The Role Of Cultural Knowledge And Cultural Competence In Mental Health Care

In the past, mental healthcare research and treatment primarily focused on white, cisgender, and able-bodied communities—often to the detriment of all others. With the rise of the civil rights movement, professionals began examining the disparities and their impact on marginalized communities, including marginalized racial and ethnic groups. Now, cultural competence is becoming a cornerstone of effective research, treatments, and therapeutic outcomes in mental health. Here, we'll examine the impact of cultural competence on diagnosis and therapeutic outcomes in mental healthcare. We’ll also offer some suggestions for finding a therapist with cultural humility and sensitivity.

The role of culture in mental health 

Culture shapes how people experience, understand, and cope with mental health challenges, as well as how (or if) they seek and receive support. Cultural practices and norms can also influence whether mental health is discussed openly, impacting individuals' comfort level in seeking help. 

Cultural differences can even shape the experience of mental illness, influencing symptom presentation, coping mechanisms, and overall well-being. Additionally, cultural barriers such as stigma, language differences, and mistrust can hinder help-seeking behaviors for mental health services among specific cultural groups. 

Why cultural competence matters in mental health care

Cultural competence also plays a core role in addressing disparities in mental health care, particularly among marginalized and minority groups. By understanding the unique challenges faced by people in these groups and tailoring support to each individual, therapists may be able to help promote more equitable care. 

Cultural knowledge and diagnostic accuracy

Recognizing cultural nuances in symptom presentation may also help prevent misdiagnosis and promote appropriate mental health treatment, since a symptom in one culture could be a normal variation or coping mechanism in another. For example, some cultures may express grief differently than others, or certain behaviors might be considered acceptable in one community but not in another. 

Therapeutic outcomes as a result of cultural competence

Cultural competence enables providers to tailor treatment approaches to respect a patient's background, beliefs, and cultural values, ultimately leading to more effective and culturally sensitive care. Increasing treatment effectiveness can also enhance client satisfaction, often resulting in better adherence to treatment plans and improved outcomes.

Culture and the therapeutic relationship

Talk therapy is a dynamic process involving collaboration between the client and therapist. Cultural competency can facilitate more effective client-therapist cooperation, and by extension, can enhance the therapeutic relationship as a whole. 

When a therapist demonstrates cultural sensitivity and has been trained on the cultural competence continuum, clients are more likely to feel understood, respected, and comfortable opening up, laying the foundation for a strong therapeutic alliance. Additionally, maintaining ethical boundaries is central to all therapeutic relationships, and cultural sensitivity can help ensure that these boundaries are understood and respected within the client's cultural context. 

Cultural barriers to mental health care

Cultural barriers to mental health run the gamut, from differing definitions of mental illness to geographical and structural barriers. These contribute to what many experts say is currently a mental health crisis in the US. 

Cross-cultural barriers to seeking help can be grouped based on how the individual and the culture they were raised in views mental health, language barriers, and structural barriers. Some examples may include the following.

Differing concepts of mental illness from culture to culture

Some cultures may not distinguish between physical and mental health, viewing them as interconnected or not recognizing specific psychological experiences as an illness that could be treatable. There can also be differences in how individuals express distress, with some cultures emphasizing emotional restraint or relying on family support rather than seeking professional help. 

Stigma and shame 

Mental health challenges are often stigmatized, leading to shame, fear of judgment, and reluctance to seek help. Any cultural stigma can be layered on top of broader societal stigma that still persists, potentially preventing individuals from seeking services or completing treatment. 

Additionally, some families may be hesitant to seek help due to concerns about the potential impact on their family's reputation or social standing. For example, social image is of significant concern within certain Asian cultures, potentially deterring some individuals within the Asian/Asian American communities from seeking support to protect the family’s reputation and avoid “loss of face,” according to an older paper on the topic. 

That said, like every group, the Asian American community is incredibly diverse and not a monolith, so part of cultural sensitivity is to avoid making assumptions and tailor care to each individual by actively listening to their unique experiences.

Mistrust of the healthcare system

Past experiences of discrimination, racism, and inequities within the healthcare system can lead to distrust among specific populations, making them hesitant to seek help through mental health services. Many groups have historical reasons to be wary of seeking help. For instance, the Tuskegee syphilis study and many other instances of medical abuse and exploitation have created a legacy of distrust that continues to influence perceptions of the healthcare system among African Americans. 

Language barriers

Language differences can create significant obstacles to receiving mental health services, hindering communication between patients and providers when the providers are unable or unwilling to accommodate multilingual individuals. Inadequate interpretation services or a lack of culturally competent therapists who speak the individual's language can lead to misdiagnosis, ineffective treatment, and premature termination of care. With over 350 languages spoken in the US by over 40 million people, the need for multilingual mental health services is urgent and, currently, significantly limiting for many patients.

Lack of providers with cultural knowledge and education about cultural diversity

A shortage of mental health professionals from diverse backgrounds can be a barrier for individuals who prefer to seek help from someone who understands their cultural context. According to one source, 73% of therapists in the US today are white. Only 8% are Hispanic or Latino despite this population making up almost 19% of people in the US, and only 4% are Black or African American despite this population making up over 12% of people in the US, for example.

Cultural mismatches between clients and therapists and a lack of cultural knowledge on the part of the provider may lead to misunderstandings, lack of trust, and ultimately, dropout from treatment. Training programs for mental health professionals may not adequately address cultural diversity and sensitivity, potentially leading to biased assessments or inappropriate treatment approaches. 

Structural barriers and inadequate resources in the mental health care system

Physical barriers like transportation difficulties, lack of childcare, and provider shortage areas in many geographic regions tend to disproportionately affect marginalized communities. Financial barriers, including lack of insurance or underinsurance, can also prevent individuals from receiving necessary mental health care.

In addition, stereotypes like the "model minority myth" can lead to underestimation of mental health needs within certain communities, potentially resulting in inadequate funding and support for culturally relevant services or assumptions on the part of individual providers. Additionally, there is a lack of culturally appropriate mental health programs and resources tailored to specific cultural needs.

Moving toward equity through recognition, cultural knowledge, and education

Progress in cultural competence in the field of mental health relies on several factors. On an individual level, mental health professionals’ recognition of barriers like stigma, language differences, and lack of culturally relevant services may help facilitate improved availability of care in different populations. Ongoing cultural proficiency training that involves defining physician training outcomes as well as promoting self-reflection can also help mental health professionals achieve cultural competence, recognize and challenge their biases and assumptions, and promote a more respectful and equitable approach to care.

On an organizational level, addressing the lack of research on culturally sensitive interventions and increasing the representation of marginalized populations in research can help guide evidence-based improvements in care. Developing and implementing policies that promote equitable availability of services, address language barriers, and accommodate cultural practices within treatment plans will be central to creating an inclusive system.

Engagement with diverse communities and collaboration with community leaders can also be important for better understanding lived experiences common among certain communities and tailoring services to meet specific cultural needs. Additionally, organizations can foster an inclusive mental health system by recruiting and supporting a diverse mental health workforce that reflects the cultural backgrounds of the populations served, which can help improve communication, reduce biases, and foster trust. 

Finding a therapist who supports, respects, and celebrates cultural diversity 

A culturally competent professional can adapt their approach to meet individual needs, demonstrating self-awareness, cultural humility, and open communication. It can be challenging to know if a therapist will do this, however, and whether they’re trained in helping individuals from diverse backgrounds and experiences. 

To assess a therapist's cross-cultural skills and level of cultural awareness, look for professionals with specific training or experience in your cultural background or in cultural sensitivity in general. Ask about their experience with your culture, their approach to cultural issues, and their willingness to learn about your background. Consider asking about past situations in which they've tailored their approach to the specific needs of the client. Chances are they won't go into too much detail to respect their other clients, but they might be able to give you a generalized example. 

Additionally, pay attention to how they communicate. Do you feel comfortable discussing your cultural background with them? Do they seem comfortable talking about it with you? A culturally competent therapist will acknowledge their own biases and be willing to learn and adapt their approach. They’ll also approach your cultural background with humility, recognizing that you are the expert on your own experience. Here are a few examples of culturally competent behaviors:

• Asking questions about your family, culture, and traditions
• Respecting your customs, beliefs, and values
• Avoiding stereotypes and generalizations
• Acknowledging the impact of social and cultural factors on your experiences
• Being open to feedback and adapting their approach accordingly
• Using culturally appropriate language and communication styles

Cultural competence in care through online therapy

Although it may not be suitable in every case, studies indicate that teletherapy can often provide numerous benefits to individuals facing cultural barriers to treatment. For example, a systematic review published in The Journal of Consulting and Clinical Psychology focused on culturally adapted digital mental health interventions for racial and ethnic minorities, and its findings suggest that these interventions were effective in addressing barriers like stigma, cost, and availability. 

With online therapy, clients can attend sessions remotely, from the comfort of their own home on a schedule that works for them. Platforms like BetterHelp partner with a diverse range of licensed mental health professionals, which can increase the likelihood of matching with a professional who suits your unique needs.