Cultural Humility Is Key for Inclusive Behavioral Health Practices

As behavioral health professionals, we have clients  who have often experienced the traumatic effects of racism. How can we ensure that we’re providing the best care to these clients regardless of our own racial identity, past experiences, and learned biases? 

Many antiracist educators believe that a first step is to approach our lives and work with a sense of cultural humility. Cultural humility is a form of cultural competence that begins with listening to the stories and experiences of clients, honoring the wisdom and resilience they already have.

These days, as our nation and world face an awakening and reckoning around the traumatic and sometimes deadly effects of racism, approaching our professional relationships with cultural humility creates an opening for both clients and clinicians.

The Harm of Negative Stereotypes

There should be no doubt in our minds that racism harms Black and Brown communities.

Multiple studies have confirmed discrimination in housing, money lending, employment, criminal justice, health care, and other arenas. And many members of disadvantaged groups experience discrimination and negative stereotyping, even at young ages. 

But how do racism and discrimination affect the behavioral health community?

First, racism is a health care issue. A 2018 study published in the Journal of Health and Social Behavior outlined some of the ways that stressors affect the mental health of people of color. It also reviewed the literature connecting discrimination with depressive symptoms, serious psychological distress, and comorbidity.

A 2018 study discovered that adults who work with nonwhite populations had high levels of racial stereotyping; the researchers found that Black kids, from ages zero to eight, were more likely to be considered lazy, unintelligent, or prone to violence than their peers.

We need to make sure these harmful stereotypes don’t make their way into our treatment practices, resulting in implicit bias. Implicit bias is a set of beliefs that exists in our subconscious minds, often based on race, ethnicity, age, or appearance. Implicit bias on the part of practitioners contributes to inferior health care experiences and outcomes for people of color.

Unfortunately, the mental health system has a long history of cooperating with racist institutions and bolstering biased beliefs and judgments. 

Mental Health Disparities

An article on the roots of racial disparities in the mental health system in Counseling Today reports that Black, Indigenous, and other people of color are less likely to seek out and receive mental health services. They are also less likely to have access to quality care and to end care prematurely. Black men are often misdiagnosed with schizophrenia and underdiagnosed with PTSD.

Some of this has to do with the cultural mismatch between client and practitioner. Eighty‑six percent of psychologists are white, for example. 

The unfortunate historical reality is that prominent psychiatrists were responsible for promoting some of the scientific racism that supported slavery, our nation’s shameful trauma. They invented mental illnesses like “drapetomania,” which caused enslaved people to flee captors, and “dysaethesia aethiopica,” which caused laziness, “rascality,” and “disrespect for the master’s property,” according to the prominent US physician Samuel Cartwright.

Some of today’s racism is less obvious, but it still harms and traumatizes millions of individuals.

Racist science was one of the institutions used to elevate white people above the other races.

How do we start to undo such a history?

Cultivating Cultural Humility

Cultural humility starts with listening to the stories and experiences of our clients and honoring their wisdom and resilience. It requires a committed exploration of culture and identity, recognizing the messages and cultural identities we grew up with. When we learn to recognize our formative experiences, values, and culture, we create greater freedom to forgive, empower, and transform. 

In a previous Consortium Speaks blog post addressing how professional training should be improved to equip social workers to address the effects of racism and disenfranchisement, researcher and social worker Erica Reshard recommends a curriculum that teaches cultural humility. She contrasts this approach with the “colorblind” curricula and approaches of the past, which discouraged students and practitioners from noticing and discussing racial differences and disparities. 

If more social workers and behavioral health practitioners were educated in the practice of cultural humility, they would become better able to have uncomfortable conversations about race and diversity in their classrooms and treatment rooms. 

When practitioners approach their clients and their practice with a deeper understanding of race‑related trauma and a sense of cultural humility, they offer the possibility of greater intimacy and authenticity. 

And that is a positive step toward a healthier society.