Cultural Diversity Series:

Meeting the Mental Health Needs of African Americans

Executive Summary

The National Technical Assistance Center for State Mental Health Planning (NTAC) is pleased to release this first installment in its Cultural Diversity Series, a series of technical assistance reports focusing on the mental health needs and access issues of diverse ethnic and non-ethnic populations. The increasingly heterogeneous composition of the U.S. population has important implications for the delivery of public mental health services, particularly for state mental health agencies (SMHAs). The Cultural Diversity Series is designed to facilitate a greater understanding of:

• the need for culturally competent mental health services;

• strategies for providing more culturally competent mental health services and supports; and

• the resources necessary and available to develop culturally competent mental health services.

Public mental health systems must adapt to the changing U.S. population or risk becoming irrelevant in the health care marketplace of the future. Foremost, is the desire to provide high-quality mental health services equitably to all persons and groups. There are also compelling business reasons to incorporate cultural competence into state mental health systems. As mental health systems evolve under managed care, growing attention is devoted to contracting requirements and patients' rights.

There are compelling business reasons to incorporate cultural competence into state mental health systems. Public mental health systems must adapt to the changing U.S. population or risk becoming irrelevant in the health care marketplace of the future. Foremost is the desire to provide high-quality mental health services equitably to all persons and groups. As mental health systems evolve under managed care, growing attention is devoted to contracting requirements and patients' rights. SMHAs face legal obligations to provide culturally appropriate services that may involve not only removing cultural barriers but also actively engaging of clients from dozens of different ethnic backgrounds and a variety of other marginalized populations. State Mental Health Agencies (SMHAs) that ignore or minimize the racial, ethnic and cultural diversity of their clientele are likely to face serious liability issues in the future.

The task of becoming culturally competent is daunting, particularly given the growing number of cultural groups represented in this country. For example, Rhode Island, the smallest state in the nation, contracts with interpreters who speak 41 separate languages to accommodate its diverse population receiving human services.

While some biases may derive from bigoted attitudes and beliefs, others arise from a simple lack of knowledge and exposure to individuals from diverse groups. However, "small" behaviors often carry large consequences; misunderstandings sometimes result from unintended "insults" based on miscommunication rather than lack of sensitivity. Training in cultural competency can help increase provider proficiency in communicating with consumers with traditions and histories unfamiliar to the provider.

Despite the challenges, efforts to develop culturally competent mental health systems steadily continue. States are adopting a wide range of approaches, including creating specialized services for some ethnic and non-ethnic minorities, establishing linkages between the formal mental health system and traditional healers and community supports, and inviting community leaders to help guide the mental health system in its efforts to improve services.

African Americans and the

Mental Health System

The initial report of the Cultural Diversity Series--African Americans and the Mental Health System --focuses on the United States' largest ethnic minority group. The report provides a demographic and cultural overview of African Americans, describes their mental health needs, and describes traditional patterns of service utilization and suggests strategies for enhancing access to effective, culturally competent mental health services. In addition, the report provides profiles of the following two outstanding programs:

• African American Family Services (AAFS), a multifaceted, culturally-specific agency that provides mental health and substance abuse services in Minneapolis and St. Paul, MN;

• The Village Project, based in South Carolina's Charleston/Dorchester Community Mental Health Center, which provides a range of mental health and support services to children and families.

The profiles address the programs' philosophy and values, services and supports, funding sources and available evaluation data. Although a high percentage of those served by these culturally competent programs are African Americans, many of the programs' strategies are also applicable to consumers from other underserved or marginalized groups.