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Shame & Mental Equity

by | Jan 28, 2022 | Equity, Mental Health

Forward, Together with western tidewater community services board

How Do Cultural, Racial & Economical Factors Play Into the Idea That Mental Health Treatment Is Shameful or Will Not Work?

This blog post was written by Brittany Sesek.

Shame, fear and guilt can all be contributing factors to the stigma of seeking out mental health services.

When we compound this stigma with someone’s cultural, racial and economic background this can create the idea that mental health treatment will be ineffectual and can prevent those who need treatment from seeking it out.

Culture, Racial, and Economic Factors and Mental Health

Let’s take a closer look at how each of these three elements could prevent someone from starting on their journey to better mental health. 

Culture and Mental Health

The DSM-V recognizes that culture has an important role to play in the identification and treatment of mental health symptoms and concerns.

It contains the Cultural Formulation Interview, which can be conducted with clients to better understand their reason for seeking treatment from a culturally informed perspective.

The interview includes questions related to the cultural definition of the problem, cultural perceptions of cause, context, and support, cultural factors affecting self-coping and past help seeking and cultural factors affecting current help seeking.

Regarding diagnoses like schizophrenia, the DSM reminds us about some important cultural competencies to consider (American Psychiatric Association, 2013, p.103):   

“Ideas that appear to be delusional in one culture (e.g., witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a religious content (e.g., hearing God’s voice) are a normal part of religious experience.”

One might avoid seeking out mental health treatment for fear of the prescribing clinician inadvertently diagnosing a serious mental illness, such as schizophrenia, due to a client having auditory hallucinations, without considering the client’s culture of origin and the impact their culture has on the display of mental health symptoms or concerns.

The adverse is true as well; symptoms could possibly be minimized or explained due to the client’s cultural background instead of considered as a serious mental illness in need of treatment.

A client might also delay their engagement in mental health treatment due to their own culture’s stigma or definition of what truly is a mental health concern.   

Next, let’s try to understand how someone’s racial background impacts the idea that receiving mental health treatment could be ineffective.

Race and Mental Health

It’s important to consider the historical context of racial discrimination in the mental health field – from states petitioning against desegregation of mental health hospitals after the Civil Rights Act was passed in 1964 to diagnoses created specifically to target African American slaves in the Victorian Era. 

Institutions and those in power have historically gone to great lengths to segregate and penalize BIPOC simply for their lived experiences but also for experiencing true mental health issues.

Their struggles or concerns have historically been pathologized, such as the diagnosis “drapetomania,” which was a term coined by Samuel A. Cartwright, which was to be an explanation for why slaves escaped captivity (Cartwright,1851).

Instead of considering the humanity behind wanting to escape a life of captivity, this behavior was constructed into a mental health disorder in need of a remedy, which was not kind and often brutal. 

There are also less mental health professionals who are of diverse racial backgrounds.

According to the APA (2018):

“In 2015, 86 percent of psychologists in the U.S. workforce were white, 5 percent were Asian, 5 percent were Hispanic, 4 percent were black/African-American and 1 percent were multiracial or from other racial/ethnic groups.”

When looking for a mental health professional, it’s common for potential clients to look for a practitioner who can identify with them and possibly have shared similar life experiences.

This lack of diversity and inclusion in practitioners can create yet another barrier for those interested in seeking out treatment. 

Economic Factors and Mental Health

Lastly, how do economical factors play into the idea that mental health treatment might not work?

Social safety programs and early intervention programs are effective in treating and preventing a myriad of mental health issues but these programs are often underfunded and oftentimes limited in accessibility.

There are significant barriers to receiving mental health treatment for those of low socioeconomic status such as inadequate child care, limited access to services due to transportation, living in a rural environment, long working hours with the inability to take time off work and no/inadequate health insurance to cover the cost of treatment.

With so many economic barriers in place and daily survival as a priority, these services can become difficult to access and utilize for the population that needs them the most.

Socioeconomic barriers to treatment can contribute to hopelessness and one might give up before even beginning to seek out treatment. 

According to a research paper published by the WHO in 2014 (World Health Organization and Calouste Gulbenkian Foundation, p. 16):  

“A systematic review of the epidemiological literature on common mental disorders and poverty in low and middle-income countries found that of the 115 studies reviewed over 70% reported positive associations between a variety of poverty measures and common mental disorders.”

We know that those experiencing poverty have a higher likelihood of experiencing mental health issues but trying to survive daily life often takes precedence over finding proper mental health treatment.

While looking critically and how cultural, racial, and economic factors contribute to shame and the idea that mental health treatment will not work, these factors can also positively contribute to one’s own treatment as well.

By finding a culturally competent practitioner, these factors can be incorporated into treatment with clients to increase positivity and hopefulness.

They can be utilized to build a positive therapeutic relationship between therapist and client, which is one of the most important factors to positive outcomes in treatment

We Are Here to Help

Western Tidewater Community Services Board is dedicated to making sure that all members of our community have the skills and resources they need to achieve a sense of wellbeing and purpose in life.

We are a community of hope and caring.

We’re here and ready to connect 24/7. We make access to professional, high-quality, wrap-around care convenient and easy – including Same Day Access for crisis intervention.

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