My Approach to Cultural Competence in Mental Health Care

Derek J. Wilson

Derek J. Wilson, Ph.D.
Prairie View A&M University

“I’m not crazy” is probably the most common phrase I’ve heard from members of the Black community when the issue of mental health care is raised. “Crazy” is shameful, a reason to be ostracized.

When seeing patients, I first gauged their understanding of the need for counseling, therapy, or other interventions. My job was to develop rapport around the truth that all kinds of people have problems, challenges, issues, and stress, and to lead them to believe that talking to someone outside their circle can help. If you talk about depression, for Black men that can mean weakness, whether weak-minded or just a weak individual. But if you talk about having to ease one’s stress or work through challenges, that’s okay. Once they get this idea, they can be more at ease. They come around to finding the freedom to express themselves. They’re not crazy, they just are dealing with some challenges, and maybe this guy can help without judging or looking down on them.

Addressing the perception of mental health among Black people
The lack of education and conversation about mental health is an impediment to Black people seeking care. Efforts to raise awareness about mental health will not make a difference unless it comes from within the community and reflects the community. And it’s not just about the talking. Images matter: if they don’t look like us, it won’t resonate.

People in the Black community need to hear from both peers and respected leaders that mental health is a real issue. People need to talk about their own experiences with mental health issues, especially positive experiences, so others will feel they can talk about it too. When a person feels connected – that they are having similar experiences as other people – they can feel comfortable revealing themselves.

Personally, I grew up with an awareness of mental health issues: my mother was a psychiatric nurse. Not only did I learn about mental health, I learned about the challenges my mother faced as a Black woman – and the people she dealt with, both the employer and patient sides.

Reconciling identity of African descent in American society
People of African descent in America have had to – and continue to – endure racism, discrimination, and societal aggression. We face challenges in society and challenges within our families. We don’t have a lot of protective factors. And we so often feel like we need to keep anything related to mental illness a secret. In that context, to be a survivor, a Black person needs to always demonstrate strength.

But there are these schisms between who they need to be to function in the oppressive systems of society and who they are within. Many Black people have never had real opportunities to express themselves and be who they are, so much so that they don’t have an understanding of who they are. They aspire to be like those who oppress them.

I like to ask them about themselves, their environment, and America. What I usually find – and what they eventually see – is that they are defining themselves and their surroundings in a way that reflects the values of a capitalist Euro-cultural male-oriented society, not their own heritage or cultural values. They come from a system built on equality for all, mutual aid, and survival of the group, which better reflects their values of communal strength and mutual respect.

We work to recognize examples that show they are in line with their cultural value system. They understand that they have been operating within another’s value system and that by making these adjustments – to act consistently with their cultural sense of self – allows for correct mental health functioning. When they know where they stand, they can work on the kinds of environments they want to build; for example, what kind of environment do we want in our home? I help them figure out where they want to be.

Ways to make progress
Providers need to understand a person’s culture, religion, family structure, cultural structure, etc. Seek out opportunities to learn what it means to be a person of African descent or whichever cultures are involved. What constitutes normal and healthy functioning within their cultural traditions? Ask about their background. Find the place where you can make a connection then work to keep it. You need to engage, not just have a one-off interaction.

Also, representation matters for patients and the professional that they are seeing. We need to recruit and support more people of color in becoming mental health professionals so that their clients can better relate to them and see that mental health is important for everyone. We also need to address how the new mental health workforce is being trained. Who is developing the curriculum? What values is it serving? Being of the same cultural background does not necessarily result in cultural competence.  We all need to learn how to work in a therapeutic relationship with people of color.

There should be training available so that clinicians can be competent to work with people of different ethnicities. Although some of that should be happening in training, clinicians should also have opportunities to learn. That’s why I am leading the effort for the Association of Black Psychologists to develop curriculum and a certification program so that people can learn to do therapy appropriately with Black clients. I feel passionate about this work, knowing that it will compensate for some of the shortcomings within our profession and training.

Editor’s Notes: Dr. Wilson is not currently in clinical practice, hence the past tense in discussing his interactions with clients. Thank you to the Association of Black Psychologists for supporting development of this post.

What do you think?

  • In what ways have your providers addressed your cultural influences? In what ways would you want them to?
  • Clinicians, what do you in your practice to work with clients with various racial, ethnic, cultural, religious, and other experiences? How do you demonstrate cultural competence?

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Author Bio

Derek Wilson, Ph.D., is an associate professor of psychology at Prairie View A&M University. Dr. Wilson is the Director of the Ubuntu Positive Mental Health Research Lab at PVA&MU. He teaches courses on socioculture psychology, human diversity, clinical psychology, and research methodological approaches with an African-Centered framework perspective. Additionally, he has published research articles on the Positive Mental Health model for those of African descent, African-centered therapeutic approaches, cultural competency, and mental health disparities. Dr. Wilson is currently the Chair of the License of Certification of Proficiency Program in Black Psychology for the Association of Black Psychologists.

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