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Race and culture matter in mental health care

Tuesday October 02, 2001

By Judith Scherr 

Daily Planet staff 


It took Maria 17 years before she told anyone her schizophrenic husband had been beating her all those years. Maria, not her real name, knew there was something terribly wrong with Juan, but was too ashamed to pour her heart out to anyone. 

“The stigma keeps people from accessing services,” said Debbie Arthur, coordinator of the city’s domestic violence prevention services. People, especially in the Hispanic and Asian communities, think, “If I go (to a therapist), I’m crazy.”  

In his recent report, U.S. Surgeon General David Satcher wrote: “A constellation of barriers deters minorities from reaching treatment. Many of these barriers operate for all Americans: cost, fragmentation of services, lack of availability of services, and social stigma toward mental illness. But additional barriers deter racial and ethnic minorities; mistrust and fear of treatment, racism and discrimination, and differences in language and communication.” 

The racial divide between those accessing services and those who do not has been a concern to Berkeley’s mental health staff for a number of years. Whites and African Americans are much more likely to access services than Hispanics and Asians, Arthur said. 

Effective treatment services depend on the mental health staff’s understanding of the client’s ethnicity and culture and the role race plays in the client’s life, said Matthew Mock, director, since 1988, of the city’s mental health services for children. 

And so Berkeley’s mental health team is trying a variety of strategies to make services more accessible to minority communities, from changing the climate of the mental health waiting rooms, to sensitizing mental health workers to cultural diversity, to taking services to the clients, whether they are in churches or on the streets. 


Race and culture matter 

“In going to the clinic, people may find (the stress factors in their daily lives) replicated by going in the door and asking for help,” said Matthew Mock. 

So the clinic attempts to employ people who speak a variety of languages, to provide materials in a number of languages and to understand the needs of clients who may have had to take three buses to get there.  

The race and language of minority patients are critical in the relationship with the therapist. Of course, when the client is talking, the therapist must be able to understand the words he’s saying. “But when we talk about culturally appropriate services, we’re not talking only about language,” Arthur said. 

The therapist must understand the meaning behind the words. 

Employing mental health staff to match the language, culture or ethnicity of all the Berkeley clients would be ideal and the city’s mental health division can partially meet that need by employing interns of diverse backgrounds. 

But a therapist and client cannot always be paired by their ethnicity and culture. And that’s where staff training in “cultural competence,” comes in. 

Cultural competence means, in part, understanding the role race plays in the client’s life. 

A Euro-American therapist must “know about the legacies of slavery, or of the Japanese internment,” Mock said. She should understand the long-term effect of the Chinese exclusion laws and about the particular kinds of stress immigrants face here. The therapist needs to understand what it means if his immigrant client is a political refugee. 

A third generation Chinese-American, Mock says traditional western therapy is not acceptable in his community. “My parents would never seek out someone like me,” he said. Mock’s parents would be reluctant to talk about personal problems to a stranger. “They would not seek help outside their own community,” he said. And they would not define the problem in the way traditional western psychotherapy sees mental health issues. Rather, they would probably see one person’s depression, for example, as an imbalance within the family structure, rather than a problem of the individual. 

A Southeast Asian and Latin American might interpret symptoms of mental illness differently, said Fred Madrano, who heads the city’s Health and Human Services Department, where the division of mental health is housed. “We can’t assume that we all see (the same thing) in the same way.” 

Therapists also need to understand that the role of the family and the extended family varies with people of different cultures. 

“(The family structure) comes in the door with women who walk in the door,” Arthur said. 


Training the mental health staff 

Berkeley mental health tries to sensitize its staff to these kinds of cultural differences and train people in how to make the client aware that the therapist understands the diversity issues and will listen with an open mind as the client talks about race and culture as part of his life and a part of what is stressing him. 

Part of that training underscores that race, in itself, is a stressor and must be considered by the therapist, along with the other stressors therapists learn about in their graduate school work. Racism, oppression, and marginalization can be significant factors in a person’s depression. These factors can cause trauma in a person’s life, Mock says. 

While the city stresses the importance of cultural awareness among its mental health staff, Mock is a critic of schools that omit questions of race when they train mental health workers and the state licensing procedure which does not require training in this area. “There is no (statewide) mandate that they have to be trained to work with different cultural communities,” Mock said. “This is an ethical issue.” 

Further, “While being highly acknowledged as having deleterious effects in society, the impact of power inequities and manifestations of oppression on mental health or illness is rarely taught in schools,” Mock wrote in a 1995 paper for the California Psychological Association: 


Need for minority mental health workers 

Training in cultural competence is only one piece of the answer. A more fundamental response would be creating a larger pool of minority mental health workers. High school students need to be funneled into the profession early, Mock says. 

The Latina Center located in Berkeley and Richmond, is attacking the problem in a unique way. Through a four-year grant, it is training a pool of paraprofessional mental health workers, who will fan out in communities from Hercules to Oakland. They’ll reach out especially to Hispanic women and attempt to remove the stigma attached to seeking services for mental health problems. They will go to churches and other community venues where the Hispanic community gathers, and facilitate peer support groups. 

“(Latinos) feel ashamed” if they need help, said Miriam Wong, the center’s director. “People need to come together and start talking about what is going on.” 


Going to the people 

Part of the challenge is to go out of the clinic to where people are. The city has a mobile crisis team that does this kind of work, often working on the streets with the city’s homeless population. 

Schools are another venue to which the city’s mental health team takes its services. Students at Berkeley High, for example, can access mental health services by going to the health clinic, rather than going to a mental health clinic. There, behind closed doors, a youth can “take off his hood and start talking about issues in his life,” Mock said. 

Mental health workers are now also in three elementary and two middle schools where they can work with both students and parents. 

The mental health staff also intervenes in the judicial system, keeping people out of jail and helping them “stay out of trouble,” Mock said. Wong adds, however, that both the courts and the police department need more training in order to differentiate between a person who needs mental health services and one who needs to be jailed. 

“There’s never enough resources,” said Harvey Turek, who heads up the city’s mental health division. 

Wong agrees, shakes her head sadly and refers back to the case of Maria, who’s schizophrenic husband battered her for years. Juan is in jail and will be there for a while, Wong said. But he’s not getting any help and won’t be any better when he gets out. 

“He’ll probably be worse,” she said. 



Berkeley mental health services can be reached at the following numbers: 

Adult services: 2640 Martin Luther King Jr. Way 



Family Youth and Children’s Services 

1925 Derby St.