LukeYoshidaARPPodcast

Cultural disparities in the field of mental health are being addressed at various levels. At the organizational level, there is a lack of diversity among practitioners, with white practitioners making up the majority. This can limit perspectives and hinder the field's ability to address Eurocentrism. At the structural level, disparities arise from economic barriers and limited access to healthcare. Minority groups are at a higher risk of developing psychological issues due to exposure to stressors like violence. Psychiatric care plays a crucial role in addressing these issues. At the clinical level, disparities occur when providers don't consider patients' cultural factors or experiences. Cultural competence and cultural humility are approaches used to address these disparities, with cultural humility emphasizing individualized relationships and self-reflection by practitioners. Hello, my name is Yashida and today we will be discussing cultural disparities in the field of mental health and how they are currently being addressed. An important part of addressing cultural disparities is identifying how cultural disparities occur in the health field as a whole. In the article defining cultural competence, a practical framework for addressing racial ethnic disparities in health and health care, Joseph R. Bentecourt and his team discuss multiple levels where cultural disparities can occur. The first level is known as the organizational level, where issues arise as a result of the health care system's ethnic composition, not matching that of a patient population. In a study from the American Psychological Association's Center for Workforce Studies by Luna Lin, it was found that the white practitioners make up 86% of the U.S. workforce. Meanwhile, Asian and Hispanic workers in the field each make up 5%, and the African American workers make up only 4%. To help discuss the issue is Armadi Pellegrini, a trauma-informed psychotherapist with a particular niche working with the role identity and oppression has in trauma. Yeah, I like, I remember this, there was like one other South Asian woman in my cohort and she was, this is like her second career, and she came up to me one time and was like, I would love to get like a group together, we could all come to my house and like eat food, and I was like, that's great, but like, there's two of us, like, I'm so happy to come to dinner and like share, but we're not going to form a group here. And the, so one is just the sheer demographics of the field itself, is that it is extremely, like it is still a really white field, it's a predominantly female field, and it is, and because of that, I think that the leadership, the faculty, the administration is also predominantly white, and then the sort of the powers that be are white, so you look at things like relationships or like couples therapy, right, the leading force behind couples therapy are the Gottman's or the Gottman Institute, they're a white couple, which does not disparage anything that they've come up with, it's just, we only have that one lens that has been widely recognized and widely, like, has gotten a lot of accolades. So a lot of the stuff that is taught to us in school, and I'm coming specifically from a social work perspective, I would guess that that is generalizable across mental health fields, whether you're talking about counseling or psychology or psychiatry, too. Some worry that the demographic makeup could affect the perspectives and policies within the field, and the lack of diversity can hinder the field's ability to address Eurocentrism. Fortunately, the demographic of those currently entering the fields or in their early careers have a demographic that more accurately represents the U.S. population, with African Americans making up 11% and Hispanics making up 17%. The second level identified in Bentecourt's paper is a structural level, where disparities stem from people's struggles navigating the healthcare system due to barriers created by economic status, language, and other factors. To talk on the matter of disparities in relation to economic status is Dr. David Moore, a clinical psychologist at Henry Ford Hospital. What I can say is that the population that I work with is, for the most part, very disadvantaged. The majority of individuals that I treat in the hospital either have no insurance or Medicaid primary, which is a primary government insurance, which oftentimes puts them in a position where they can't get access to preventative healthcare. Oftentimes, those individuals will defer care because they can't afford it. While there is a common theme in terms of the lack of access to care, I also think that there are some systemic roadblocks that are put up. That is a problem of society as a whole. The perception in America, for the most part, is that we live in a meritocracy, which means if you work really hard and you do really well, then you're going to be fine. While that's the case for some people, I think that it fails to appreciate the barriers that are placed up for certain groups of individuals that may either unintentionally or be intentionally maintained in place to keep them in the position that they're in. For instance, removing racial or ethnic background from the discussion because it's actually, while commonly associated with that, it's probably not a primary causal factor. I think one of the biggest causal factors is the socioeconomic status. I think the literature is pretty clear on that. If you don't have access to resources, you can't get access to quality education. If you can't get access to quality education and mentorship and training, you can't get access to stable or quality employment. The whole cycle then repeats itself. One article in the Journal for Black Studies titled Exploring the Impact of Increasing the Number of Black Men in Professional Psychology by Samuel Beasley discusses how increased exposure to stressors like violence, police brutality, and unemployment puts minority groups at a higher risk of developing psychological issues such as anxiety, depression, and substance abuse. Dr. Moore also goes into how psychiatric care plays a key role in addressing these issues. It's been my passion to try to develop a specialty clinic for our most at-risk patients that can provide high-quality evidence-based behavioral health care in what we call a wraparound program, which includes multidisciplinary specialists from social work, case management, psychologists, psychiatrists, and community health workers, so folks actually from the community, to provide that high-quality care to anyone that needs it. What we know is that that treatment has been shown to increase quality of life overall, increase physical health, getting access to more resources to increase overall quality of life, and can also stop the cycle of community violence. Because we know that trauma is a really unique specialty in medicine, and that it's the only set of medical and surgical problems that is 100 percent preventable. Every single traumatic injury is a preventable problem. The traumatic injuries that we see related to violence and to human choice, like direct human choice, is something that is psychologically and socially driven, and that many times violence is an externalization of an inability to cope with and manage their own internal experience. So by engaging people proactively in behavioral health interventions and treatment after they become the victims of violence, you can actually send a shockwave through the community, reducing violence as a whole, because you're teaching people to deal with those difficult feelings in a way that doesn't lead them to engage in externalization of that distress. The final level in Bendicourt's paper is the clinical level, which involves the interactions between patients and providers. On this level, disparities may occur because providers don't account for patients' cultural factors or experiences during the care. When providers don't take proper accommodations for the beliefs of patients or disrespect them, a patient may become unsatisfied with care and become uncooperative, further hindering the quality of care. The remainder of this podcast will be dedicated to exploring the ways in which those in the field try to address disparities on this clinical level, specifically through the ideas of cultural competence and cultural humility. Cultural competence was first introduced in 1989. After a meta-analysis of academic literature, cultural competence was defined as understanding the importance of social and cultural influences on patients' health beliefs and behaviors and considering how these factors interact at multiple levels of the healthcare delivery system. Early approaches of cultural competence were scientific in nature, as cultural knowledge, theories, and scientific trends involving identity are collected and implemented into care. Principles of cultural competence have been implemented into medical education and training curricula of many hospitals and universities. The Massachusetts General Hospital, McLean Hospital's Adult Psychiatry Residency Program, Columbia University, and Cambridge Health Alliance offer varying courses on how to effectively deal with diverse patient populations. However, as years passed, people began to question the term cultural competence. For example, in 2009, Yvonne Johnson, an associate professor at Whitaker University and the State University of New Jersey, wrote the paper, The Fundamental Contradictions in Cultural Competence. In her paper, she mentions that those in the fields of psychology and social work often seek to understand their client on an individualized level, where they can learn about the client from the client themselves and be able to become familiar with the patient's individual experiences. She argues that cultural competence in the collection of knowledge goes against the standard practice and poses the risk of treatment overlooking uniquenesses of individuals and perpetuating the risk of stereotyping during treatment. Due to the rising controversy, another principle has grown in popularity in order to address these issues. This principle is known as cultural humility. The term cultural humility was first coined by Melanie Trevilon and Jan Murray-Garcia in their 1998 paper, Cultural Humility versus Cultural Competence, a critical distinction in defining physician training outcomes and multicultural education. Cultural humility is the formation of an individualized relationship between client and practitioner where one is taught about how culture has influenced their life by observing and listening to the patient, aligning more with the standard practice in psychiatry and social work. It encourages self-reflecting behaviors where a practitioner must be aware of how their own culture has affected their own beliefs and biases, as well as how their own culture affects the patient both inside and outside of the care setting. In this mindset, the collection of knowledge in the attempt to gain cultural competence still has a key role in cultural humility as practitioners are told to have an open and curious mind while being aware of the importance of learning from the patient's own voice. It also emphasizes that a provider needs to be comfortable with the possibility of never being able to entirely know and understand everything about a patient's experiences. In summary, the cultural disparities discussed here can be grouped into three levels, the organizational, the structural, and the clinical. On the organizational level, a lack of diversity causes some to worry about the field's ability to address Eurocentrism. On the structural level, people can struggle to navigate the health system due to social and economic factors. And on the clinical level, insufficient awareness or consideration of a patient's identity can hinder a patient's interactions. We also discussed the circulation of the ideas of collecting knowledge with cultural competence and the individual inquiry in person-centered care with cultural humility. The creation and growth of these terms demonstrates how identifying the issues of cultural disparities play a key role in creating ways to address them. This is Luke Ishida, and thank you for listening.