Addressing culture in mental health practice

The development of evidence-based practices (EBPs) has been a major force in improving the quality of mental health services. EBPs are ways of delivering services to people using scientific evidence that has shown that the services actually work, based on the results of rigorous evaluations. Treatments like cognitive-behavioral therapy (CBT), shown to be efficacious in numerous treatment studies across researchers, are considered more likely to yield positive outcomes than treatments without such data.

Although providing EBPs for people of color with mental illnesses would appear to be a logical way to increase the quality of care received and its outcomes, this approach has been controversial. Many ethnic minority communities raise concern that minority populations were not include in clinical trials of EBPs and thus the impact of culture on EBP treatment efficacy is unknown. Given the significant ethnic/racial differences in how people conceptualize mental illness, recognize their own distress, communicate their distress to others, seek help, and participate in treatment, it is clear that culture matters.

Consideration of the impact of culture has been minimal, yet EBPs are being adopted and promoted by private insurers and state and local governments across the nation in the name of increasing quality of services and optimizing financial investments. As a result, many funders in multicultural communities now require the use of EBPs in provider contracts and providers are presented with the problem of having to “fit” EBPs with little guidance on standards for adaptation for culture, language, and context.

The Minnesota Department of Human Services (DHS) Mental and Chemical Health Division began a multiyear collaboration with its partners Metro State University, Minneapolis Community and Technical College, and Prairieland Addiction Technology Transfer Center to work together on a motivational interviewing (MI) train-the-trainers project for mental health providers and chemical health counselors to learn how to deliver basic training in motivational interviewing and subsequently integrated cultural adaptations for Native people into the MI curriculum. Program elements regarding the training initiative, challenges and solutions in recruitment of native people, the delivery of MI to Native people, developing competencies, and the need to recruit Native Americans as trainers will be discussed. Other tribal examples of cultural adaptations of EBPs include the experiences of the American Indian and Alaska Native systems of care (1994-2007) approaching cultural adaptation from different perspectives. The Indian Country Child Trauma Center’s (www.icctc.org) work on cultural adaptation of Parent-Child Interactive Therapy, Trauma-Focused Cognitive Behavioral Therapy, and Children with Sexual Behavior Problems Therapy will be highlighted.

In 2006, the Hogg Foundation for Mental Health announced awards to five Texas organizations to adapt the delivery of evidence-based practices (EBPs) to be compatible with the cultures of the populations of color served by these organizations (Latinos and African Americans) . Such cultural adaptations, including challenges and solutions to implementation, are the focus of the Foundation's Cultural Adaptation Initiative. The Foundation's objectives are to increase the availability of effective mental health services for people of color in Texas and to generate new knowledge about cultural adaptations of EBPs. and to generate new knowledge about cultural adaptations of EBPs.