By: Harini Morisetty
The 2001 supplement to the Surgeon General’s Report titled “Mental Health: Culture, Race, and Ethnicity” highlights the importance culture, race, and ethnicity play in mental health treatment and care. This is the first time a formal document addressed culture in mental health care in the United States. Critics, however, point out that “if both the original report and the Supplement had appeared earlier, mental health might have joined diabetes, cancer, cardiovascular disease, infant mortality, HIV/AIDS, and immunization among the primary emphases of this initiative.”
A recent report based on data from the World Health Organization (WHO) describes how health disparities from mental health treatment result from several barriers experienced around the globe. If a patient does not perceive that they need care—which can be dictated by family beliefs, environment, or culture—they will not seek care. Physical access to care based on the environment and location also plays a role in how or when people are able to receive assistance, posing additional barriers. There is also a lack of agreement on definitive characteristics on what symptoms indicate a need for mental health care, which may cause individuals to feel that their condition is not as serious or they may not need treatment. Additionally, people may perceive their conditions in different ways. While one person experiencing symptoms of depression may view that as very serious and is in need of help, another person may view the same symptoms as insignificant with no need to seek care.
Additionally, minorities in the U.S. are not as likely to get mental health services that abide by national treatment guidelines. The authors of the Surgeon General’s Report address this issue, stating, “existing treatment guidelines should be used for all people with mental disorders, regardless of ethnicity or race. But to be most effective, treatments need to be tailored and delivered appropriately for individuals according to age, gender, race, ethnicity, and culture.” The national standards for care are not generalizable to all populations, races, and ethnic minorities. Adjustments and alterations need to be made based on each individual case. Cultural misinterpretations and miscommunications from the improper use of national mental health treatment standards can lead to adverse results for the patient or client, creating a gap in treatment seeking behaviors and overall practitioner competence. Health disparities between white and non-white individuals in need of mental health care in the United States are prominent. Better services, treatment modalities, facilities, training, and facilities are needed to move towards bridging the existing gaps in care.
Several recommendations have been made to address the lack of cultural competence in mental health care and services. Some personal suggestions, based on research, include ethnic matching in the therapeutic setting, culturally adapted evidence based practices, utilizing the socio-cultural frameworks, therapist training, and evaluations of community mental health centers. Based on review articles and evaluation studies, these recommendations have been incorporated into a variety of interventions and training programs, most of which have shown positive results and health outcomes for a diverse set of patients and clients, which provides hope for the future of mental health treatment. Until further research studies can be conducted on diverse populations, the current ethnic matching and evidence based practice interventions should be utilized in the therapeutic setting. These recommendations are only beginning strategies to improve mental health treatments and will hopefully lead to a better future for individuals receiving poor mental health care.
1. Manson, S. M. (2003). Extending the boundaries, bridging the gaps: Crafting mental health: Culture, race, and ethnicity, a supplement to the surgeon general's report on mental health. Culture, Medicine, and Psychiatry, 27, 395-408.
2. Center for Behavioral Health Statistics and Quality, (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA), SMA 15-4927. Retrieved April 18, 2016, from http://samhsa.gov/data/
3. Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., ... Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO world mental health surveys. Psychological Medicine, 44, 1303-1317. doi: 10.1017/S0033291713001943
4. Services, D. o. H. a. H. (2001). Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD.
 Some examples of interventions include: Castro, F. G., Jr., M. B., & Steiker, L. K. H. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213-239. doi: 10.1146/annurev-clinpsy-033109-132032; Copeland, V. C., & Butler, J. (2007). Reconceptualizing access: A cultural competence approach to improving the mental health of African American women. Social Work in Public Health, 23(2/3), 35-58. doi: 10.1080/1937191080214826; and Whealin, J. M., & Ruzek, J. (2008). Program evaluation for organizational cultural competence in mental health practices. Professional Psychology: Research and Practice, 39(3), 320-328. doi: 10.1037/0735-7028.39.3.320
 Including Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7(15), 15-25. doi: 10.1186/1472-6963-7-15; Bhui, K. S., Aslam, R. h. W., Palinski, A., McCabe, R., Johnson, M. R. D., Weich, S., ... Szczepura, A. (2015). Interventions to improve the therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: Systematic review. The British Journal of Psychiatry, 207, 95-103. doi: 10.1192/bjp.bp.114.158899; Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. American Psychological Association, 43(4), 531-548; and Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14, 99-116. doi: 10.1037/0033-318.104.22.1681.