Executive Summary Contents
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Main Message: Culture Counts
Culture and society play pivotal roles in mental health,
mental illness, and mental health services.
Understanding the wide-ranging roles of culture and
society enables the mental health field to design and
deliver services that are more responsive to the needs of
racial and ethnic minorities.
Culture is broadly defined as a common heritage or
set of beliefs, norms, and values (DHHS, 1999). It refers
to the shared attributes of one group. Anthropologists
often describe culture as a system of shared meanings.
The term "culture" is as applicable to whites as it is to
racial and ethnic minorities. The dominant culture for
much of United States history focused on the beliefs,
norms, and values of European Americans. But today's
America is unmistakably multicultural. And because
there are a variety of ways to define a cultural group
(e.g., by ethnicity, religion, geographic region, age
group, sexual orientation, or profession), many people
consider themselves as having multiple cultural identities.
With a seemingly endless range of cultural subgroups
and individual variations, culture is important
because it bears upon what all people bring to the clinical
setting. It can account for variations in how consumers
communicate their symptoms and which ones
they report. Some aspects of culture may also underlie
culture-bound syndromes - sets of symptoms much
more common in some societies than in others. More
often, culture bears upon whether people even seek help
in the first place, what types of help they seek, what
coping styles and social supports they have, and how
much stigma they attach to mental illness. All cultures
also feature strengths, such as resilience and adaptive
ways of coping, which may buffer some people from
developing certain disorders. Consumers of mental
health services naturally carry this cultural diversity
directly into the treatment setting.
Culture is a concept not limited to patients. It also
applies to the professionals who treat them. Every group
of professionals embodies a "culture" in the sense that
they too have a shared set of beliefs, norms, and values.
This is as true for health professionals as it is for other
professional groups such as engineers and teachers. Any
professional group's culture can be gleaned from the
jargon they use, the orientation and emphasis in their
textbooks, and from their mindset or way of looking at
the world.
Health professionals in the United States and the
institutions in which they train and practice are rooted in
Western medicine which emphasizes the primacy of the
human body in disease and the acquisition of knowledge
through scientific and empirical methods. Through
objective methods, Western medicine strives to uncover
universal truths about disease: its causation, diagnosis,
and treatment. Its achievements have become the cornerstone
of medicine worldwide.
To say that physicians or mental health professionals
have their own culture does not detract from the universal
truths discovered by their fields. Rather, it means
that most clinicians share a worldview about the interrelationship
between body, mind, and environment
informed by knowledge acquired through the scientific
method. It also means that clinicians view symptoms,
diagnoses, and treatments in ways that sometimes
diverge from their clients' views, especially when the
cultural backgrounds of the consumer and provider are
dissimilar. This divergence of viewpoints can create
barriers to effective care.
The culture of the clinician and the larger health
care system govern the societal response to a patient
with mental illness. They influence many aspects of the
delivery of care, including diagnosis, treatments, and
the organization and reimbursement of services.
Clinicians and service systems, naturally immersed in
their own cultures, have been ill-equipped to meet the
needs of patients from different backgrounds and, in
some cases, have displayed bias in the delivery of care.
The main message of this Supplement is that "culture
counts." The cultures that patients come from shape
their mental health and affect the types of mental health
services they use. Likewise, the cultures of the clinician
and the service system affect diagnosis, treatment, and
the organization and financing of services. Cultural and
social influences are not the only influences on mental
health and service delivery, but they have been historically
underestimated - and they do count. Cultural differences
must be accounted for to ensure that minorities,
like all Americans, receive mental health care tailored
to their needs.
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