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.
I am pleased to welcome 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.
This post is Part 1 of 2 in which Dr. Chapman discusses healthcare’s responsibility to our changing community.
What are mental health disparities?
Dr. Chapman: Mental health disparities refer to significant differences in the assessment, study, treatment, or rates of mental disorders in underrepresented groups.
What is the importance of addressing mental health disparities in our culture?
Dr. Chapman: There are a number of important reasons to address mental health disparities in the United States. First, non-Hispanic Whites will be a minority in the US by 2050. Furthermore, our understanding of how cultural factors affect mental health and wellness in ethnic minority groups will be paramount for the delivery of culturally proficient psychological interventions. Second, the usefulness of “gold standard” assessments for mental health conditions continues to be questioned, since many studies suggest differences in symptom presentations in ethnic minority individuals as compared to non-Hispanic Whites. Third, ethnic minority individuals are uniquely impacted by cultural factors and these factors influence perception, manifestation, and description of many psychological symptoms.
What might we learn from studying mental health disparities within our larger culture? In what ways might standard evidence-based treatments differ when applied across various cultures?
Dr. Chapman: Evidence-based treatments for ethnic minority individuals remains mixed at best for a number of reasons including but not limited to: small sample sizes, attrition, and failure to adequately address racial and ethnic identity in treatment outcome studies. Additionally, there is a significant amount of heterogeneity in ethnic minority individuals (e.g., differences within groups) due to age, generational factors, neighborhood, SES, education, racial identity, racial identity of parents, and acculturation) so the description of symptoms may significantly vary (see Carter, Sbrocco, & Carter, 1996; Chapman, Vines, & Petrie, 2011).
Most studies fail to adequately address these factors, not to mention contain very few ethnic minorities in treatment outcome studies while often arbitrarily concluding that a treatment is “generally effective.” One example of such is the handling of “safety behaviors” in the treatment of panic disorder. A person of faith who engages in prayer prior to being exposed to a feared situation where panic may occur may be engaging in a “safety behavior” which is typically construed as contraindicative to treatment. However, understanding the role of prayer in many cultures requires a clinician to understand how and when to alter an empirically supported treatment to fit the needs of an individual client; it requires a high quality, unspecified amount of training to obtain cultural proficiency and the necessary knowledge and skills to know when and how to adapt treatment to meet the needs of diverse individuals.
We will welcome Dr. Chapman back on Thursday to discuss issues such as access to care, mental health delivery systems, treatment response, and improving evidence-based practice with attention to diverse populations. To learn more about Dr. Chapman, visit the Center for Mental Health Disparities.
Dr. L. Kevin Chapman
Leader Photo can be found on 123RF.