epocrates
Culturally competent care key to addressing mental health needs of Black patients
Members of marginalized communities, including Black Americans, face higher morbidity and mortality rates than White people from chronic conditions such as heart disease, diabetes and, increasingly, anxiety and depression.
The unique mental health needs of Black Americans have been well-researched. Frequent exposure to systemic and daily racism can lead to post-traumatic stress disorder (PTSD) or symptoms such as hypervigilance, withdrawn behavior, and depression that are often associated with PTSD. Black adults are more likely than white adults to report persistent symptoms of emotional distress, according to 2022 data from the Health and Human Services Office of Minority Health. (Hoskin, 2024; OMH, 2022)
Despite these findings, non-Hispanic white Americans receive mental health care services at higher rates (52%) than Black Americans (39%), according to the Substance Abuse and Mental Health Services Administration.
The reasons behind this disparity in mental health care are multifactorial and include unequal access to care, the stigma associated with mental health care, and, importantly, a perceived lack of cultural sensitivity by health care professionals.
Primary care physicians are often the first point of contact for patients seeking help for chronic stressors and conditions that can negatively impact mental health and deserve attention. In addressing the needs of the Black community—and any member of a marginalized group—physicians should be able to provide culturally competent care regardless of any ethnic, gender, sexual identify, or other differences between a clinician and a patient. Curiosity, empathy, respect, and humility are some basic attitudes that have the potential to help the clinical relationship and to yield useful information about the patient’s individual beliefs and preferences. (Georgetown University, 2024)
Dr. Anita Misra-Hebert of the Department of General Internal Medicine at The Cleveland Clinic Foundation offered the following four key points to keep in mind when considering how to improve physician cultural competence (Misra-Hebert, 2003):
1. The provider-patient relationship is built through verbal and nonverbal communication. Misra-Hebert stresses the importance of speaking to the patient directly, using a normal tone of voice. Avoid slang or technical terms and ask one question at a time, while keeping in mind that nonverbal gestures are not culturally universal. Concepts of personal space and preference for eye contact differ by culture; do not interpret a patient’s behavior or emotional state by your interpretation of their space preference or lack of eye contact.
2. Understand how the patient interprets his or her symptoms, conditions, and needs. Elicit the patient’s explanatory model by asking questions like, “how do your symptoms affect you?”, “what are the chief problems your sickness has caused for you?”, and “What are the most important results you hope to receive from treatment?”
3. Involve the patient in managing next steps. Acknowledge and respect your patient’s wishes when it comes to involving family in diagnosis and treatment discussions. Inquire about the patient’s wish to explore the use of alternative or complementary treatments.
4. Be aware of your own values and belief system and how biases may affect your interactions with patients. The perception of authority/status, privacy, and physical contact are just a few issues that may present barriers to communication.
Sources:
Georgetown University Health Policy Institute. Cultural competence in health care: is it important for people with chronic conditions? https://hpi.georgetown.edu/cultural/
Misra-Hebert, A. (2003, April). Cleve Clin J Med. Physician cultural competence: cross-cultural communication improves care. https://pubmed.ncbi.nlm.nih.gov/12701983/
Hoskin, MN. (2024, January 31). Everyday Health. How to find a therapist who understands black identity. https://www.everydayhealth.com/emotional-health/how-to-find-a-therapist-who-understands-my-black-identity/
U.S. Department of Health & Human Services Office of Minority Health. Mental and behavioral health – African Americans. https://minorityhealth.hhs.gov/mental-and-behavioral-health-african-americans