Why Cultural Competence?

According to the 2000 Census, Hispanics represented 27% of New York City’s population, while African Americans represented 25% and Asians represented 10%. NYC was found to have a 62% majority of Hispanics, African Americans, and Asian, making "minorities" the majority. Moreover, forty-seven percent (47%) of New York City households speak a language other than English in the home. In fact, more than one-quarter of the City's residents are limited-English proficient.

It is especially important to consider New York’s diverse population when thinking of healthcare. Ethnically and linguistically underserved people face decreased detection of mental health problems in primary care, and have lower rates of entry into, adherence with, and retention in specialty mental health services (Borowsky et al., 2000; Alegria et al., 2002; Hough et al. 2002, Olfson et al. 2006). Once they access mental health treatment, African Americans and Latinos are less likely to receive guideline- concordant care. (Wang et al., 2000;l Young et al., 2001; Miranda et al., 2003). In addition, linguistic minorities have to cope with severe limitations in the availability of linguistically appropriate services (Snowden et al. 2007). Like their majority counterparts, minority patients with serious mental illness (SMI) are at risk for untreated medical disorders, but their risk is even greater than in the white community due to higher baseline rates of hypertension, diabetes, and obesity, as well as poorer-quality medical care (Betancourt et al. 1999, DHHS, 2000; IOM, 2002).
A culturally competent approach to care provision has a potential to address some of these health disparities. Cultural Competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations (Cross et al., 1989). As part of culturally competent care, a care provider would consider culture-specific elements of a patient’s lifestyle such as emotional expression, familial living arrangements, or recreational activities. Considering these elements facilitates accurate diagnosis and treatment planning that reaches across cultural boundaries and is acceptable to patients and their families.
Therefore, providers and systems should always incorporate cultural information into the treatment process, but particularly when:

• Facilitating treatment across cultural boundaries
• Identifying untreated mental health and physical disorders in ethnically and linguistically underserved patients

A culturally competent approach to care would result in:

• Reducing barrier to access by improving coordination across sectors of care in ways that are consonant with patients’ expectations
• More accurate diagnosis and treatment planning that reaches across cultural boundaries and is acceptable to patients and their families
• Better patient and family engagement with the treatment process leading to improved retention and adherence

Works cited:
Alegría, M., Canino, G., Ríos, R., Vera, M., Calderón, J., Rusch, D. et al. (2002). Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino White.  Psychiatric Services, 53(12), 1547-1555.

Betancourt, J., Carrillo, J.E., & Green, A.R. (1999). Hypertension in multicultural and minority populations: Linking communication to compliance. Current Hypertension Reports, 1, 482-488.

Borowsky, S.J., Rubenstein, L.V., Meredith, L.S., Camp, P., Jackson-Triche, M., & Wells, K.B. (2000). Who is at risk of nondetection of mental health problems in primary care? Journal of General Internal   Medicine, 15, 381-388.

Cross, T. L., Bazron, B. J., Dennis, K. W., & Issacs, M. R. (1989). Toward a culturally competent system of care. Washington, D. C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.

Hough, R.L., Hazen, A.L., Soriano, F.I., Wood, P., McCabe, K., & Yeh, M. (2002). Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services, 53(12), 1556-1562. Institute of Medicine (IOM) (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academies Press.

Miranda, J., Duan, N., Shebourne, C., Schoenbaum, M., Lagomasino, I., Jackson-Triche, M. et al. (2003). Improving care for minorities: Can quality improvement interventions improve care and outcomes for depressed minorities?: Results of a randomized, controlled trial. Health Services Research, 38(2), 613-630.

Olfson, M., Marcus, S.C., Tedeschi, M., & Wan, G.J. (2006). Continuity of antidepressant treatment for adults with depression in the United States. American Journal of Psychiatry, 163(1), 101-108.

Snowden, L.R., Masland, M., & Guerrero, R. (2007). Federal civil rights policy and mental health treatment access for persons with limited English proficiency. American Psychologist, 62(2), 109-117.

Wang, P.S., Berglund, P., & Kessler, R.C. (2000). Recent care of common mental disorders in the United States. Journal of General Internal Medicine, 15, 284-292.

Young, A.S., Klap, R., Sherbourne, C.D., & Wells, K.B. (2001). The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry, 58, 55-61.