With the growing diversity of the U.S. population, it is imperative that we, as mental health treatment providers, are culturally aware and competent in providing the best possible evidence-based healthcare.
This post is Part 2 of 2 in which Dr. Chapman discusses healthcare’s responsibility to our changing community. Part 1 can be found at: What are Mental Health Disparities?
I am pleased to welcome back Clinical Psychologist, Dr. L. Kevin Chapman, who serves as Associate Professor, and Director of the Center for Mental Health Disparities at the University of Louisville. Dr. Chapman is an expert in evidence-based psychotherapy practice and focuses his academic endeavors on efforts to eliminate mental health disparities.
Are there differences in the accurate diagnosis of those from minority groups? If so, what are some of these differences and why might they be?
Dr. Chapman: Absolutely. Historically, African Americans have been diagnosed with schizophrenia at higher rates than White Americans and have been shown to have more comorbid PTSD and specific phobias of animals. Although some studies suggest that African Americans have lower rates of social phobia, other studies (my own for example, see Chapman, Vines, & Petrie, 2011; Chapman, Petrie, Vines, & Durrett, 2012) suggest higher rates of social phobia. Some studies suggest similar prevalence rates of panic disorder, depression, and other mental disorders. Again, many of these differences in diagnoses are due to inadequate sampling and the utilization of traditional assessment tools that may not accurately identify symptoms in ethnic minorities. Unfortunately, this is also due to inadequate training in understanding the role of culture in mental health.
Are there differences in access to care and quality of care provided to different groups within our larger culture? What are some of these differences? Treatment response?
Dr. Chapman: Ethnic minorities continue to have higher mortality rates, less access to quality healthcare, less access to healthy food options (e.g., fewer health food stores in lower income environments), and have a historical stigma associated with health /mental health treatment due historical mistreatment from healthcare professionals. Furthermore, ethnic minorities report more racism related stress than White Americans. Treatment response in ethnic minorities remains mixed with some studies indicating higher attrition rates (dropout) with ethnic minorities while others report no differences. Most studies suggest that cultural match is more important than racial match when assessing treatment satisfaction and longevity. As aforementioned, the majority of studies assessing the roles of race and ethnicity in treatment lack adequate sample sizes of ethnic minority individuals and fail to assess racial and ethnic identity of participants, which is particularly important given the significant heterogeneity within ethnic minority groups (e.g., how important is one’s racial identity, cultural heritage, and interacting with a dominant group?)
How might the study of disparities improve mental health delivery systems? How might evidence-based practice of mental health treatment improve with increased cultural awareness? What might this look like in practice?
Dr. Chapman: Being a culturally proficient practitioner would undoubtedly reduce disparities associated with mental health conditions by decreasing stigma associated with treatment in many ethnic minority groups. Similarly, increasing the number of culturally proficient practitioners would presumably decrease attrition rates, enhance our understanding of the role that culture plays in symptomatology, and allow us to more easily disseminate “ingredients” of culturally sensitive therapies (CSTs) into empirically-supported treatments (ESTs).
“CST” refers to the modification of evidence-based treatments to adequately address mental health conditions while incorporating factors that are endemic to culture. Cognitive-behavioral therapy (CBT) is a good example of an evidenced based treatment that warrants CST incorporation since this form of treatment has proven to be effective, time-limited, and applicable across emotional disorders.
By enhancing our understanding of cultural factors in assessing and treating mental health conditions, we would continue to be efficient in our assessment and treatment across diverse populations while showcasing the effectiveness of, say CBT, across diverse populations. A specific example from my own work is my CBT treatment protocol for panic disorder. Specifically, I have a panic disorder treatment protocol that ranges from 9-12 sessions across racial and ethnic groups. By understanding my client or patient’s racial identity, acculturation experiences (via assessment and rapport building), understanding of CBT, and his or her explanatory model of panic, I am simultaneously building rapport while maintaining the integrity of the treatment program. This is an example of CBT becoming a CST in practice; being able to effectively treat a mental health condition (e.g., panic) in an ethnic minority client (still incorporating and understanding the role of cultural factors) while the length of the treatment program remains intact (9-12 sessions for panic; 17 for OCD).
Thank you, Dr. Chapman for taking the time to share your insights on this important topic. To learn more about Dr. Chapman and his work, visit the Center for Mental Health Disparities.
Dr. Kevin Chapman
Lead photo available at 123rf.com