July 5th, 2023
In 2008, like every other therapist/social worker and psychologist, I took my “Multicultural Counseling” class in graduate school. I was particularly excited about this class coming from a bilingual immigrant household while growing up in America. Mainly, I was looking forward to learning about working with clients from my Middle Eastern background. Throughout the class, we learned about many different races and cultures and the specifics of their mental health treatment, but never my own. I walked away from that class realizing that one class does not make you fully proficient in working with another culture and that while we can have cultural competency in a culture that is not our own, being from that culture is going to be how we can provide the best care for those clients.
Turns out the stats supported my beliefs. In 2007, the APA put out an article showing that therapy is twice as effective in a client’s native language. It also found that interventions designed for a particular culture are four times more effective than interventions designed for multiple minority groups. We also know that immigrants are susceptible to a set of problems that are unique only to immigrants such as uncertainty about their immigration status, exposure to extreme violence (war) or harsh living conditions in their country of origin, loss of social status (job or education may not be transferable) upon leaving their country, loss due to separation of family/social support when leaving their country, and the overall shock of coming into a country where they don’t know the language or the culture.
At my first job out of graduate school, I worked at a psychiatric hospital with teens. We used a translation service to do family therapy sessions with parents who did not speak English. The services were always available to us via phone and there was no language that wasn’t covered. While this service was beneficial to our team, I often got feedback from my clients that the translator would put their own 2 cents into the discussion when speaking to parents or that they weren’t translating medical terminology properly. It made this service useful and a barrier to proper treatment and care for these clients.
According to the APA in 2015 86% of all Psychologists were white, 5 percent were Asian, 5 percent were Hispanic, 4 percent were black/African-American and 1 percent were multiracial or from other racial/ethnic groups. Looking at the statistics of racial groups in the US, this split is close to what we see in the general population of the US. So, a barrier is not necessarily that we aren’t accurately representing minorities in mental health work, it’s just that this country is mostly made up of people who are not ethnic minority groups. In 2016 the APA put out a stat that showed 10.6% of psychologists spoke at least 1 other language besides English. By comparison, the most recent US census data shows that 21.6% of Americans speak a language other than English at home.
In a study called “Provision of Non-English Language Services in U.S. Mental Health Facilities”, they found that Mental status evaluations performed in patients’ non-primary languages can lead to distorted assessments and failures to identify disordered thoughts or delusions. They also cited that having limited English proficiency has been associated with underutilization of mental healthcare services and this could be improved for minority communities by providing mental health services in a patient’s primary language. In this same study, many of the facilities that were surveyed cited cost as a barrier to having more culturally competent services in a range of different languages. They also noted that there are only a few private insurance companies and only 13 state-funded Medicaid plans that reimburse for translation services, meaning in many cases when mental health providers/facilities provide translation services they are losing money in doing so.
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