ISSUE:  Lack of cultural competency in service provision provided by mental health workers

Individuals accessing mental health services come from a variety of racial, ethnic, religious and social groups with belief systems that are the foundation of their identity and play a vital role in their recovery.  Many providers and mental health professionals lack the knowledge and training essential in working with culturally diverse individuals.  This is a crucial issue because the racial and ethnic composition of Pennsylvania is drastically changing and will continue to do so.  There is a clear need for “cultural competence” (i.e., the capacity to function effectively as an individual and as an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities) in service provision so that practitioners will be able to work more effectively with individuals across racial and ethnic backgrounds.  In order to close the racial and ethnic disparities, cultural competency must be addressed and incorporated into practice by service providers. 

Please provide feedback by responding to the three questions listed below:

1.   What is your understanding of the issue?

2.   Based on your personal experience or what you know is happening within your community, how is this issue manifested in your community?

3.   What do you believe PMHCA can do to address the issue?

Creating awareness about your organization in the community is a good way to reach a variety of people and in addition you could post jobs on diverse websites and partner with local colleges’ office of multicultural affairs to recruit students through jobs fairs and internships. Outreach is key to having a more diverse workforce but I think that the agencies also need to develop a more inclusive work environment so that potential employees would want to work there. Having a work environment that respects differences and treats everyone equally is vital to attracting and maintaining a diverse staff. Also having a physical work space that inclusive has also made me feel more comfortable. This would include things like having pictures, art work and magazines around the office that represent a variety of cultural and ethnic backgrounds.

Based on my own experiences, different ethnic groups either don't believe in seeking help for mental illness but feel it is an issue that should be addressed only within their family, extended ethnic families, or their faith community.  Folks sometimes don't feel comfortable with their MH provider due to them not understanding their culture. My own personal experiences with trying to outreach to the Hispanic community regarding mental health and other disability issues is that folks within the Hispanic community prefer to receive help from someone within their own culture even if that person is not a specialist for that illness. For instance in Hazleton, a Hispanic optometrist is looked upon as the leader in his community.  I found when making presentations it is best to have someone who is from that culture or ethnic group present with you or by themselves.  Trust is often an issue!

I found in my immediate small rural community that is primarily Caucasian with a church on every corner. . .many people don't believe that mental illness is real and that you need to "pray more" or "pull yourself up by your bootstraps".  It is seen as a sign of weakness.

PMHCA can address this issue by providing trainings and materials on cultural competency. Provide PMHCA materials in Spanish for those that speak Spanish.  Develop outreach materials for faith communities.  Develop an outreach network with cultural and ethnic groups in Pennsylvania particularly African American and Latino or Hispanic groups.  We can all help by telling our story and educating those within our own communities.

Yes, I agree - by labeling, we just perpetuate the differences instead of embracing the here and now, the "present-ness" of our fellow beings on this planet...I can see why the labels are there, but how about stepping aside from labels and the damage they cause and perpetuate and instead approaching things from a new place...if the approach changes, the situation may change...if I see myself as different, I am already placing myself in a different situation than you.  If I am a fellow human feeling being, I don't see difference; I see hope.

We are all unique individuals. I do agree that by labeling people it can place an emphasis on differences; however I identify myself as a women of color and I don't want that to be overlooked. Whether I am going in for services or I am providing services, my culture is always with me and impacting me. The key is to be open. Everyone is different from the way they think, act or look and being open and non-judgmental is the best way to work with individuals. Unfortunately, due to the history of racial inequalities in this county there are certain ethnic groups that have been and are still being underserved in society at large and in the mental health system. We are not doing our jobs as advocates if we are not addressing and working to solve this problem. As someone already mentioned, printing material is Spanish is a good starting point. From there, conduct outreach with the Latino community and building relationships so that you create trust. This outreach is not about imposing one set of beliefs on another but about being accepting and willing to learn. Within the African American community there is a strong emphasis on religion and PMHCA could do outreach to local pastors. They could meet with pastors and listen to their concerns about their congregations and work together to have presentations or workshops for the members of the churches. This will also create trust with the larger African American community. It is also important to do outreach with the Asian community and contact organizations and form relationships with them so that PMHCA can become aware of the community’s needs.

This was just posted on Alternatives discussion site and also applies here:

Howdy all!
Thanks for the mind stretch, about the only exercise I get these days.  LOL We certainly can get bogged down in language and two movements I've been involved are still debating it.  Gay Liberation and Mad Liberation were roots that grew into an umbrella of special interest, demographic and diverse spokes.  Bottom line is VOLUNTARY, ACCESS and CHOICE.  HealthCare needs to be practical, affordable and universal. 

Areas of Health consideration, including but not limited to:
Mental Health
Physical/Medical Health
Spiritual Health
Social Health
Sexual Health
Emotional Health
Holistic Health
Economic Health
Environmental Health
Family Health
 
Prevention and Recovery including, but not limited to:
Preventing Illness, Promoting Wellness
Good Mental Health is Recovery
Suicide Prevention
Addictions Recovery
Co-Occurring Recovery
Prevention of HIV/AIDS, Hepatitis, STDs, etc.
Prevention of Domestic Violence
Prevention of Trauma Triggers
Prevention of Poverty
Spiritual, Social and Sexual Freedoms and Inclusion
Access to HealthCare
Access to Information and Technology
Generational, Economic and

There is more to add to this wish list, but basically I use an acronym MESSS:  I'm a MESSS and every day I'm working to clean up my MESSS in the broad areas of Medical, Emotional, Social, Spiritual and Sexual elements.  My WRAP is managing the MESSS.  This is nothing invented, just a rearrangement of the elements to create a unique acronym of the MAD (Mark Alan Davis) variety.

Queer Dollars is the inflation of Two Cents Worth and Queer as a Three Dollar Bill (or is it Two Dollar Bill?) is an old phrase.  Just this week the editor of the Philadelphia Gay News called for our communities to support LGBT businesses in the "Gayborhood" and elsewhere during these times of economic crisis.  It takes a village to save the village so to speak.  Another tactic for public education he called of our communities to stamp currency as "Gay Dollars" to demonstrate our impact on the health of the economy.  Ever see a Gay Dollar or Gay Money stamped or written on bills?  What can our movement learn from that?  How about if we start stamping our money "Crazy Bucks?"  On my personal checks I show devotion and support for the Ohio State Buckeyes (who play in Big Ten Champ game today).  It simply says "Go Bucks" and is both Buckeye Cheer and Bye Bye Bucks, however many Bucks the check is made out for...would that be a REALITY CHECK?  LOL As you pose, "what is reality?"  The use of Queer is a way to simplify and embrace the alphabet soup of diversity of sexual and gender identity:  Gay, Lesbian, Bisexual, Intersex, Transgender, Two-Spirit, Questioning, etc.  The International Gay & Lesbian Film Festival didn't include gender identity in their name.  I waged a mini battle last year for title to include transgender and for that matter bisexual, but when a list is made it excludes intersex, gender queer, and the long list goes on.  Well after a split of the business, creative and oversight groups and reunion amidst law suits, they merged back to put on the usual two festivals changing Philadelphia Film Festival to Philly Cinefest and Gay one to Philadelphia QFest.  So the debate goes on, but in the end, it's a building of community (village) identity full of diversity that unites our common bonds.  And boy/girl did I ever go beyond what I thought I'd say here...

Cheers...

I'd like chime in on this topic. My understanding of Cultural Diversity this that is exactly what is said. Cultural Diversity.  Differences in Culture that the provider may or may not know. From my understanding, Pennsylvania has always been a conservative state. As the years progress in the future, there is the ever present diversity in large populated cities. Within small rural towns and cities there seems to be the same diversity. Ethnic differences, Socio-Economic diffferences, Religious differences and sexual differences. One could take it a step further and include individual differences such as sub cultures as listening to certain musics, style of clothing and lifestyles. It appears to be a broad spectrum of differences. Many that the provider may or may not have difficulty in addressing. Some things that have helped me address certain issues is a basic principle of understanding. Understanding differences and communicating with willing individuals plays a key role in addressing a possible problem. Effective communication and understanding opens the door to peoples life. A willingness to learn about the person and his similarites and differences could allow the person to address the needs. I agree with outreach and education, but on a level that the people that are being trained are from the very places we are trying to learn about.
Not saying that they educate us on the quirks of a certain culture but one that knows of the culture that they are talking too. Will this happen all the time. Not necessarily, in most cases no. We are left with the very exct differences that are talked about in the first place.

When a person experiences a Mental Health Diagnosis, there is possiblity of several things. The person is not interested in help, the person wants help and the person can't be help and the person can help him/herself. What can we do about this? I'am a firm believer in the Peer Support Initiative. People helping People. I would like to refer to a recovery principle used by a 12step group. Where one person can help another. I'am a firm believer in education and all the hard Social Workers that have their degrees but what I think we need is people to beleive that they can suceed in life. That they can go to college, that their is scholarships and grants for people. That they have a role in society and are accepted. I'm sure there is or isn't but one thing is that peer support does work. If I somebody would have told me years ago that I have a Mental Illness and that I'am doing far better with therapy and treatment, I would have disagreed.

The Office of Minoirty Health has established recommended* standards for Culturally and Linguistically Appropriate Services (CLAS) in health care for which PMHCA should advocate:

I. Culturally Competent Care
1. Health care organizations should ensure that patients/consumers† receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.

2. Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.

3. Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in CLAS delivery.

II. Language Access Services
4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with LEP at all points of contact and in a timely manner during all hours of operation.

5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

6. Health care organizations must ensure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).

7. Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.

III. Organizational Support
8. Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide CLAS.

9. Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.

10. Health care organizations should ensure that data on the individual patient’s/consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updated.

11. Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.

12. Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.

13. Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.

14. Health care organizations are encouraged to make available regularly to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.

NOTES:

* CLAS standards are nonregulatory and therefore do not have the force and effect of law. The standards are not mandatory but they greatly assist health care providers and organizations in responding effectively to their patients’ cultural and linguistic needs. Compliance with Title VI of the Civil Rights Act of 1964 is mandatory and requires health care providers and organizations that receive Federal financial assistance to take reasonable steps to ensure LEP persons have meaningful access to services.

†CLAS standards use the term patients/consumers to refer to “individuals, including accompanying family members, guardians, or companions, seeking physical or mental health care services, or other health-related services” (page 5 of the comprehensive final report; see http://www.omhrc.gov/clas).