Tuesday, Aug 10, 2021

Belonging and Culturally Centered Care Are Key to Effectively Supporting the Mental Health of Diverse Populations

Alyson WatsonFounder & CEO, Modern Health


World events of recent years, including the global pandemic, its related economic fallout, and incidents of racial violence have called stark attention to the many racial disparities in mental health care. 

As just one example, rates of depression and anxiety spiked among Black Americans following George Floyd’s murder in May 2020, with no mental health care safety net in sight: Amid the pandemic, the field was experiencing an era of unprecedented demand for mental health services that Black Americans were less able to access. Similarly, the U.S. uptick in anti-Asian racism resulted in increased anxiety, depression, and sleep concerns for Asian Americans and Pacific Islanders, and AAPI individuals are worryingly less likely to receive mental health care than any other racial group. In these and other ways, events of the last few years held a mirror up to the field of mental health care and pointed out our collective failings in caring for huge numbers of our populations.

So how do we do better, and care for the mental health and well-being of all of our patients and members more fully? To start, it’s become apparent that leaders in mental health care need to broaden their thinking about their diversity, equity, and inclusion (DEI) strategies to incorporate the psychological concept of belonging. In this sense, to belong means to feel safe, accepted, and welcomed for all aspects of your identity in a group setting. In the context of the workplace—where Modern Health meets most of its members—belonging relates to “feeling seen for your unique contributions, connected to your coworkers, supported in your daily work and career development, and proud of your organization’s values and purpose.” Belonging is a fundamental need, as made evident by the sharp drop in psychological well-being in the era of social isolation during COVID. If, as mental health leaders, the ultimate goal of your DEI initiatives is to support and uplift your members, prioritize their well-being, and extend them more equitable opportunities, then belonging cannot be left out of your planning. When you add belonging to your strategy (and it becomes DEIB), you’ll think more holistically about equitable spaces for providing care, the types of care that should be offered, and even who should provide it. 

On that note, probably the most obvious “solution” for addressing DEIB in mental health is increasing the diversity of provider networks. This is a crucial effort for many reasons; research has shown that a provider-client racial match may be linked to greater satisfaction, increased service utilization, decreased dropout from treatment, and other positive treatment outcomes, for example. But there is a dramatic shortage of mental health professionals worldwide, and the shortage of providers who identify as Black, Indigineous, and People of Color (BIPOC) is even more pronounced: A 2019 assessment of practicing psychologists in the U.S. revealed that 83% identified as white, 7% as Hispanic, 4% as Asian, and 3% as Black/African American, nowhere near mirroring the racial makeup of the nation. Yet, despite industry awareness of the problem, between 2009 and 2019, the percentage of psychologists who identified as white remained relatively steady, showing little to no change in the diversity of the field. The challenge becomes even more pronounced when intersectionality is considered (e.g., a patient seeking a provider who is Black, queer, and female). We and our peers must commit to narrowing this gap while recognizing that it will take decades to close it. By leveraging technology to connect providers with individuals not in the same region, we are able to start optimizing for this imbalance as we try to increase the supply of BIPOC providers. But in the meantime, we must find ways to improve mental health outcomes for diverse populations now. 

While it’s not scalable to rapidly increase the diversity of the worldwide mental health provider network, it is scalable to improve the skills of the providers the world does have available. So we propose making culturally centered care a standard practice for all mental health providers. By culturally centered care, we mean care that is “patient-centered, values cultural humility among providers, and is implemented in environments that respect and appreciate patient diversity and represented cultures.” Culturally centered care has cultural humility at its core—in other words, the provider being open to worldviews other than their own, which they may never fully understand but are still committed to respecting and learning more about. Evidence shows that culturally centered care works, and we believe all providers—both U.S. and international—should be trained in culturally centered care and participate regularly in continuing education to overcome pre existing and lingering biases and stereotypes. 

The last element of integrating DEIB into mental health care that I want to address is something I mentioned earlier—how considering belonging mandates questions about how and where mental health care is delivered. We believe it’s crucial to offer people a choice in how they want to receive mental health care. While clinical therapy is widely considered the default modality of care, our research shows that not only do most people not need this intensive type of care, more than 50% of our members don’t prefer this type of care. Desire for therapy versus other treatment types like one-on-one coaching, self-serve digital care like courses and meditations, and group care vary by demographics like age, gender, and ethnicity, and to fail to offer a choice in care type is to fail to offer culturally centered care. Similarly, integrating belonging into mental health care necessitates making space for individuals to improve their well-being in the context of their social identities—places where they can collectively share, connect, heal, and grow. Examples include identity-specific, provider-led group sessions in mental health care settings and employee resource groups in the workplace. 

While there are many ways to address the rising need for mental health services among diverse populations amid the continued shortage of mental health providers who identify as racial and ethnic minorities, we believe these three factors are crucial to developing a system of mental health care that fosters a sense of belonging, acknowledges cultural diversity, and improves access to care for our entire populations. 

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