Finding culturally competent care may take research, education, and communication. One option is to consider asking for recommendations from friends, family, and leaders or representatives of your religious or cultural community, if you feel comfortable. There are also online directories and resources specializing in connecting individuals with inclusive, culturally affirming therapists—some of which also offer free or sliding-scale sessions.
During your initial consultation or first session, consider asking the therapist about their experience working with individuals from your background, their approach to cultural topics, and their understanding of your specific cultural context. Ask about their training in cultural competency, their familiarity with your culture's attitudes towards mental health, and their willingness to learn about your cultural practices that they may not be familiar with.
(The US Department of Health and Human Services, National Alliance on Mental Illness, and National Center for Cultural Competence at Georgetown University all offer training and resources to help providers increase their cultural and linguistic competency.)
Also, take note of how they communicate with you. A culturally inclusive therapist will make you feel comfortable discussing your cultural background and be willing to learn and adapt to your needs. They should display self-awareness and cultural humility by acknowledging their own biases and topics about which they are less knowledgeable, if any of these come up.
The benefits of online therapy for mental health
Though it may not be appropriate in every case, research suggests that virtual therapy may offer several potential benefits to individuals facing cultural barriers to effective treatment. For example, in a study published in the Canadian Journal of Psychiatry, Canadian participants with South Asian origins experienced improvements in depression and anxiety symptoms after participating in a culturally adapted online cognitive behavioral therapy (CBT) program.
Platforms like BetterHelp partner with a diverse pool of mental health professionals from various backgrounds, which may give you a higher chance of matching with someone who meets your unique needs. Once matched, you can attend remote sessions from the comfort of home on a schedule that works for you. Plus, online therapy sessions can cost less than traditional treatment without insurance.
Takeaway
Why is culturally competent healthcare important?
Culturally competent healthcare services can improve health outcomes and help in reducing health disparities. When a medical or mental health provider has been trained to interrogate their own belief systems, perceive health as a human right, and tailor their approaches to diverse populations as needed, patient care often improves.
What is an example of cultural competence in healthcare?
Cultural competence in health care services can take many forms. One example would be community health centers hiring community health workers who represent the population of that area and speak the dominant language there in order to reduce cultural and language barriers to receiving care.
How to show culturally competent care?
Culturally competent care can involve addressing one's own biases, avoiding assumptions, and tailoring care to each individual client's linguistic and cultural needs. Health care providers who are aiming to show culturally competent care should typically seek medical education that involves cultural awareness training which helps promote health literacy and equity in health care systems. For providers whose universities or medical schools did not provide training on how to deliver culturally competent services, there are many options for continuing education on this topic.
What is an example of intercultural competence?
Intercultural competence in healthcare workers can involve tailoring treatment to each individual. Culturally competent healthcare services take into account each client’s multiple identities as well as their physical and mental ability, languages spoken, and other elements of their experience.
What is the meaning of cultural competence in healthcare?
In the context of health care delivery, cultural competence involves tailoring treatment to the unique needs of each individual client, taking into account all major aspects of their identity and culture. Health providers can receive specific training on cultural competence, which may help improve patient health outcomes.
What are the four Cs of cultural competence in healthcare?
The four Cs of cultural competence in healthcare are key components of culturally sensitive care that can improve patient outcomes when present. These are: culture, cooperation, competence, and communication.
What are the 5 principles of cultural competence?
Cultural competence can help address health disparities among the patient population, including ethnic health disparities. Five principles of this approach include not making assumptions about an individual based on their identity alone, showing a genuine interest in learning about the patient's culture, offering appropriate language services, listening actively, and addressing one's own biases.
What are the 4 pillars of cultural competence?
Four key pillars of cultural competence include communication, culture, cooperation, and sensitivity. Components like these can help clinicians provide quality, tailored care.
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