Every July, the US commemorates National Minority Mental Health Awareness Month, now often called BIPOC Mental Health Month. This is a month dedicated to raising awareness of the unique needs and challenges facing marginalized racial and ethnic groups, and best practices for providing mental health care. However, while “awareness” is helpful, it’s not the only barrier to providing culturally sensitive care.
The Problem with a Focus on Cultural Competence
While many books and trainings exist that aim to educate clinical staff on the culture, history and values of marginalized communities, the framework of “cultural competence” is being increasingly questioned by members of those communities. A 2020 article in the psychiatric journal Focus defined cultural competency as “the need for health care systems and providers to be aware of, and responsive to, patients’ cultural perspectives and backgrounds.”
Cultural competency is a noble goal, but the idea that it’s a skill that can be taught and mastered can discourage members of dominant social groups from continuing to learn and grow over time. The truth is, no one is ever completely competent in any culture – including their own – because culture is always evolving. There is always more to learn and more work to do on unlearning one’s unconscious bias. The assumption that simply possessing deep knowledge about another culture automatically translates into more sensitive or competent care is not necessarily true. It’s easy to memorize a list of facts, but learning to think critically and practice true empathy is much harder. A perception of competence may also lead to stereotyping members of a group, rather than approaching them as individuals with their own thoughts, feelings and perspectives.
And finally, those who are not well-versed in another culture may assume there is no way they can provide adequate care. However, it is possible to work with others from a background wildly different from one’s own, even without training in that culture, if one adopts an attitude of curiosity and self-reflection.
This is why the senior staff has spent the last year in training with Cliff Jones and Capacity Building Partnerships learning how to address our own cultural bias and that of others in order to support an environment that is inclusive, nurturing and anti-racist. The desired outcome for this work is to support individual and collective transformation across the agency to advance diversity, equity, inclusion and justice, and eliminate inequity and oppression.
Cultural Humility is an Ongoing Practice
So how do we move beyond the framework of “competence?” This is where the concept of “cultural humility” comes into play. The Focus article describes cultural humility as an approach that “de-emphasizes cultural knowledge and competency and places greater emphasis on lifelong nurturing of self-evaluation and critique, promotion of interpersonal sensitivity and openness, addressing power imbalances, and advancement of an appreciation of intracultural variation and individuality to avoid stereotyping.”
So how does one practice cultural humility in a clinical setting? The New Social Worker suggests 3 guiding principles:
- Committing to an ongoing process of self-awareness and inquiry. This involves reflecting on one’s own biases and stereotypes, as well as taking the time to seek out the perspectives of others with different life experiences. By making a conscious effort to seek out a wide range of perspectives, we can become aware of our own blind spots.
- Being open to correction and willing to learn. By prioritizing the perspective and experience of a BIPOC client or colleague, clinicians can view others’ lives without judgment or imposing their own values. They must also be willing to acknowledge when they have made a mistake, embracing it as an opportunity to learn rather than becoming defensive.
- Keeping greater social structures in mind. We are all shaped by our experiences, and a marginalized person’s perception of the world is based on interactions with their environment. Previous negative experiences with the mental health system may cause a BIPOC client to be suspicious and distrustful, for example. Instead of taking that distrust personally, clinicians should be understanding and work to minimize the power imbalance in the relationship, giving clients choices about their care and collaborating on treatment goals.
It’s important to note that cultural competence and cultural humility are not approaches that exist in opposition to one another. At LifeWorks NW, we encourage both. All of our staff are required to complete yearly training in Diversity, Equity, Inclusion and Justice, and how best to serve diverse populations. They also are encouraged to participate in our Diversity Resource Crew to learn how they can best support their colleagues from marginalized backgrounds.
We also encourage our staff to look outside of their own experiences, to approach others with curiosity and compassion, and to be willing to listen to people who are different from themselves. By continually learning about others’ history and experiences and adopting an attitude of humility, we can provide the best possible care to marginalized clients and the best work environment for our colleagues.
If you’re interested in learning more about cultural humility and how to practice it in your own work, the University of Oregon has put together a page with links to additional articles, videos, and other resources to help you get started.