Cultural Competence And The African American Community

CULTURAL COMPETENCE9Only 31 percent of African Americans believed that depression was a ‘health problem’,African Americans were more likely to believe that depression was ‘normal’ than theoverall survey average, 56 percent believed that depression was a normal part of aging,45 percent believed it was normal for a mother to feel depressed for at least two weeksafter giving birth. (Mental Health America, 2012,Para. 9-11)The study goes on to show that:40 percent believed it was normal for a husband or wife to feel depressed for more than ayear after the death of a spouse, Barriers to the treatment of depression cited by AfricanAmericans included: Denial (40 percent), Embarrassment/shame (38 percent), Don’twant/refuse help (31 percent), Lack money/insurance (29 percent), Fear (17 percent),Lack knowledge of treatment/problem (17 percent), Hopeless (12 percent) AfricanAmericans were less likely to, take an antidepressant for treatment of depression; only 34percent would take one if it were prescribed by a doctor. (MHA, Para. 12)The findings of the MHA are significant because they are indicative of the low numbers ofAfrican American clients enlisting our services as mental health professionals. The study doesnot indicate that there is a lack of mental health issues in this community. Now that studies suchas this one and those aforementioned in this analysis have shown by conducting evidence basedresearch that there exists a need for mental health services in this community, the indicationdoes, however, support the notion that there may be a lack of implementation of culturalcompetency training within the mental health community among other issues.Based on the findings of MHA, it is apparent that the majority of participants appeared tohave both cultural and socio-economic reasons for not seeking mental health counseling. It isapparent that the cultural views of depression held by African Americans would not lead them to

CULTURAL COMPETENCE10seeking mental health treatment. This indicates that besides cultural competency training,community education about mental illness, in particular depression is needed in this community.The African American Health Institute of San Bernadino California initiated a communityeducation program in order to educate African American about mental health disorders, however,this writer feels this type of initiative would better serve this community if also implemented ona national scale. In order to prepare for an influx of new clients from this community, therapistsneed to be prepared by gaining more knowledge about cultural views of mental illness amongthis and other minority groups.There are also some limitations to this study as it is fully support by government fundingand the results are based solely on participants living in the state of California. Also, whenreviewing the results of this study it was not clear why African Americans were being overdiagnosed and under treated and whether or not the disparities between the levels of health carecoverage of Caucasians versus African Americans had been taken into consideration.Despite its limitations, its results are nonetheless important as they provide usefulimplication regarding the issues faced by African Americans across the country as indicated byU.S. Surgeon General’s report on mental health in the United States.Overall, the MHA study indicates that no matter what the causes, there is a need to bridgethe gap between mental health professionals and African Americans with mental illness.Responding to this need are numerous cultural competency programs which are being fundedboth privately and publicly through government funding initiatives among state and localagencies. These agencies are available to not only mental health professionals but many otherservice oriented agencies in the health field and beyond.

CULTURAL COMPETENCE11Numerous cultural competency training programs have been put in place in order to helpprovide the tools mental health professionals need in order to learn how to become moreculturally sensitive when working with minority clients, however, despite the breadth of thesetraining programs, they are not being implemented, as there remains large numbers of mentalhealth professionals who do not consider themselves culturally competent without theappropriate training, as indicated in the aforementioned study conducted by Tummala–Narra, P.,Singer, R., Li, Z. et al.Necessity for Cultural Competence TrainingIn order to further investigate cultural competence implementation deficiencies in theUnited States, this writer has chosen to review evidence based research and practice basedstudies focused on the topic of cultural competence and mental health practitioners in addition tomental health issues and the African American Community. This writer will also discuss culturalcompetence program models currently available in the United States, as well as several methodsand techniques that may be utilized when working with African American clients.The purpose of becoming a culturally competent mental health professional is to learnhow to better serve our underserved populations in a therapeutic setting, in particular, the AfricanAmerican community. Cultural competence training is important because a number of studieshave found that there are significant cultural differences between Caucasians and ethnicminorities due to different styles of life as well as different cultural perceptions regarding mentalhealth. Research conducted by the Surgeon General examines cultural differences among AfricanAmericans and found that there are discrepancies among the services being provided and howthey are being utilized by this community. Because the majority of mental health practitionersare Caucasian in the United States according to the 2000 U.S. Census Report conducted by the

CULTURAL COMPETENCE12U.S. Surgeon General, the discrepancy may in be indicative of a lack of cultural competence onthe part of the practitioners which may lead to a significant number of misdiagnosis andplacements of treatments being provided as well as services. When reviewing several evidencebased articles and several practice based articles on this topic it became apparent that there is asignificant need for mental health services within this community, however this writer wasunable to discern whether or not it was due to actual diagnosable mental disorders or themisdiagnosis of mental disorder. According to the California Department of Mental Health:There are pertinent differences between African Americans and Whites in the U.S. (inscientific reports Whites are still considered the reference population because they arethe majority population). African Americans are 30% more likely to be diagnosed withserious psychological distress than Whites, and in 2007, were 50% more likely to reportsymptoms of depressive episodes. However, Whites are more than twice as likely toreceive antidepressants prescription treatments as are African Americans. (CDMH, 2009p. 5)In order to encourage African American clients to seek mental health services and avoidmisdiagnosis among the African American clients that do seek mental health services,psychological organizations need to set the standard by requiring professionals in this field tobecome properly trained by implementing cultural competency training in our colleges,universities mental health clinics and through the offering of Continuing Education Units(CEU’s). In 2012 Yeung published an article which was based on a report on African Americanscommissioned by the state of California, Annelle Primm, the American PsychiatricAssociation’s deputy medical director and director of its Office of Minority and National Affairsstated:

CULTURAL COMPETENCE13Due to lack of cultural understanding, some clinicians may misdiagnose AfricanAmerican patients. For instance, it is well documented in the literature that AfricanAmericans have been over diagnosed with schizophrenia and underdiagnosed withillnesses like major depression and bipolar disorder. Expressing 'healthy paranoia,'regarded as a survival skill among African Americans, may prompt an uninformedclinician unfamiliar with African American culture to consider this as a symptom ofschizophrenia or psychosis. (Yeung, 2012, Para. 4)Although there is a need for more mental health practitioners to become culturallycompetent and an abundance of cultural competency training programs available, there stillremains a lack of cultural competence training program implementation across the United States,there. This is important because if African Americans’ perception of mental health symptomsvary from those of Caucasian, our profession will need more culturally competent practitionerswho have the ability to recognize and address these differences in order to avoid misdiagnosisand clients’ under reporting of symptoms. Furthermore, the reason for misdiagnosis of AfricanAmericans may also be attributed to under reporting of symptom. For example, one studyshowed that African Americans are less likely to report symptoms of depressive episodes may beattributed to their culturally shaped views of depression and the utilization of mental healthservices in general (MHA, 1996).Notable Cultural Competence Training ProgramsIn support of this research that this writer has found indicates that training our futurecounselors to become competent when working with ethnic minorities is beneficial not only tothe clients but also serves as a vehicle which promotes positive social change. In response to theneed for cultural competency training among professional helpers in the United States, several

CULTURAL COMPETENCE14non-profit organizations such a Mental Health America (formerly known as The National MentalHealth Association), the National Center for Cultural Competence (NCCC) of the Center forChild and Human Development at Georgetown University and centers such as the Nathan KlineInstitute (NKI) Center for Excellence in Culturally Competent Mental Health, along with severalorganizations who offer to provide funding in support positive social change such as the John D.and Catherine T. MacArthur Foundation and several federal government agencies across theUnited States.Professional Requirements for Cultural Competence TrainingMany colleges and university graduate level programs often require students to take amulticultural counseling courses, many professional counselors are encouraged to become moreculturally sensitive, however, studies as recent as 2009 show that the percentage of AfricanAmerican enlisting mental health services remains lower than those of other cultural groups. Thenumber who reported having a mental illness is also quite low. According to a report about theAfrican American population in the United States:Any mental illness among adults aged 18 or older is defined as currently or at any time inthe past year having had a diagnosable mental, behavioral, or emotional disorder(excluding developmental and substance use disorders) of sufficient duration to meetdiagnostic criteria specified within the DSM-IV, regardless of their level of functionalimpairment (APA, 1994). In 2009, about 17% of Asian, Native Hawaiian/Other PacificIslander, Hispanic, and African American groups reported having any mental illness.Whites and American Indians/Alaska Natives were a little higher at 21%. The highestprevalence (32.7%) of any group who reported having any mental illness was amongpersons of two or more ethnicities. (Woods, 2009, Para. 6.2)

CULTURAL COMPETENCE15There may be many reasons that ethnic minorities are reporting mental illness at a lower rate thatCaucasian Americans, however as further research indicates this reason is largely due to a lack ofcultural competence among mental health professionals, the majority of which in the U.S. arelargely Caucasian. According to the MHA’s report on African American Communities andMental Health based largely on the 2000 US census report; “In 1998, only 2 percent ofpsychiatrists, 2 percent of psychologists and 4 percent of social workers said they were AfricanAmericans”. Low numbers of African American mental health professionals at that time may beanother reason why African Americans may not consider enlisting mental health service as aviable option. Part of seeking this type of service is to gain insight into one’s personal mentalhealth issues. When doing this it is important that one feels that their personal norms, beliefs andvalues will be understood, rather than discounted or being judged by someone who may notunderstand their and their community’s value system and beliefs. This may indicate yet anotherreason for the low number of African Americans who are willing to enlist the services of mentalhealth professionals in the United States.According to Sue part of the issue may be that many practitioners are choosing not toseek cultural competence training due to their belief that treating everyone the same is sufficientfor working with this community, when in fact this is not sufficient. According to Sue (p. 122,2009):Mental health professionals who enter the field usually have a strong desire to helpclients regardless of race, creed, gender, and so on. They operate under the dictum of‘liberating clients from their distress and doing no harm’ whenever possible. Becausehelping professionals view themselves as just, fair, and non-discriminating, they find itdifficult to believe that they commit microagressions and may be unhelpful and even

CULTURAL COMPETENCE16oppressive. The fact that therapists possess unconscious biases and prejudices isproblematic, especially when they sincerely believe they are capable of preventing theseattitudes from entering the session. (Sue, 2009, p. 122):Furthermore, by not acknowledging the client’s culturally unique qualities anddifferences, the therapist may be sending the message to the client that their cultural experiencesare unimportant and not worth acknowledging (Sue, 2009).Methods and TechniquesIn order to understand the culture of others we must first accept the belief that there aremany different ways to conduct ourselves in society and whether or not we agree with them, weneed to learn to embrace and accept them. This is not to say that we cannot hold clientsaccountable for their actions because we still must uphold the basic laws that govern our country.For example, if a male Pakistani client tells you that last week he punished his wife for beinginsolent and he hit her several times with a cane so that she would learn from her mistakes, andthen he tells you that it was the right thing to do because in his culture that is how such insolenceis handled. The laws of our country do not allow one person to physically assault another. Thecorrect response would be to explain to the client that you are a mandated reporter and what thatmeans, and then refer the client to your informed consent agreement, followed by explaining thatas a mandated reporter you must report the abuse, as no allowance for cultural differences cansupersede the current laws that govern our country.According to Sue:Many social scientists (Boyd-Franklin, 2003; Duran, 2006; Guthrie, 1997; Halleck, 1971)believe that psychology and therapy may be viewed as encompassing the use of social

CULTURAL COMPETENCE17power, and that therapy is a handmaiden of the status quo. The therapist may be seen as asocietal agent transmitting and functioning under Western values. (Sue, 2007, p. 141)As mental health practitioners, we must also be aware of inadvertently exposing ourclients to our own biases through microagressions such as microassaults and microinsults whichSue et al (2007) defines as; “brief and commonplace daily verbal or behavioral indignities,whether intentional or unintentional, that communicate hostile, derogatory, or negative racialslights and insults that potentially have harmful or unpleasant psychological impacts on thetarget person or group.”. Once aware of your own cultural beliefs, you will begin to recognizethe existence of other cultural norms, beliefs and values. Therefore, as a mental healthpractitioner who will be working with a wide variety of clientele from a variety of cultures,gaining a better understanding of one’s own cultural beliefs is a crucial component to becomingan effective and culturally competent practitioner. According to Sue: “In almost all humanservice programs, counselors, therapists and social workers are familiar with the phrase: “knowthyself”. Programs stress the importance of not allowing our own biases, values or hang-ups tointerfere with our ability to work with clients” (Sue, 2007, p. 44). In the above quote Sue pointsout the significance for a practitioner to have a good understanding of their own culture and thiswriter supports the idea of self evaluation of one’s own culture as it seems to be a good way togain knowledge of our limitations and gives us the opportunity to expand our culturalunderstanding of others.Based on the research of Sue acknowledging the differences between a client andtherapist is acceptable. It is advisable for therapist to ask questions, to be unafraid to take the roleof the student, allowing the client to take the role as the teacher. It is not offensive to seekknowledge about a cultural difference between yourself and the client. One aspect of becoming

CULTURAL COMPETENCE18culturally competent begins with becoming aware of how others communicate. According to Sue(2007), who examined therapeutic interventions addressing the highly contextualized manner inwhich various ethnic minorities prefer to communicate and which approaches are mostcompatible with their style of communication is vital to becoming culturally competent. Sueadvised practitioners; “many minority clients prefer an active/directive approach to an inactivenondirective one in treatment.” Therefore other Western approaches such as Person CenteredTherapy and Rogerian Psychotherapy, are incompatible with therapeutic approaches that arerecommended for use with African American populations.In 2001, Sue developed a Multidimensional Model of Cultural Competence (MDCC)which was designed for practitioners to use when working with minority clients. According toSue:This was an attempt to integrate three important features associated with effectivemulticultural counseling: (1) the need to consider specific cultural group’s worldviewsassociated with

Theodore Mattson II & Tristan Mattson: Thank you for your patience and support over the past two years. I appreciate your willingness to take on extra responsibilities around the house in order to allow me the time I needed to complete my homework assignments. I am amazed by your creativity and ability to adapt to my ever changing schedule .