Culturally Responsive Care in Mental Health

Culturally responsive care is a philosophy that guides mental health providers toward fully seeing and valuing clients for all aspects of their identity, background, and experiences. By helping people feel safe, understood, and accepted, cultural competence makes mental health care more accessible and effective for LGBTQIA+ communities, Black, Indigenous, and people of color (BIPOC), and other underrepresented populations.

As the world becomes more diverse and mental health needs grow rapidly, the need for cultural competence in mental health services has never been more pressing. In this guide, we’ll explore the connection between mental health and culture and offer tips for finding culturally responsive care for your employees.

What is culture?

The word culture means “the beliefs, customs, arts, etc., of a particular society, group, place, or time.” Our culture is a part of our experience, and it shapes how we see the world, how we react to situations, and how we interact with others.

Cultures are made up of individuals with unique social identities, or a sense of who they are based on their mental, physical, or social characteristics. For example, race/ethnicity, gender, sexual orientation, disabilities, socioeconomic status, and religion are types of social identities. Individuals make up communities, and communities make up and are part of a larger culture.

Culture’s impact on mental health

Culture influences people’s beliefs and values, how they speak and dress, and other ways of experiencing the world. It can also impact their mental health, including whether they seek help, what type of help they seek, and who provides emotional support along the way. Here are some of the ways culture and mental health intersect:

Cultural beliefs about mental illness

Culture can influence how people interpret mental health symptoms and which ones they report. For example, people may be more likely to report physical symptoms like headaches or dizziness than emotional ones, such as sadness or worry. Culture also impacts how people interpret their symptoms, including what caused them, what they mean, and whether they require support. In addition, culture relates to how people cope—for example, whether they avoid upsetting thoughts or actively face them.

Cultural stigma and mental health

Due to historical oppression and systemic racism, people from various social identities in the United States face a stigma that leaves them underrepresented in mental health treatment. In many cultures, mental health conditions carry a stigma—or negative attitudes or beliefs that can lead to fear and discrimination. When people feel they may be judged or treated unfairly because of their condition, it can be harder to talk about concerns openly and ask for help.

Family and community support

Stigma leaves many people alone in their efforts to find treatment and manage symptoms. Culture influences how much support people get and where they go for help, whether it’s a doctor, spiritual or religious leader, mental health specialist, or another type of healer.

Physical health

Due to gaps in health care access, housing insecurity, exposure to environmental hazards, and other disparities, BIPOC communities in the U.S. have shorter overall life expectancies and higher rates of illnesses like cancer, heart disease, and diabetes than white Americans. This can affect mental health in several ways. Chronic physical illness can increase the risk of mental health disorders. In addition, those with both a physical and mental illness are more likely to have their mental health condition missed or misdiagnosed by a health care provider.

Although culture plays a significant role in our mental health, not enough mental health providers respond to the impact of their clients’ cultural backgrounds. This is why cultural competence is important.

What is culturally responsive care?

Culturally responsive care is the intentional and consistent decision mental health care providers make to see, respect, and celebrate the aspects that make each person unique. It’s an acknowledgment of their intersectional existence in the world and how this shapes their experiences.

Culturally competent mental health providers:

Culturally responsive care has several components, including:

Cultural awareness

The mental health provider evaluates who they are in relation to their client. A key aspect of building cultural awareness is humility, or a willingness to engage in an ongoing process of introspection and actively address inherent power differences in the client-provider relationship.

Cultural competence

Cultural competence in counseling calls upon providers to look at what they know and what they need to learn. As a foundational element of quality care, it’s listed as one of psychology’s core competencies.

So, what is cultural competence? The Centers for Disease Control and Prevention (CDC) defines cultural competence as “the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes.”

Cultural competency has two prongs:

1. Cultural knowledge, or learning about other communities through books, articles, training, and other resources
2. Cultural attunement, which is using curiosity and empathy to better understand clients’ experiences

What’s the difference between cultural competence and cultural humility, awareness, or sensitivity? Each builds on the other and is necessary to deliver culturally responsive care.

• Cultural sensitivity is knowing that there are differences between cultures without assigning value (good or bad) to those differences.
• Cultural awareness is being open to the idea of changing cultural attitudes.
• Cultural humility means admitting to not having all the answers and being willing to practice ongoing self-evaluation, learn about clients’ experiences, and fix power imbalances.
• Cultural competence puts knowledge and understanding into action, so providers actively operate in different cultural contexts.

“For providers, culturally responsive care is more than just cultural competence. It’s about what we do with the knowledge that we have and translate it into the care we are providing,” said Danielle Cottonham, PhD, clinical manager of culturally responsive care at Lyra Health. “For example, we know that repeated experiences of oppression can result in a greater likelihood of developing a mental health condition and increased severity of symptoms. With this knowledge, we should be asking about and thoughtfully considering how the sociopolitical context may be a significant source of stress for our clients, especially those from marginalized communities.”

Cross-cultural skills

Based on their awareness and knowledge, providers adapt their clinical interventions to best serve the individual client.

Culturally responsive care examples

Why is cultural competence important in mental health care?

Cultural competence in therapy helps address the many barriers to care that prevent marginalized populations from receiving support.

People from every culture can develop mental health issues such as anxiety or depression, but the experiences they may face because of their cultural backgrounds—for example, race-based discrimination—can influence the severity and impact of their symptoms, how they respond to different therapies, and whether they choose to seek treatment at all.

For example, while depression is a universal problem, rates of depression are lower in people who are Black (24.9 percent) or Hispanic (19.6 percent) than in white people (34.7 percent). However, depression in those two groups is likely to be more persistent. Communities of color are also less likely to seek and receive care. While 54 percent of people in the U.S. with a mental illness do not receive treatment, the percentage of those without care significantly increases in these groups, with 63 percent of African Americans and 65 percent of Hispanic people not receiving treatment.

LGBTQIA+ individuals face different, but related challenges. They are more than twice as likely as heterosexual people to have a mental health disorder, and are also more likely to receive care. More than half of LGBTQIA+ youth who want mental health treatment don’t receive it, with Black, Latinx, and Asian youth reporting greater challenges in getting care than others. When people go untreated or undertreated, their symptoms may worsen, which can lead to problems with work, finances, health, and other areas of life.

Gaps in care have many contributing factors, including:

Discrimination

Documented abuses, inequities, and oppression—past and present—have led some people of color to lose trust in health care providers and mental health professionals. Studies show people of color more often receive lower quality mental health care than white people. Members of the LGBTQIA+ community also report avoiding or delaying health care services due to discrimination.

Stigma

Mental health stigma in marginalized communities is a result of system failures and negative experiences in therapy due to cultural bias. It permeates across ethnicities, gender identities, and backgrounds and deters people from getting needed support. For example, in one study, just 12 percent of Asian Americans said they’d mention their mental health challenges to a friend or relative, and only 4 percent would go to a psychiatrist or specialist for help.

Lack of diversity in mental health providers

One of the most significant factors that impact a person of color’s decision to seek care is the lack of racial and ethnic diversity among mental health care providers. Research has shown that when people are of the same race or ethnicity as their provider, they are more likely to stay engaged in treatment. However, racial and ethnic populations only represent one-sixth of psychologists, even though these communities represent closer to 40 percent of the U.S. population.

Lack of culturally responsive clinicians

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “Consideration of culture is important at all levels of operation—individual, programmatic, and organizational—across behavioral health treatment settings. It’s also important … at every treatment phase: outreach, initial contact, screening, assessment, placement, treatment, and continuing care and recovery support.”

Unfortunately, culture isn’t always accounted for in mental health care. Studies have found that a lack of cultural competence and understanding among mental health care providers is one significant barrier to care for underrepresented communities. And in 2021, the American Psychological Association (APA) adopted a resolution that outlined how the field of psychology has contributed to and upheld racist systems, practices, ideologies, and beliefs that have resulted in harm for communities of color.

As a result, people of color may be less likely to get mental health treatment because they don’t believe in its effectiveness or credibility. This is understandable since most evidence-based therapies are grounded in research that lacks significant representation. If mental health care feels personally relevant and congruent with their values, marginalized populations may find it more attractive and effective.

Clinician bias

Mental health providers may have conscious or unconscious biases, defined as unwarranted judgments, expectations, or reactions to people based on a certain quality or group membership. These can deter marginalized communities from asking for help and lead to inaccurate diagnosis, lower quality treatment, and lack of trust between providers and clients. For example:

• African Americans tend to be overdiagnosed with schizophrenia and underdiagnosed with bipolar disorder and depression.
• Mental health disorders are frequently overlooked in Asian Americans due to the “model minority” myth, or stereotype that this community is “problem-free.”
• Research has found that heterosexual substance use treatment providers held more negative implicit attitudes toward lesbian and gay clients than did LGBTQIA+ providers.

With appropriate cultural competence training for mental health professionals, clinicians can recognize how cultural differences impact the therapeutic relationship and take steps to provide the best possible care based on the person’s needs.

Cost and lack of insurance

Cost and poor insurance coverage are among the biggest barriers to accessing mental health care. One-quarter of Americans said they had to choose between getting the treatment they need and paying for basic needs.

The high costs of mental health care disproportionately impact marginalized communities. People of color are more likely to be uninsured and live at or below the poverty level than white people. People of lower socioeconomic status can also have a difficult time finding providers in their community. As a consequence, many live with undiagnosed and untreated illness.

Complex health care systems

Navigating the health care system can be confusing and time-consuming. Research suggests that many Americans lack access to information that builds mental health literacy. As a result, people are less likely to:

• Recognize mental health symptoms
• Understand mental health diagnoses
• Know where to get information and support
• Navigate insurance and the health care system
• Get mental health treatment
• Practice coping skills and self-care

Why culturally responsive care is an integral part of a mental health benefits strategy

More companies are looking to add mental health care and resources to their list of benefits. According to a recent survey of companies across the U.S., 98 percent of respondents said they’d either implemented or planned to implement a mental health benefit as part of their compensation package. But if the care provided isn’t evidence-based and culturally responsive, it may not be helping everyone in the workforce.

Here are a few reasons why it’s important to make culturally responsive care an integral part of your provider network’s approach to care:

Meets the needs of your diverse workforce

As the U.S. population continues to grow in its diversity and more organizations recognize that diverse companies outperform their less diverse peers, companies are making diversity, equity, inclusion, and belonging (DEIB) a large part of their recruiting strategy. This goes hand in hand with adopting a workforce mental health benefit that focuses on evidence-based, culturally responsive care.

More likely to start—and complete—treatment

Research shows that providing culturally competent care helps people feel more comfortable getting mental health support and stay engaged in treatment.

Higher quality treatment

To truly meet the breadth of a diverse workforce’s needs, your mental health benefit needs to provide high-quality care that reflects the experiences of the individual. Unfortunately, only 20 percent of mental health treatments have been proven effective, according to the APA.

Lyra Health uses evidence-based treatments (EBTs), which have been rigorously tested in randomized controlled trials or a series of case studies and proven to have effective outcomes. EBTs are proven to help people see a reduction in their symptoms. However, they may not be effective for every person if they aren’t adapted to meet cultural differences or used within a culturally responsive framework.

Many commonly used EBTs were developed from a white, Eurocentric perspective and validated with predominantly white people. The process of validating various mental health treatments that were developed between 1986 to 2001 was not diverse, and few studies during this time examined if these treatments were effective for different racial and ethnic groups. Because of this lack of intersectional research, there’s a significant need for cultural competency and better awareness when treating people from diverse backgrounds.

Better outcomes

Most therapists receive some training around cultural diversity. However, more specialized education and training in culturally responsive care, such as modifying evidence-based treatments so they’re tailored to specific groups and individuals, leads to better outcomes. Cultural competence in counseling improves communication, motivation, and openness, which can translate into more effective care. It can also make the experience of receiving care more satisfying for clients.

How to find culturally responsive care for your team

As a human resources or benefits professional, it can be difficult to know how to evaluate whether a mental health benefit supports the needs of your diverse workforce. How can you know whether your company’s mental health benefits adequately reflect and incorporate your DEIB values and ensure that your employees have access to care that helps them feel seen and heard, wholly and authentically?

As people with more culturally diverse backgrounds seek mental health care, it is essential to offer access to an equally diverse network of providers with culturally responsive clinical skills. When researching a mental health benefit program, important questions to ask include:

1. Are your providers trained to address race and other social identities in therapy sessions?
2. Are your providers diverse in their linguistic capabilities, so they don’t have to rely on translators to give care to multilingual clients?
3. Has your network trained providers to incorporate cultural adaptations that best fit their clients?

Lyra Health’s provider network at a glance

A culturally responsive mental health benefit supports providers by:

• Providing training and ongoing consultations to strengthen their culturally responsive clinical skills (for example, helping providers integrate clients’ coping styles into treatment)
• Providing specialized, ongoing training to address race and other social identities in therapy
• Providing support to help providers understand how to make cultural adaptations so therapy is tailored to each individual’s needs
• Taking steps to combat stigma so those with the most barriers to care can feel comfortable asking for support

At Lyra, culturally responsive care grounds evidenced-based therapies in an anti-oppressive practice that builds on a foundation of responsiveness, humility, and respect. We strive to redefine the standard for mental health care. Providers are able to offer treatment that incorporates their background and life experiences as part of the therapeutic process. We do this through a network of diverse providers who are educated in culturally responsive care, so that clients can feel seen, understood, and valued in their sessions.

To incorporate culturally responsive care in the practice of evidence-based therapies, Lyra provides ongoing education for providers that includes:

• Intersectional frameworks for understanding clients’ presenting concerns
• Training on being an anti-oppressive therapist working with LGBTQIA+ individuals and people of color
• Training in working with transgender clients
• Culturally responsive support for Black men
• Getting parents ready to talk about race
• Training in the social justice implications for evidence-based treatments
• Training in understanding white privilege and allyship in therapy

Additionally, Lyra empowers providers to incorporate culturally responsive care by integrating them into a community of similarly minded mental health professionals. This means that therapists in our blended care therapy program have access to consultation groups and other experts who can help determine the best treatment options and approach for clients.

A safe space to heal

In an ever-changing political and social landscape, it’s more crucial than ever to ensure that your mental health benefits strategy is rooted in a philosophy of culturally responsive care. This helps ensure that your employees have a safe space to process all of their experiences, including those influenced by their cultural identities.