A Newsletter of the Office of Minority Health
Mental Health and Minorities
September 1997
Interview with Juan Ramos, PhD, Associate Director for Prevention, National Institute of Mental Health (NIMH)
Q. There is a lot of talk out there about how important it is to encourage mental health professionals to learn about treating diverse populations. Is this enough?
A. The encouragement is certainly important, but it is not enough. It places responsibility solely on the individual. It is more important to look at the infrastructure and authorizing bodies that impact the delivery system. It is vital that mental health facilities, educational institutions, and accrediting and licensing bodies incorporate cultural competency in their standards, criteria, and requirements.
Q. Do you think that such authorizing bodies are moving toward cultural competency requirements?
A. Not really. I have seen a lot of resistance in this area. It is true that organizations are giving increasing recognition to the importance of developing multicultural services. For example, the American Psychiatric Association has included information to enhance the cultural validity of the Diagnostic and Statistical Manual (DSM-IV) as a result of work done by an NIMH work group on culture, diagnosis, and care. The manual stresses that a clinician who is unfamiliar with a patient’s cultural frame of reference may incorrectly judge as psychopathology those normal variations in behavior, belief, or experience that are particular to the individual’s culture. While addressing cultural competency this way is a step in the right direction, it’s not a serious enough move toward actually requiring psychiatrists to know aspects of cultural competency. Licensing examinations do not include questions on cultural competency, so those in the helping profession cannot claim cultural competency when they successfully pass their licensing exams.
Q. What about educational institutions that offer courses on cultural competency? Are they on the right track?
A. They’re on the right track, but we run into problems when that individual begins practicing in a mental health system that is not aware of cultural differences. The clinic may have set rules of treatment, and so what the practitioner learned in school might not be accepted or allowed. This is why culture needs to also be incorporated into the clinic’s treatment programs. This can be done as part of meeting accreditation standards that require cultural and linguistic competency.
Q. What are the main steps that need to be taken to create real change and make cultural competency in mental health a reality?
A. Change is always a hard thing to come by, but there must be a systematic effort that’s based on accountability. The main steps are incorporating cultural and linguistic requirements in the criteria for accreditation of mental health organizations, agencies, and professional training programs, and in the factors in assessment or diagnostic tools, as well as in questions in national and state exams for licensing or certifying mental health professionals.
Q. What is NIMH doing to make these changes happen, and what can we do to help?
A. NIMH is developing the body of knowledge that will inform and improve diagnosis, treatment, and services. The Institute provides resources for the training of researchers in this area. Funded minority research centers are contributing to this knowledge base. Other agencies are applying knowledge and in the process raise pertinent research questions. We need to hear from the helping professions about research questions and relevant issues criticalfor behavioral interactions that are culturally appropriate.
Q. What are some examples of the organizations that should be making these changes--organizations that establish standards and render accreditation decisions?
A. The Joint Commission on Accreditation of Health Care Organizations (JCAHO); the Centers for Medicare and Medicaid Services (CMMS); the Council on Recognition of Postsecondary Accreditation (CORPA); and the Council on Accreditation of Services for Families and Children (COA). Changes are also necessary in national and state exams for the helping professions such as the Licensed Clinical Social Work Examination.
-Interview by Jean Oxendine
