Cultural Competence in the Treatment of Ethnic Minority Populations

The call for cultural competence in mental health practice has been a frequent theme voiced by the four major ethnic minority psychological associations (Asian American Psychological Association, Association of Black Psychologists, National Latina/o Psychological Association, and the Society of Indian Psychologists). In an effort to address concerns and provide assistance to service providers, these four associations have produced this booklet to:

  • produce a highly readable brochure summarizing in broad terms the mental health issues of greatest concern to the four ethnic minority psychological associations,

  • increase awareness regarding the need for balance between culturally universal modes of helping with the increasing recognition of the effectiveness of culture-specific and indigenous healing approaches, and

  • provide culturally relevant mental health practice recommendations to practitioners and students who work with ethnic minority populations.

Recommendations for the Treatment of Asian American/Pacific Islander Populations

According to the 2000 U.S. Census,“single race” Asian Americans and Pacific Islanders comprised 4.2% of the U.S. population.Asian Americans/Pacific Islanders is one of the fastest growing visible racial/ethnic groups, with a projected increase in population to 6.2% by 2025, and 8.9% by 2050.

Prevalence rates of mental illness among Asian Americans/Pacific Islanders are believed to be no different from those of other Americans. However, the type of psychopathology, ethnicity and generational status, acculturation and cultural background all appear to influence the manifestation of psychological distress among Asian Americans/Pacific Islanders.

As the population of Asian Americans and Pacific Islanders continues to grow and become more diverse, there is an increased need for culturally competent mental health services and providers with expertise in working with this population.Not providing these services will result in negative effects, not just for the Asian American/Pacific Islander population, but also for the U.S. population as a whole.

Recommendations for the Psychological Treatment of Persons of African Descent

The current mental health care system fails this particular population since the underlying assumptions that go into creating psychological theories and precepts to explain human behavior do not take an African worldview in to consideration. As a consequence, conceptions of mental health have not been inclusive of the more holistic and integrative definitions that require focus on the society/community and the individual, both moral and economic development, respect for nature and humanity, the spiritual and material aspects of being.

Implications for Culturally Competent Care

  • Must provide culturally congruent training so that more effective treatment can be provided

  • Must employ a more holistic/integrative approach that examines the physical, spiritual, psychological, and social aspects of the presenting problem.

  • Clinicians must receive adequate graduate, post graduate, continuing education and ongoing professional in-service training in assessment and treatment issues with persons of African descent to ensure that clinicians are knowledgeable and skilled in their treatment.

  • Clinicians must develop the ability to effectively communicate cross culturally.

Recommendations for the Psychological Treatment of Latino/Hispanic Populations

According to the 2000 U.S. Census, the number of persons in the United States who identify themselves as Hispanic is now over 35 million, or approximately 13% of the total U.S. population.This figure represents an almost 60% increase over the last decennial census and indicates that the number of individuals of Latino descent is increasing faster than expected. Because of high fertility and migration rates, Hispanics will soon constitute the largest minority group in this country. Indeed, Hispanic girls already rank as the largest minority group of girls in the country.

Although there remains much to be learned about the physical and mental health needs of Latinos, it is known that Latinos currently access both mental health and medical services at lower rates than the general population.They are less likely to receive services from a non-White professional and less likely to receive specialty services from a trained professional of any ethnic group.When they do receive services, they are more likely to receive services from nondoctoral level or paraprofessional personnel and to discontinue services before achieving therapeutic goals.

To effectively address the mental health needs of this country’s Latino population, it will be necessary to modify practices at both the individual provider and systems levels so that diagnoses and treatment can be individually tailored. Modified approaches to assessment and diagnosis should be developed along with new models for treatment that will reduce the likelihood of premature termination and increase the probability for therapeutic success. These approaches must reflect an understanding of and respect for Latino culture, traditions, beliefs, and values and incorporate these elements into services as appropriate.

Recommendations for the Treatment of American Indian Populations

Although the American Indian/Native American/Alaska Natives population has the lowest numbers of minority group members in the United States, it possesses the greatest diversity among the Native tribes. According to the 2000 U.S. Census, the American Indian population comprises 0.9% of the population, with 2.4 million people. This very diverse group consists of about 550 federally recognized tribes and nearly 300 tribal groups that have not achieved federal recognition.

In the face of very difficult times, American Indian people have demonstrated extraordinary strength, and many have found healthy ways of coping with the stress of forced acculturation, attempted genocide, loss of land and culture, and the death of loved ones.They have coped by practicing Native spirituality, valuing connections with families and communities, and initiating a grassroots movement toward healthier life styles. Unfortunately, all these stressors have taken their toll on American Indian and Alaskan Native people. Depression and adjustment reactions are the most prevalent mental health problems, with suicide among adults more than twice as high as rates in the majority culture, and in school-age children 3 times greater than that of White Americans. A congressional hearing on Native juvenile alcoholism and drug abuse reported that 52% of urban Indian adolescents and 80% of reservation Indian adolescents engaged in heavy alcohol or drug use compared to 23% of their urban, non-Indian counterparts. Delinquency and arrest rates are the highest of any ethnic minority group. Because of alcohol problems and family disruption, child abuse is also a problem in some tribes.

Given the unique history and challenges facing Native American people, culturally competent mental health treatment must consider the following:

  • Many Native Americans will seek help from family members or traditional healers before considering professional mental health services. Professionals should acknowledge family and community resources as an intricate part of treatment.

  • Many who seek professional help will stay only for one session. It is important to discuss the fact that counseling and psychotherapy are healing processes that differ from traditional healing methods so that they understand what to expect from the counseling process (length and number of sessions, etc.).

  • Because many providers serving Native people are non-Native, sensitivity to cultural issues is imperative, but often absent. Each tribe needs to have guidelines describing culturally competent treatment and training for those mental health workers who do not understand or accept the culture.

  • Trust of the formal mental health system is low. As in the majority culture, providers for Native people must earn their respect by providing services that are culturally sensitive and effective.
    There is a strong need to understand that tribes and the individuals within each tribe differ greatly and cultural knowledge needs to be tribal specific.