Transcript:
[0:00] Hello, I’m Moushumi Mukerji, psychiatric nurse practitioner and certified nurse–midwife. Today, I will be discussing some basic information you need to know about working with patients who come from diverse backgrounds. I hope to offer you some practical points on how to make sure your psychiatric diagnosis and treatment planning are more responsive to the unique needs of these patients.
I know it can be overwhelming to try to learn the many ways in which different racial and ethnic groups might experience disparities in mental health care. The goal of this podcast episode isn’t really to tell you every single thing you need to know about providing mental health care to every group within communities of color. Rather, what I hope to do is to call attention to why this is an important topic and to give you some broad but practical guidance you can start using today to ensure equitable care for all of your patients.
[1:07] I think it’s important to first lay some groundwork to clarify what we mean by “BIPOC.” This acronym stands for “Black, Indigenous, People of Color” and highlights the unique experiences of these individuals. In the context of this discussion, we wish to underscore the ways people of color use the term to refer to racial or ethnic groups who experience unequal treatment by others in society—in other words, groups of people who are marginalized and discriminated against because of their race or ethnicity.
This is a very diverse collection of individuals we are talking about here. But the reason it is so important to think about how we care for each of these groups is because the data are indicative: People of color may experience disparities in psychiatric diagnosis, treatment, quality of services, and outcomes. According to the American Psychiatric Association, people from racial or ethnic minority groups are less likely to receive mental health care than Whites.
The only way we are going to be able to reduce these disparities is by recognizing that they exist and by adapting our mental health delivery practices to meet the needs of individuals affected by them.
[2:31] So, you might be wondering, what should I keep in mind when working with a patient who identifies as BIPOC? The key is to recognize that such patients may have diverse mental health needs and experience interactions with the health care system differently based on their unique identity, culture, belief systems, life experiences, language, and more. The ways in which these patients present their mental disorder symptoms may be different. BIPOC individuals may use different language to express psychic distress, or they may somaticize their symptoms.
Because of this, it is important to avoid making assumptions about why a patient is experiencing a mental health problem and how best to treat them. Invest time and effort into really getting to know each patient and understanding their situation and background. I encourage you to do this for all patients, of course.
To get a better understanding of your patients’ life experiences, attitudes, and beliefs, ask questions from a place of humility, respect, and sensitivity. Recognize that bias exists, and explore whether bias and discrimination are things your patient has experienced. It is also important to be aware of our own biases—we all have them! Be aware that developing a healthcare provider and patient relationship might take time, as it is not unusual for some individuals to mistrust medical and mental health professionals.
[4:14] How might you adapt your approach to diagnosing patients from marginalized groups? Well, one of the main changes to the DSM-5 from the DSM-4 was the inclusion of more culturally responsive diagnostic criteria and text descriptions throughout several disorders. You can use the Cultural Formulation section of DSM-5 to guide your diagnostic interviews and treatment planning. And for any disorder you are considering ruling out or ruling in, be sure to review the “Culture-Related Diagnostic Issues” text in DSM-5 to see whether symptom onset, expression, and severity might differ for that patient. For instance, DSM-5 suggests substantial cultural differences exist in how major depressive disorder presents.
To reduce the risk of misdiagnosis, use a structured interview tool that is sensitive to and has been validated to address cultural issues, like the Cultural Formulation Interview tool in the DSM-5.
Now, what about treatment? In many cultures and subcultures, mental disorders are considered stigmatizing and might cause someone to avoid seeking appropriate treatment. Some patients may have negative feelings about taking psychotropic medication or engaging in talk therapy. So just a prescription or a psychotherapy referral may not be enough for certain patients.
Patient-centered care can help you understand a patient’s values and treatment philosophies. You can also consider what treatment options you might be able to offer that may be more individualized for that patient. For example, some individuals from both Western and non-Western cultures may prefer complementary and alternative approaches like herbal remedies, massage, acupuncture, yoga, meditation, and spirituality or prayer; yet, studies show BIPOC individuals are less likely to discuss these integrative approaches with their health care provider. Be open to discussing non-conventional treatments, where appropriate.
In terms of how best to engage patients from diverse backgrounds in mental health treatment, understand that taking the time to build trust and rapport is so critical, right from the very first visit. Use a shared decision-making approach—that is, be collaborative and include patients in the treatment planning process rather than simply telling them what to do. This will help patients feel empowered, heard, and validated. Base treatment goals on what is important to the patient, not on what you think they should be achieving, and explore with patients how they feel about different aspects of their social or cultural identity. Respectful questions can open the conversation, such as “What does your ethnicity mean to you ?” or “I’d like to know more about your experiences as an immigrant.” Such phrases demonstrate authentic interest and a genuine desire to understand.
[7:36] I want to close things out by mentioning a common clinical challenge when working with BIPOC patients, and that’s the challenge of identifying and overcoming your own biases.
I don’t point this out to be shaming or to make anyone feel they’re not a good person: everyone carries unconscious beliefs and biases. It’s crucial to do some self-exploration to better understand your own misperceptions and biases about different groups, because these might just impact the way you care for patients. One example to illustrate how biases can influence appropriate care, is a recent study which found that racial bias by clinicians may cause inappropriate referral of patients of color to electroconvulsive therapy.
We don’t like to think that we are treating patients differently based on their background or appearance or anything of that sort. But the truth is, unconscious biases and beliefs exist and can influence our behaviors. As healthcare professionals, we have an obligation to look inwards and do the hard but necessary work to identify and correct these potentially harmful thoughts.
I hope this episode has been helpful to you and makes your work with patients from minority groups more successful. I look forward to speaking with you again.
