Cultural Competency and Mental Health

James Walker, a project manager at a public relations firm from Fairfax, Va., remembers many in his family echoing the same sentiment.  “You know how so and so is. Don’t pay them any mind. They’re just a little off.”

“In my family,” says Walker, who is black, “depression is not considered a medical condition. It’s not discussed like high blood pressure or diabetes.”

Though stigma is not exclusive to the black community, says Amy Alexander, co-author of “Lay My Burden Down: Suicide and the Mental Health Crisis Among African-Americans, “resistance and stigma tend to be more thickened and more hardened.”

Because of this stigma, terms like mental illness and depression don’t seem to resonate with the black community, says Dr. Annelle Primm, a board certified psychiatrist and director of the Office of Minority and National Affairs at the American Psychiatric Association. As a result, mental illness frequently goes unaddressed, she says. When mental illness is discussed, it is indirect, more often using terms such as “bad nerves,” “shaky,” or as in Walker’s family, being “a little off.”

Senior producer in the medical unit for CNN’s Atlanta-bureau, Jennifer Pifer Bixler, refers to this as “cultural nuances.” “Mental health is different for different groups,” says Bixler, who has been awarded for her coverage of minority mental health issues. “There are different nuances.”

The most recent Surgeon General’s report specifically addressing mental health, culture, race and ethnicity, found that only two percent of psychiatrists and psychologists are African-American. Statistically, this means that the majority of black patients seeking treatment do so from practitioners of different cultural backgrounds.

All doctors need to be culturally competent.  If they are, they will be just as alerted to phrasings such as “being off” or having “bad nerves,” as they would be if a patient were to say they were sad all the time.

“Doctors need to understand the lexicon that we use,” says Primm, who is also black. “There needs to be cultural competency in doctors who treat people of color.”

Medical schools are beginning to address this, Alexander says. “They are now building in units about cultural differences that exists among patients,” she says. Medical schools at universities such as Harvard and Stanford are examples of programs that integrate cultural competence into their curricula.