Cultural Competence: Improving Mental Health
How might developing cultural competence improve mental health services?
The inequalities within the health and social care system are widely recognised (K272, Unit 1, p. 10, K272, Unit 4, p. 79). These inequalities relate to the boundaries within the society and especially communication (Anderson et al, 2003). The disproportions in the multicultural society may be even bigger due to higher number of boundaries and lack of understanding demonstrated by the majority towards minorities. Health and social care services should accommodate everybody’s needs. Mental health services should be developed to promote equality and inclusion and should be available for whole society. Implementing the cultural competence model could be one of the ways to ensure fairness of the mental health services. In this essay we will discuss what the cultural competence is and how to implement it in the metal health services. We will also try to distinguish if the implementation of cultural competence model would improve current services. …show more content…
The cultural competence model was developed by I.
Papadopoulos and colleagues in 1998 to ‘help health care workers respond sensitively to patients’ (K272, Unit 4, p. 92). Cultural competence goes further than multiculturalism which focuses on knowledge of different cultures and developing sensitivity to cultural diversity (The Open University, 2010). Cultural competence focuses on the structures and boundaries within the society. According to I. Papadopoulos the knowledge of different cultures promotes tolerance and understanding within society but doesn’t promote the equality (The Open University, 2010 ). Even further the structures of organisations could be enabling people but also the can create boundaries and disabling individuals or groups from accessing the services (The Open University,
2010).
Developing cultural competence is a process. The model on its own is divided into four stages. The first step is the development of the cultural awareness. As highlighted by I. Papadopoulos (The Open University, 2010 ) ‘as cultural beings we need to really look at our own culture, our own cultural heritage , our own identity, the importance how it defines our lives and how it impacts on our behaviour and our health’. The first step is to understand and realise how the culture we were brought up affects us and how we respond to it. I. Papadopoulos also highlights the importance of the professional and any other acquired cultures (The Open University, 2010 ). Every individual acquires culture of the group that they belong to either professional (lawyer, doctor, teacher) or recreational (hockey player, choir singer).
The next step in developing cultural competence is cultural knowledge which can be achieved by contact with people from other ethnic groups that yours (K272, Unit 4, p. 93). Values and beliefs of the minorities groups which health and social care workers are getting familiar with should be then related to their own. That process should help to realise the differences and similarities between cultures. The final point in that stage should be the realisation that everybody is different but there are more similarities than differences between people (The Open University, 2010 ). Another important aspect in developing cultural knowledge is the issue related to the power between service user/survivor and practitioner. Superior knowledge possessed by the professional may create unequal relationship between them and service users/survivors (The Open University, 2010 ).
The third stage of the model focuses on skills developed by the practitioner. The cultural sensitivity is about how professionals see service users/survivors and how they develop professional and appropriate relationship (K272, Unit 4, p.93). The issue of power and trust is predominant in that stage. If the relationship between individual and health or social care professional is not built on partnership the cultural sensitivity might not be achieved (K272, Unit 4, p. 93).
The final stage of the model, which is called cultural competence, brings and ties cultural awareness, knowledge and sensitivity together (The Open University, 2010 ). The focal point in that stage is the assessment that can be made without any oppressive practice and is built on partnership and understanding (K272, Unit 4, p. 93). Services which achieved cultural competence should be able to challenge any racism or discriminatory practice and recognise cultural issues within and outside of the service.
After establishing what cultural competence means we should consider how the services which are culturally competent may be developed. We will consider the development of the culturally competent services on different levels. Firstly we will consider the national level. The development of one mental health service that is culturally competent for all cultural groups is impossible due to the vast number of different cultures represented in the society and theirs geographical spread. It doesn’t mean that the culturally competent services can’t be designed and implemented. The focus of the service should be on the minority groups which are represented in the local area. To establish the needs of the service in the locality the statistic data should be used (Department of Health, 2005, p. 61) in correlation with the assessment of the services. Existing services should be assessed for the cultural competence and the future mental health services should be planned to implement cultural competence model. The nation strategy for development of culturally competent services should be implemented which took place in England in 2005 (Department of Health) and in Scotland in 2012 (Scottish Government). The local and national government should enable the local and national organisations by creating the culture of social inclusion and equality which help developing appropriate mental health services (K272, Unit 4, p. 90).
On the service providers level clear policies on equality should be developed. Organisations should implement training on equality, racism and discrimination along with cultural awareness and communication skills. This should enable front line staff to achieve cultural awareness and knowledge (K272, Unit 4, p. 93). The employment policy may also have impact on cultural awareness and knowledge. Creating the opportunity of working in multicultural team may help staff to understand the culture and reflect on the diversity of the society. It can also help to realise the similarities between different ethnic groups, which should promote cultural knowledge and cultural sensitivity (K272, Unit 4, p. 93). The identification of the barriers in personal and career development along with achieving diversity on all levels of the organisational structure can lead to the achievement of the cultural competence amongst staff (Anderson et al, 2003, p. 73). However it is not always possible to employ appropriate person due to lack of interest amongst the ethnic minority group.
The bilingual workforce or use of the interpreter services can assure the high quality service by promoting the choice of the service users/survivors, better understanding of symptoms and preferences in treatment or interventions (Anderson et al, 2003, p. 73).In that aspect the cultural knowledge and sensitivity could be exercise which would promote the implementation of the cultural competence model in mental health services (The Open University, 2010). Due to complexity of the language, involvement of the third party (interpreter), professional jargon and lack of training the translation may lead to additional barriers in communication. The service should be therefore planned in advance and the means should be undertaken to overcome these barriers (Anderson et al, 2003).
As stated by L. Anderson and colleagues (2003, p. 74) ‘health information messages developed for the majority population may be inaccessible or unsuitable for other cultural or ethnic groups’. Also some healthcare settings may create barriers to communication and therefore may not be used by minority groups (Anderson et al, 2003). These two aspects would prevent the cultural knowledge and sensitivity to be developed and therefore the cultural competence could not be implemented (The Open University, 2010). In some cases the outreach services may be more appropriate and easier to accept for the service users/survivors.
There are more barriers which jeopardise the implementation of the model of cultural competence. The religious aspects of individual’s life may not be respected, the same gender staff may not be available, lack of the diet which reflects cultural or religious beliefs, lack of continuous assessment of service users/survivors needs may be pointed as some of them (K272, Unit 4, pp. 95-96). The barriers may be multiplied by abandoning the holistic approach to mental health, which correlates with the model of cultural competence.
The holistic approach which focuses on the person and their background highlights the necessity of the wide overview of the individual. The person must be seen as individual with personal history and identity that developed over the time. In that aspect the culture, beliefs, emotions and social interactions shape the individual being (K272, Unit 1, pp. 23-24). The correlation between the holistic model of mental health and the model of cultural competence can be recognised in the approach to the person as an individual with background that is as much important as the physical human being. The mental wellbeing is shaped by all the aspects of the holistic model. These aspects create the culture which shaped the individual during their life. To achieve the mental health services which are culturally competent we must recognise and use the holistic model of mental health.
As highlighted by I. Papadopoulos (The Open University, 2010) the implementation of the model of cultural competence is a long term process. The learning about service users/survivors, their background and culture should happen on a constant basis. The process is long lasting and the model focuses on development of cultural competence (K272, Unit 4, p. 94). People and their culture changes under influence of their peers, family, society therefore the process should be focused on the learning new facts and skills and implementing them on a daily basis in the mental health services.
Implementing the cultural competence model in mental health services is reflected in recent policies and approaches to mental health. It is important to develop culturally competent services to accommodate needs of whole society and prevent exclusion of the minority groups. It is important to challenge any discriminatory approaches and incident to implement equality amongst society. The culturally competent services should improve the quality of service provided. It should also help to access the mental health services by the ethnical and cultural minorities. However the implementation of the model of cultural competence may be a long lasting process focused on raising awareness of the diversity in the society, promoting knowledge and development of new skills and their implementation. The learning process should be maintained as new cultural aspects may arise and society may become more diverse.
References:
Anderson, L. M., Scrimshaw, S. C., Fullilove, M. T., Fileding, J. F., Normand J., Task Force on Community Preventive Services (2003) ‘Culturally competent healthcare system. A systematic Review’, American Journal of Preventive Medicine, Vol. 24, No. 3S, [online:] http://www.thecommunityguide.org/social/soc-AJPM-evrev-healthcare-systems.pdf, (accessed 10 December 2012)
Department of Health (2005) Delivering Race Equality in Mental Health. An Action Plan for Reform Inside and Outside Services, London, [online:] http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4100775.pdf, (accessed 10 December 2012)
Scottish Government (2012) Mental Health Strategy for Scotland: 2012-2015, [online:] http://www.scotland.gov.uk/Publications/2012/08/9714, (accessed 10 December 2012)
The Open University (2010) K272 Challenging Ideas in Mental Health, Block 1 ‘Shifting boundaries’, Unit 1 ‘Boundaries of explanation’, Milton Keynes, The Open University.
The Open University (2010) K272 Challenging Ideas in Mental Health, Block 1 ‘Shifting boundaries’, Unit 4 ‘Culture, ethnicity and mental health’, Milton Keynes, The Open University.
The Open University (2010) Audio 1 ‘Shifting Boundaries’, Track 4 ‘Cultural competence’, K272 Challenging Ideas in Mental Health’ Milton Keynes, The Open University
Words: 1730
The inequalities within the health and social care system are widely recognised (K272, Unit 1, p. 10, K272, Unit 4, p. 79). These inequalities relate to the boundaries within the society and especially communication (Anderson et al, 2003). The disproportions in the multicultural society may be even bigger due to higher number of boundaries and lack of understanding demonstrated by the majority towards minorities. Health and social care services should accommodate everybody’s needs. Mental health services should be developed to promote equality and inclusion and should be available for whole society. Implementing the cultural competence model could be one of the ways to ensure fairness of the mental health services. In this essay we will discuss what the cultural competence is and how to implement it in the metal health services. We will also try to distinguish if the implementation of cultural competence model would improve current services. …show more content…
The cultural competence model was developed by I.
Papadopoulos and colleagues in 1998 to ‘help health care workers respond sensitively to patients’ (K272, Unit 4, p. 92). Cultural competence goes further than multiculturalism which focuses on knowledge of different cultures and developing sensitivity to cultural diversity (The Open University, 2010). Cultural competence focuses on the structures and boundaries within the society. According to I. Papadopoulos the knowledge of different cultures promotes tolerance and understanding within society but doesn’t promote the equality (The Open University, 2010 ). Even further the structures of organisations could be enabling people but also the can create boundaries and disabling individuals or groups from accessing the services (The Open University,
2010).
Developing cultural competence is a process. The model on its own is divided into four stages. The first step is the development of the cultural awareness. As highlighted by I. Papadopoulos (The Open University, 2010 ) ‘as cultural beings we need to really look at our own culture, our own cultural heritage , our own identity, the importance how it defines our lives and how it impacts on our behaviour and our health’. The first step is to understand and realise how the culture we were brought up affects us and how we respond to it. I. Papadopoulos also highlights the importance of the professional and any other acquired cultures (The Open University, 2010 ). Every individual acquires culture of the group that they belong to either professional (lawyer, doctor, teacher) or recreational (hockey player, choir singer).
The next step in developing cultural competence is cultural knowledge which can be achieved by contact with people from other ethnic groups that yours (K272, Unit 4, p. 93). Values and beliefs of the minorities groups which health and social care workers are getting familiar with should be then related to their own. That process should help to realise the differences and similarities between cultures. The final point in that stage should be the realisation that everybody is different but there are more similarities than differences between people (The Open University, 2010 ). Another important aspect in developing cultural knowledge is the issue related to the power between service user/survivor and practitioner. Superior knowledge possessed by the professional may create unequal relationship between them and service users/survivors (The Open University, 2010 ).
The third stage of the model focuses on skills developed by the practitioner. The cultural sensitivity is about how professionals see service users/survivors and how they develop professional and appropriate relationship (K272, Unit 4, p.93). The issue of power and trust is predominant in that stage. If the relationship between individual and health or social care professional is not built on partnership the cultural sensitivity might not be achieved (K272, Unit 4, p. 93).
The final stage of the model, which is called cultural competence, brings and ties cultural awareness, knowledge and sensitivity together (The Open University, 2010 ). The focal point in that stage is the assessment that can be made without any oppressive practice and is built on partnership and understanding (K272, Unit 4, p. 93). Services which achieved cultural competence should be able to challenge any racism or discriminatory practice and recognise cultural issues within and outside of the service.
After establishing what cultural competence means we should consider how the services which are culturally competent may be developed. We will consider the development of the culturally competent services on different levels. Firstly we will consider the national level. The development of one mental health service that is culturally competent for all cultural groups is impossible due to the vast number of different cultures represented in the society and theirs geographical spread. It doesn’t mean that the culturally competent services can’t be designed and implemented. The focus of the service should be on the minority groups which are represented in the local area. To establish the needs of the service in the locality the statistic data should be used (Department of Health, 2005, p. 61) in correlation with the assessment of the services. Existing services should be assessed for the cultural competence and the future mental health services should be planned to implement cultural competence model. The nation strategy for development of culturally competent services should be implemented which took place in England in 2005 (Department of Health) and in Scotland in 2012 (Scottish Government). The local and national government should enable the local and national organisations by creating the culture of social inclusion and equality which help developing appropriate mental health services (K272, Unit 4, p. 90).
On the service providers level clear policies on equality should be developed. Organisations should implement training on equality, racism and discrimination along with cultural awareness and communication skills. This should enable front line staff to achieve cultural awareness and knowledge (K272, Unit 4, p. 93). The employment policy may also have impact on cultural awareness and knowledge. Creating the opportunity of working in multicultural team may help staff to understand the culture and reflect on the diversity of the society. It can also help to realise the similarities between different ethnic groups, which should promote cultural knowledge and cultural sensitivity (K272, Unit 4, p. 93). The identification of the barriers in personal and career development along with achieving diversity on all levels of the organisational structure can lead to the achievement of the cultural competence amongst staff (Anderson et al, 2003, p. 73). However it is not always possible to employ appropriate person due to lack of interest amongst the ethnic minority group.
The bilingual workforce or use of the interpreter services can assure the high quality service by promoting the choice of the service users/survivors, better understanding of symptoms and preferences in treatment or interventions (Anderson et al, 2003, p. 73).In that aspect the cultural knowledge and sensitivity could be exercise which would promote the implementation of the cultural competence model in mental health services (The Open University, 2010). Due to complexity of the language, involvement of the third party (interpreter), professional jargon and lack of training the translation may lead to additional barriers in communication. The service should be therefore planned in advance and the means should be undertaken to overcome these barriers (Anderson et al, 2003).
As stated by L. Anderson and colleagues (2003, p. 74) ‘health information messages developed for the majority population may be inaccessible or unsuitable for other cultural or ethnic groups’. Also some healthcare settings may create barriers to communication and therefore may not be used by minority groups (Anderson et al, 2003). These two aspects would prevent the cultural knowledge and sensitivity to be developed and therefore the cultural competence could not be implemented (The Open University, 2010). In some cases the outreach services may be more appropriate and easier to accept for the service users/survivors.
There are more barriers which jeopardise the implementation of the model of cultural competence. The religious aspects of individual’s life may not be respected, the same gender staff may not be available, lack of the diet which reflects cultural or religious beliefs, lack of continuous assessment of service users/survivors needs may be pointed as some of them (K272, Unit 4, pp. 95-96). The barriers may be multiplied by abandoning the holistic approach to mental health, which correlates with the model of cultural competence.
The holistic approach which focuses on the person and their background highlights the necessity of the wide overview of the individual. The person must be seen as individual with personal history and identity that developed over the time. In that aspect the culture, beliefs, emotions and social interactions shape the individual being (K272, Unit 1, pp. 23-24). The correlation between the holistic model of mental health and the model of cultural competence can be recognised in the approach to the person as an individual with background that is as much important as the physical human being. The mental wellbeing is shaped by all the aspects of the holistic model. These aspects create the culture which shaped the individual during their life. To achieve the mental health services which are culturally competent we must recognise and use the holistic model of mental health.
As highlighted by I. Papadopoulos (The Open University, 2010) the implementation of the model of cultural competence is a long term process. The learning about service users/survivors, their background and culture should happen on a constant basis. The process is long lasting and the model focuses on development of cultural competence (K272, Unit 4, p. 94). People and their culture changes under influence of their peers, family, society therefore the process should be focused on the learning new facts and skills and implementing them on a daily basis in the mental health services.
Implementing the cultural competence model in mental health services is reflected in recent policies and approaches to mental health. It is important to develop culturally competent services to accommodate needs of whole society and prevent exclusion of the minority groups. It is important to challenge any discriminatory approaches and incident to implement equality amongst society. The culturally competent services should improve the quality of service provided. It should also help to access the mental health services by the ethnical and cultural minorities. However the implementation of the model of cultural competence may be a long lasting process focused on raising awareness of the diversity in the society, promoting knowledge and development of new skills and their implementation. The learning process should be maintained as new cultural aspects may arise and society may become more diverse.
References:
Anderson, L. M., Scrimshaw, S. C., Fullilove, M. T., Fileding, J. F., Normand J., Task Force on Community Preventive Services (2003) ‘Culturally competent healthcare system. A systematic Review’, American Journal of Preventive Medicine, Vol. 24, No. 3S, [online:] http://www.thecommunityguide.org/social/soc-AJPM-evrev-healthcare-systems.pdf, (accessed 10 December 2012)
Department of Health (2005) Delivering Race Equality in Mental Health. An Action Plan for Reform Inside and Outside Services, London, [online:] http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4100775.pdf, (accessed 10 December 2012)
Scottish Government (2012) Mental Health Strategy for Scotland: 2012-2015, [online:] http://www.scotland.gov.uk/Publications/2012/08/9714, (accessed 10 December 2012)
The Open University (2010) K272 Challenging Ideas in Mental Health, Block 1 ‘Shifting boundaries’, Unit 1 ‘Boundaries of explanation’, Milton Keynes, The Open University.
The Open University (2010) K272 Challenging Ideas in Mental Health, Block 1 ‘Shifting boundaries’, Unit 4 ‘Culture, ethnicity and mental health’, Milton Keynes, The Open University.
The Open University (2010) Audio 1 ‘Shifting Boundaries’, Track 4 ‘Cultural competence’, K272 Challenging Ideas in Mental Health’ Milton Keynes, The Open University
Words: 1730