Understanding cultural competence in mental healthcare

We live in a vibrant, colourful country brimming with unique cultures. But in the world of mental health, there's a noticeable disconnect in understanding what cultural competence truly means. And that’s having a negative impact on both therapists and their clients.

So, what is cultural competence?

The term cultural competence gets thrown around a lot, especially in my experience of training sessions and casual workplace discussions. However, pinning down a singular definition can be tricky. 

In the UK, the NHS defines cultural competence as ‘a set of aligned and transparent skills, attitudes and principles that acknowledge, respect and work together as a system towards optimal interactions between individuals and the various cultural and ethnic groups within a community.’

On a broader scale, Psychology Today frames it as ‘the ability to first recognize and understand one’s own culture and how it influences one's relationship with a client, then understand and respond to a culture that is different from one’s own.’ 

Given these diverse interpretations, it's understandable why there might be some confusion in its practical application. This ambiguity can be problematic and when therapists are unclear on this concept, misunderstanding can occur more frequently. 

What do the statistics say?

• According to a review from the Mental Health Foundation, in the UK, Black people are four times more likely to be detained under the Mental Health Act compared to white people. This highlights a potential disconnect in understanding and appropriate responses to mental health issues in Black individuals.
• Black Caribbean individuals are three times more likely to be diagnosed with psychosis than white individuals, as reported by Care Quality Commission (CQC).
• According to a Race Equality Foundation report, Black and minority ethnic groups are less likely to access psychological therapies but more likely to be prescribed medication, highlighting potential barriers or biases in treatment recommendations.
• Despite the UK's rich linguistic diversity, many NHS Trusts lack adequate interpreter services, which can be essential for mental health sessions. A lack of interpreter services can severely limit the effectiveness of therapy for non-English-speaking patients.

Peeling back the layers of culture

It’s tempting to think that just having more Black therapists could solve this puzzle. But, based on my experience, it's not that straightforward. I'm Nigerian, and even within Nigeria, there's a mosaic of cultures. Take the Yoruba and Igbo cultures – they're distinct in traditions, languages, and practices. Grouping all Nigerians together misses these essential nuances.

When a Nigerian client engages with a therapist, merely categorising them as Black or African doesn't dive deep enough. It's about delving into the intricacies of their culture. 

For instance, the terms Aunty and Uncle in many Nigerian cultures, including Yoruba which I’m a part of, go beyond familial ties. These terms epitomise respect and recognition of age or standing within the community. An older person, regardless of blood relation, might be referred to as Aunty or Uncle out of reverence. 

In a therapeutic context, understanding this nuance is pivotal. If a younger client addresses me as Aunty, it isn't just a title; it's an expression of respect influenced by their cultural upbringing. I find it essential to address this upfront. By letting them know they don't need to call me Aunty in our sessions, I'm aiming to adjust the power dynamics, creating a comfortable space for open dialogue. Additionally, in many Nigerian cultures, children grow up learning not to talk back to their elders. Recognising this, therapists can help younger clients feel more empowered to express themselves in the therapeutic setting.

Being proactive, not reactive

We shouldn't wait until a specific client walks through our door to get a crash course on their culture. By then, it's too late. It's up to us as therapists to take the initiative to learn about the cultures of the clients we might interact with, well in advance. This means actively addressing our biases, confronting our prejudices and remaining open to continuous learning. It's a personal responsibility, one that extends beyond our professional roles, shaping us as individuals who genuinely appreciate and celebrate the diversity around us.

And the sources of self-education aren’t restricted to formal training or reading. They're useful, yes, but genuine understanding comes from a broader spectrum. Shows like Say Yes to the Dress, Bob heart Abisola, Love & Toxic: Blue Therapy, celebrate cultural diversity, providing a glimpse into various traditions and practices. The aim is to stay curious and be open to soaking in insights from every source.

Where policies fall short

There’s a puzzling issue at hand: while NHS policies  emphasise cultural competence in mental health care, they rarely offer adequate tools to achieve it. A 2018 Cabinet Office report highlighted that Black adults, despite having a higher prevalence of mental health issues, were the least likely among all ethnic groups to access mental health support. It’s high time for the decision-makers to step up and provide real, actionable training.

A quote that always resonates with me is: ‘It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.’ – Audre Lorde, an American writer and professor.

True understanding comes from acknowledging each other's unique perspectives, which, in turn, allows us to grasp a more comprehensive view of the world around us. 

By pretending colour or culture doesn't matter, we miss the richness and depth of our shared human experience. By pretending to be colourblind, we risk subjecting clients to damaging microaggressions. 

Where do we go from here?

While cultural competence sounds good on paper, there's plenty of work ahead. The collaboration between the overarching mental health system and individual therapists is vital. Our shared objective? Crafting therapeutic environments where every client feels truly acknowledged, understood and safe, regardless of their cultural background.