Cultural Diversity and Mental Health Treatment Concerns needing to be addressed by mental health policies

Changing Demographics By 2025, 35% of U.S. population will be members of ethnic minority groups. By 2025, 35% of U.S. population will be members of ethnic minority groups. Ethnic minority children will be 48% of all children residing in the U.S. Ethnic minority children will be 48% of all children residing in the U.S. Latino Americans are now the largest minority group; African Americans are second Latino Americans are now the largest minority group; African Americans are second In early 1900’s, most immigrants came from Europe and Canada; now they come from Latin America and Asia. In early 1900’s, most immigrants came from Europe and Canada; now they come from Latin America and Asia.

Help-seeking behavior Ethnic minorities less likely to seek professional mental health treatment than whites. Ethnic minorities less likely to seek professional mental health treatment than whites. For example, whites are 1 ½ times as likely voluntarily to seek mental health care than are African Americans. For example, whites are 1 ½ times as likely voluntarily to seek mental health care than are African Americans.

Ethnic minorities are more at risk Ethnic minorities are more likely to belong to high-risk groups, such as the homeless or HIV-infected people. Ethnic minorities are more likely to belong to high-risk groups, such as the homeless or HIV-infected people. Ethnic minorities are more likely to lack health insurance. Ethnic minorities are more likely to lack health insurance. 14% of whites are uninsured14% of whites are uninsured 26% African Americans are uninsured26% African Americans are uninsured 38% of Latinos are uninsured38% of Latinos are uninsured 23% of Asian Americans are uninsured23% of Asian Americans are uninsured

Appropriateness of services Ethnic minorities more likely to be misdiagnosed. Behavior that is normal in some cultures may be seen as pathology if the evaluator doesn’t understand the culture. Ethnic minorities more likely to be misdiagnosed. Behavior that is normal in some cultures may be seen as pathology if the evaluator doesn’t understand the culture. Ethnic minorities more likely to drop out of treatment, especially after the first session. Ethnic minorities more likely to drop out of treatment, especially after the first session.

Culturally relevant services Increase cultural competence of all mental health professionals. Increase cultural competence of all mental health professionals. Hire mental health professionals who are members of ethnic minority groups. Hire mental health professionals who are members of ethnic minority groups. Develop culturally sensitive programs. Develop culturally sensitive programs.

Effect on outcomes Research shows that matching ethnic minority clients with mental health professionals of the same background helps: Research shows that matching ethnic minority clients with mental health professionals of the same background helps: Drop-out rates are loweredDrop-out rates are lowered More sessions are attendedMore sessions are attended But, except for working with monolingual non-English speaking clients, outcomes are similar, whether or not there is a match.But, except for working with monolingual non-English speaking clients, outcomes are similar, whether or not there is a match.

Culturally appropriate programs Programs are culturally appropriate if they incorporate the values, beliefs, worldview, and behaviors of ethnic minorities into assessment and therapeutic activities. Programs are culturally appropriate if they incorporate the values, beliefs, worldview, and behaviors of ethnic minorities into assessment and therapeutic activities. E.g., cuento therapy for Puerto Rican childrenE.g., cuento therapy for Puerto Rican children EthnotherapyEthnotherapy In addition, attention needs to be paid to the social, economic, and political problems of ethnic minorities. In addition, attention needs to be paid to the social, economic, and political problems of ethnic minorities. E.g., empowerment modelsE.g., empowerment models

Culturally appropriate programming has to go beyond just incorporating cultural elements into treatment; it should have a clear conceptualization of its purposes and methods. Culturally appropriate programming has to go beyond just incorporating cultural elements into treatment; it should have a clear conceptualization of its purposes and methods. More research on effectiveness is needed. More research on effectiveness is needed.

Problematic issues What causes mental illness? What causes mental illness? Biological dysfunction? If so, why bother with cultural relevance?Biological dysfunction? If so, why bother with cultural relevance? How do you adapt mental health services to diverse cultural groups? How do you adapt mental health services to diverse cultural groups? What assumptions do you make about culture? Is it primarily rooted in tradition, history—or is it more accurate to think about culture as very much shaped by social factors, institutions, power relationships?What assumptions do you make about culture? Is it primarily rooted in tradition, history—or is it more accurate to think about culture as very much shaped by social factors, institutions, power relationships?

Socioeconomic Status Stressors make one more vulnerable to mental disorders. Stressors make one more vulnerable to mental disorders. Ethnic minorities tend to experience more stress as a result of their social status. Ethnic minorities tend to experience more stress as a result of their social status. However, there is much variation among members of ethnic minority groups. Programs need to take these differences into account as they develop services that are sensitive to the needs of ethnic minorities. However, there is much variation among members of ethnic minority groups. Programs need to take these differences into account as they develop services that are sensitive to the needs of ethnic minorities.

Purposes and Functions of Mental Health Services in Society Maintaining order and conformity--social control? Maintaining order and conformity--social control? Protecting societyProtecting society Protecting people who have mental disordersProtecting people who have mental disorders Complementary to market: Improve people’s ability to compete and perform in the labor market/be economically self- sufficient? Complementary to market: Improve people’s ability to compete and perform in the labor market/be economically self- sufficient? Compensatory to market: Contribute to achieving a more equitable distribution of resources? Compensatory to market: Contribute to achieving a more equitable distribution of resources?

Service Models Clinical services model (medical model) Clinical services model (medical model) Primary purpose of mental health services is to alleviate symptoms of psychological distress for individualPrimary purpose of mental health services is to alleviate symptoms of psychological distress for individual Social welfare model Social welfare model Mental health services need to address broader range of community services; sees mental health problems as caused by social problemsMental health services need to address broader range of community services; sees mental health problems as caused by social problems Empowerment model Empowerment model Mental health services need to address psychological, economic, political, and social barriers through empowering peopleMental health services need to address psychological, economic, political, and social barriers through empowering people