Culture is a way of life, shared by a group of people, and passed on over time. One's culture includes deeply held beliefs, attitudes, or values that come from one's ethnicity or other cultural factor, personality, or life experience.
What is Cultural Competence?
Cultural competence refers to an ability to interact effectively with people of different cultures. Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across different cultures.
What are Common Indicators of Culturally Competent Mental Health and Substance Abuse Treatment?
Staff is fluent in or at least knowledgeable about the primary language of the client
Staff understands the cultural nuances of the client population
Staff has backgrounds/life experiences similar to the client population
Treatment methods reflect the culture-specific values and individualized treatment needs of clients
Inclusion of the client population in program governance and decision-making
What Does a Culturally Competent Staff Member Do?
Holds all cultures in high esteem
Has awareness of his/her own worldview
Has awareness of his/her positive and negative attitudes toward cultural differences
Seeks to add to his/her own knowledge base and that of the organization
Applies cross-cultural skills in ways that promote the rehabilitation and recovery of the client
Yes. We all carry bias toward others we perceive different from ourselves. We need to understand our own biases toward cultural differences. If you doubt you are biased, take one of the demonstration tests at:
Bias is evident, so how do we provide culturally competent services?
We need to understand and resolve common sources of cross-cultural misunderstanding . Thoughtful self-assessment and a willingness to engage in Open, non-judgmental communication is essential.
What biases about people of other cultures do I have?
What assumptions have others made about my culture?
What misunderstandings have arisen because of this?
What steps do I take to prevent these misunderstandings from impacting my work with clients and co-workers?
We need to develop sound clinical strategies for culture-informed assessment and treatment.
Some of these include:
Assessing/treating clients in their preferred language
Using references and symbols that clients understand
Factoring in racial identity and personality development when individualizing treatment
Assessing how each client’s culture affects their beliefs about mental health and substance use and their goals during treatment
Lesson 2 Reasons for Medical Mistrust Stigma Stereotypes
“ Each racial/ethnic group believes that the treatment needs of its population are not fully understood and incorporated into standard practice. Each group is right.” - Lula Beatty, Director of Special Populations for the National Institute on Drug Abuse, (NIDA) Most racial and ethnic groups are initially skeptical about the services provided by systems and people different from themselves. Why?…
For forty years between 1932 and 1972, the U.S. Public Health Service (PHS) conducted an experiment on 399 Black men in the late stages of syphilis. These men, for the most part illiterate sharecroppers from one of the poorest counties in Alabama, were never told what disease they were suffering from or of its seriousness. Informed that they were being treated for “bad blood,” their doctors had no intention of curing them of syphilis at all
Some doctors are afraid to treat mental health consumers
Some pharmaceutical companies won’t work toward developing new treatments for consumers
Many people believe consumers can’t really be helped or are dangerous or incapable of a meaningful life
Some families either deny the problem or cut off contact with consumers in their families
We all have attitudes and judgments that affect how we think about and behave toward others. When we talk about negative attitudes and behavior toward others based on their gender, sexual orientation, culture, race or religion, we use the words prejudice and discrimination . So let’s call stigma what it really is. Centre for Addiction and Mental Health
What is helpful is understanding the basic norms in each culture so we can approach our clients more sensitively
Individual clients may or may not adhere to the beliefs and norms about substance use or disability in their particular culture. Do not base your assessment or treatment on stereotypes: Get to know the individual and how he/she relates to the world.
There is no such thing as “the Black family” “the Mexican-American family”, etc. All families are unique as are the people in them.
What Drugs are Americans Using ? Past Month illicit drug use rates 2007 - SAMHSA 1) Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used non-medically.
Who is at highest risk of negative outcomes related to substance use?
Slightly higher rates of illicit drug dependence than Caucasians
Almost double the rate of crack cocaine use compared to Caucasians though overall rates of cocaine (powder or crack) use are comparable.
African-Americans have been arrested on drug charges between 2.8 to 5.5 times more, relative to the population, than white Americans and are convicted much more frequently even though their rates of substance use are very similar to Caucasians.
Double the rates of substance abuse treatment vs. Caucasians (probably partially related to arrest rates – going to treatment often reduces the time in jail/prison one is sentenced to).
Overall rates of mental illness appear to be similar to those of non-Hispanic whites
More likely to suffer from phobias, less likely to suffer from depression, compared to non-Hispanic whites
Somatization is more common in African Americans (15%) than whites (9%)
African Americans are over-represented in high-need populations that are particularly at risk for mental illness: homeless (40%), incarcerated adults (50%), children in foster care (45%), children and adults exposed to violence who met diagnostic criteria for PTSD (25%)
African Americans are under represented in outpatient treatment but overrepresented in inpatient treatment.
Nearly 1 in 4 African Americans is uninsured, compared to 16% of the U.S. population
In addition to differences in substance abuse rates across racial/ethnic lines, there are many other cultural differences that influence patterns of substance abuse across any given population in time
Cultural differences – as evidenced by age, gender, sexual orientation, religion, and socio-economic status – are often key factors in understanding the needs of the client.
We encourage you to seek out and advocate for additional training in these areas.
Most people with co-occurring mental health and substance-related problems only get treatment for their mental health problems if they get any help at all. The graph on the next page shows this in detail.
Past Year Mental Health Care among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2007 SAMHSA
What’s the correlation between substance abuse and psychiatric illness?
The following slide offers a snapshot of the percentage of substance-related disorders based on psychiatric diagnosis.