Cultural incompetence among mental healthcare providers
Second of a three-part story
Related content: Barriers to Black mental health
Although the ways in which individuals in the African American community treat mental illnesses, coupled with community judgement and attitudes, affects the level of medical literacy African Americans have when they seek help for mental illnesses, there is also the problem of culture biases and a lack of cultural literacy among mental healthcare professionals.
“Mental health providers have always been culturally incompetent and insensitive and uninformed,” said Rozenia Fuller, a member of the executive board of the Hennepin County Mental Health Advisory Council and a member of the Minnesota State Advisory Council on Mental Health. “They are not familiar, for the most part, since your provider 90 percent of the time doesn’t look like you, is not the same color you are, [and] is not the same gender you are.
“I think that’s a barrier for African Americans because it takes a lot of courage to actually go in and see a doctor or to admit to someone that you need help… And [it’s bad] that it’s someone that doesn’t understand who you are as a human being and is not sensitive to your needs as an African American male or an African American woman.”
The African American Community Mental Health Fact Sheet published by the NAMI Multicultural Action Center in 2004 found that only two percent of psychiatrists, two percent of psychologists, and four percent of social workers in the U.S. are African American. The Fact Sheet also found that cultural biases against mental health professionals and healthcare professionals prevent many African Americans from accessing the care they need due to prior experiences and a lack of cultural understanding.
Fuller spoke of similar issues.
“There’s the level of having mental health practitioners that truly aren’t culturally competent, and so you combine that with someone who may finally end up, one way or another, seeing a mental health practitioner and they may feel judged and they may feel misunderstood… Because the system has so little time to spend with [and] really talk with patients, you walk out horribly misunderstood and a lot of people never go back,” Fuller said.
The issues of cultural biases and lack of cultural competence exist and are a problem for many African Americans who seek help for their mental illness. However, statistics taken from the Mental Health: Culture, Race and Ethnicity Supplement to the 1999 U.S. Surgeon General’s Report on Mental Health indicate that African American physicians are five times more likely to treat African American patients than White physicians even though the same report indicated that African Americans seeking help for a mental health problem have trouble finding African American mental health professionals.
African Americans also face the barrier of historical adversity, which can bar many individuals in the community from getting help and contributes to making their experience with mental illness differ from the White experience. This historical adversity includes race-based exclusion from health, educational, social and economic resources that African Americans have been subjected to throughout American history through slavery, sharecropping and Jim Crow, among other practices.
The race-based exclusion that has existed in the United States translates into socioeconomic disparities experienced by African Americans today. These socioeconomic disparities link back to mental health because people who are impoverished, homeless, incarcerated, or have substance abuse problems are at higher risk for poor mental health.
Fuller spoke about historical adversity as well.
“When we talk about an historic adversity…it’s not just what happened during slavery, it’s what happened post-Emancipation Proclamation,” Fuller said. “Which is when people were freed but had nowhere to go, [and] the only place they could get employment from was the slave owners who released them.”
Some conclude that the institution of slavery ended on January 1, 1863, when President Abraham Lincoln issued the Emancipation Proclamation. However, slavery was not abolished in the United States until December 6, 1865, when the 13th Amendment to the United States Constitution was ratified.
Mechanization and the migration of six and a half million African American from the Southern United States to the Northern United States from 1910 into the 1970s put an end to the sharecropping system by the 1960s, even though some forms of tenant farming still exist in the 21st century. Jim Crow is considered to have ended in 1954 when the Supreme Court reversed Plessy v. Ferguson in Brown v. Board of Education of Topeka.
Next: Historical trauma as a factor in Black mental illness
Daniel Abramowitz is an MSR journalism intern and a student at Macalester College. He welcomes reader responses to firstname.lastname@example.org.