Written by Karen Tang, General Member
For November, this month’s YCRH theme is surrounding Diversity Health Month. Although diversity can take many forms, from ethnic, cultural, gender minorites, (dis)abilities, and so on, I wanted to specifically dedicate a blog to the intersectionality of cultural diversity and mental health. As a clinical psychology resident, I have personally witnessed the interplay between culture and mental health in both my clinical work, as well as my research endeavors (in fact, it’s the topic of my PhD dissertation!).
Mental health among racial/ethnic communities
We know mental health challenges and issues are not new, but the COVID-19 pandemic greatly exacerbated these concerns. This was particularly true with stay-at-home orders limiting the amount of social connection we could have (and subsequently, increasing feelings of loneliness), to heightened anxiety and concern associated with getting an infection. Research emerging post-pandemic has shed light on the state of mental health, and the numbers are not good. To no surprise, 80% of Americans now struggle with anxiety, depression, grief, or isolation. Furthermore, there are also racial/ethnic inequalities to consider, and the numbers are even more striking. In the United States of America, Asian people are 51% less likely to use mental health services compared to their White/European counterparts. Similarly, African-Americans are 21% less likely to use mental health services, and Latinx folx are 25% less likely.
Unique consequences of mental health
The consequences of mental health challenges in diverse populations can be far-reaching. For example, cultural minorities often bear a disproportionately high burden of disability as a result of their mental illness. Mental health problems are common among justice-involved people, which is disproportionately represented by ethnic/racial minorities; in Canada, we know Indigenous populations are often overrepresented in the criminal justice system, in addition to the intersectionality of intergenerational trauma as a result of Canada’s Colonial History. Additionally, a lack of cultural understanding and competency by health care providers may contribute to underdiagnosis and/or misdiagnosis of mental health conditions of patients from culturally diverse backgrounds. Indeed, factors such as language differences, experiences of discrimination and racism, sense of displacement, stigma towards mental health, as well as cultural presentation of symptoms can greatly play a role.
How can we create a more equitable system for culturally diverse groups?
Given these drastic disparities mental health faced by cultural minorities, what can we do? Researchers have suggested ways to move forward in both policy and clinical practice in a paper published in Frontiers in Public Health.
It is important to consider and acknowledge cultural diversity when assessing for mental health conditions. For example, the creation of the Cultural Formulation Interview in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) explores cultural identity, the patient’s conceptualization of illness, psychosocial stressors, and resiliency using the words of the client. Another recommendation includes integrating traditional healing practices and systems through collaborations and community-based care, such as talking circles and sweat lodges for Indigenous clients. Extending on this idea means considering developing cultural partnerships rather than simply striving for cultural competency. It is becoming increasingly important to develop more equitable partnerships and realign the power dynamic between mental health service providers and clients. This could include cultural partnerships between mental health clinicians and diverse cultural communities, hiring mental health providers of diverse backgrounds, as well as forging partnerships with traditional healers or community leaders.
Summary
Evidently, the interplay between cultural diversity and mental health is an important intersectional factor to consider as it can lead to unique consequences and considerations. Together, we can create a more equitable mental health system for culturally diverse groups.
Resources and further reading:
Mental Health Fact Sheets for various diverse populations, as created by the American Psychiatric Association: https://www.psychiatry.org/psychiatrists/diversity/education/mental-health-facts
Peer-reviewed paper titled “Cultural Diversity and Mental Health: Considerations for Policy and Practice”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018386/
Cultural Formulation Interview in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview.pdf