The 1999 Surgeon General Report on Mental Health: Culture, Race and Ethnicity revealed that clients that identified as racial minorities were less likely than whites to receive quality mental health care. Almost 20 years later, we are still facing the same challenges in service delivery, which are directly tied to the high level of racial health disparities experienced across the spectrum of mental health concerns.
Racial minorities face overwhelming barriers to care that prohibit adequate progression toward healing and uphold incongruities in quality of life and life expectancy, compared to their white counterparts. This is particularly so for Black and Latinx individuals, across the lifespan.
Although the issue of race-based health disparities is a complex one that requires a complete reformation of multiple systems, including the U.S. healthcare system, mental health professionals have a unique position in the matter. The continued efforts of mental health professionals to improve the quality of care received by Black and Brown people is likely to have considerable impact in eradicating disparities in mental health.
The American Psychological Association (APA) has embedded within its service guidelines several regulations for the practice of psychotherapy and consultation with ethnic, linguistic, and culturally diverse populations. According to the APA, the aspiration is for clinicians, consultants, and administrators to hold their practice to a standard of ethical compliance by adhering to these principles. Therapy that lacks the cultural competence and humility required for the provision of services with minority individuals infringes upon the integrity of the practice, and is also not ethically compliant. As such, psychologists who seek to do work with racial minorities are tasked with aiming to achieve the highest level of cultural competency to ensure that quality service is being offered to everyone.
What does history tell us about the relationship between People of Color and health systems?
Unethical practices in medicine have historically negated the human rights of People of Color. One of the most notorious examples we have of this is the Tuskegee Syphilis Experiment (1932 - 1972), which was conducted by the U.S. Department of Health, Education and Welfare with the intention of observing the natural progression of untreated syphilis in African American men, who were injected with the disease under the assumption that clinicians were only drawing blood. Out of the innumerable accounts of exploitation of Black and Brown people in medical experiments, was also the series of experiments conducted in the 1990s by pharmaceutical companies who tested new drugs and vaccines through dubious consent processes with Native American children.
As a result of incidents like these, People of Color continue to have substantiated mistrust towards Western forms of medicine, leading to disengagement from treatment. With communities that continue to be largely oppressed and socially disadvantaged, we can’t take the risk of continuing to experience extensive underutilization of health services and large attrition rates in both the physical and mental health realms. Quality and ethical care must therefore be prioritized within all health-related fields, including psychology.
What are some challenges experienced by People of Color when seeking quality mental health services?
People of Color experience a host of obstacles that interrupt the potential to assume quality care within the field of mental health. These barriers are usually framed around the experiences of Clients of Color oftentimes living in areas where there is a dearth of services that are offered in the preferred language of that client and that honor the cultural context that People of Color exist in by way of integrating this context into every facet of treatment. Social distrust of health institutions, due to the long history of discrimination toward People of Color, is also a marker that diminishes a client’s motivation to seek out mental health treatment and largely speaks to the underutilization of services. Instead, Clients of Color usually resort to seeking care for mental health related matters through alternative sources like spiritual guides and traditional healers, and at times from less stigmatized sources like their primary care clinicians.
So how do we go about achieving quality mental health care?
Although quality care is a comprehensive approach that requires an extensive review of each health system and its key practices, there are some practical approaches that are more readily available. This is not an exhaustive list, but these steps can offer a starting point.
1. By acknowledging and affirming the humanity of People of Color.
Therapy is a platform for clients to be able to express their concerns in an unfiltered, unhindered way. If not provided with an opportunity to do so, Clients of Color will likely feel misunderstood and the healing journey will be curtailed.
It is important for clinicians to always bear in mind that People of Color don’t go to therapy to have their humanities assailed, but affirmed. It is then the duty of clinicians to provide optimal room for growth and affirmation within the context of therapy. Therapists and clients can work together to ensure that the client’s cultural narrative, cultural strengths, and indigenous beliefs and practices are being privileged in the therapeutic dyad. In doing so, therapy can operate as a space in which oppressive exchanges are not being recapitulated.
2. By requiring providers to intentionally assess their own racial identity, racial biases, and racial prejudices.
When Clients of Color perceive that a racial microaggression has taken place, it severely disrupts the therapeutic progress. Therapy is a process in which clients are prompted to engage in self-analysis. However, therapists too can be intentional about gaining insight to their thoughts and emotions, particularly as it relates to established biases they may hold about the racial groups their clients belong to. Studies have shown that when these types of biases remain unchallenged, they can lead to racial aggression towards clients.
The APA urges all psychologists to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves. For effective, anti-racist treatment to be enacted, therapists would have to take this goal a step further towards challenging their attitudes and beliefs about People of Color on an on-going basis, so that it doesn’t interfere with therapeutic alliances and prosperity. This would first mean that therapists must participate in intentional self-inquiry about who they are as a racial being. Progressive, productive, and effective mental health treatment necessitates that clinicians produce within themselves a healthy racial identity. For white clinicians, this involves constant movement in the direction of developing an anti-racist stance, which is directly connected to one’s racial identity development. The greater racial awakening one has, the less likely a clinician is to produce a racially hostile therapeutic environment for Clients of Color.
Clients of Color ought to also feel authorized to inquire with their therapists on their beliefs and when possible, decide to discuss it within the context of treatment.
3. By expecting service providers to act as agents of social change.
Culturally-competent practices, at least those which are truly effective, extend beyond the therapy room. As therapists, we are positioned to advocate against matters that create adverse consequences upon Black and Brown lives. Therapists are tasked with utilizing their privilege to bolster equity for communities of Color. This is a practice that is not mutually exclusive from the practice of therapy, but is very much a part of the treatment itself.
If therapists ever want more guidance on how to effectively engage in advocacy for their clients, there are different levels of inquiry they could engage in to access this goal. Clinicians can engage in dialogues with Persons of Color to facilitate cultural understanding of themselves and others. They can immerse themselves in cross-cultural experiences with People of Color to have more experiential knowledge of cultures that differ from their own and potentially learn about areas that represent a need for advocacy. By following these steps, clinicians can conjoin with their clients’ communities to successfully start the process of engaging in social advocacy work.
So to revert back to the original question, “Is therapy for People of Color?”
The answer is yes. When therapy can engage People of Color in their own language and context, it can be the right environment for psychic healing. Anything that falls short of that will not embody a truly culturally relevant space for the healing of Black and Brown people.
Adames, H. Y., Chavez-Dueñas, N. Y. (2016). Cultural foundations & interventions in Latino/a mental health. New York, NY; Routledge.
Adames, H. Y., Chavez-Dueñas, N. Y., & Organista, K. C. (2016). Skin color matters in Latino/a communities: Identifying, understanding, and addressing Mestizaje racial ideologies in clinical practice. Professional Psychology: Research and Practice, 47(1), 46-55.
Sue, D. W., & Sue, D. (2015). Counseling the culturally diverse. Hoboken, NJ: Wiley.
Sue. D. W. (2016). Race talk and the conspiracy of silence: Understanding and facilitating difficult dialogues on race. Hoboken, NJ: Wiley.
McGuire, T. & Miranda, J. (2008). Racial and ethnic disparities in mental health care: Evidence and policy implications. Health Affairs, 27(2), 393-403.
Daw, J. (2001). Culture counts in mental health services. Monitor on Psychology, 32(11), 16.
Office of Ethnic Minority Affairs. (2017). Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations. American Psychological Association. Retrieved from http://www.apa.org/pi/oema/resources/policy/provider-guidelines.aspx
Chow, J. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental Health services in poverty areas. American Journal of Public Health, 93(5): 792–797.
Owen, J., Tao, K. W., Imel, Z. E., Wampold, B. E., Rodolfa, E. (2014). Addressing racial and ethnic microaggressions in therapy. Professional Psychology: Research and Practice, 45(4), 283-290.
Smith, A. (1966). Conquest: sexual violence and American Indian genocide. Durham, NC: Duke University Press.