Mental Health & Cultural Diversity

Evidence Based Practice & Cultural Competence project

Group from Oct. 2011 meeting

In October of 2011, we convened 21 distinguished leaders from around the country for a series of dialogues devoted to rethinking some basic professional assumptions about the way we deliver mental health services to culturally diverse populations.

The first publication stemming from that conference was McGill University professor Laurence J. Kirmayer’s article, “Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism,” which appeared in the the international journal Social Science and Medicine in April. Kirmayer, a professor in the division of Social and Transcultural Psychiatry at McGill, outlined the challenges of addressing cultural diversity in evidence-based practice and grounding cultural competence in evidence.

Several other members of our interdisciplinary team will present papers at conferences in for their respective professional organizations in the coming months, and work is also underway additional prospective journal articles.

Striking a balance

In the field of mental health, practitioners and clients alike are often caught between conflicting trends in diagnosis and treatment. One such challenge in our increasingly diverse society rises from the tension between culture and clinical science. It’s important to recognize the influence of diversity and culture on illness and wellness on one hand, and the imperatives of standardization and evidence on the other.

  • Cultural competency encourages practitioners to understand, respect, and engage clients’ unique cultural orientation. At its best, this approach expands the number of resources available to help the client; at its worst it becomes merely a set of nuisance variables to be managed. Writ large, cultural competency is not just about respecting diversity. It recognizes that culture, as well as biology, can be part of what constitutes health or illness.
  • Evidence-based practice is hard science, based on the gold standard of the randomized controlled trial. It’s great at sorting the wheat from the chaff – distinguishing statistically what works from what doesn’t. Evidence-based treatments are an important part of effective, efficient mental health services. But, because large scale randomized clinical trials are complex and expensive to conduct, many interventions never see this type of evaluation. To date, most clinical trials have focused on the biomedical interventions and neglected cultural considerations.

So how can mental health providers take cultural factors seriously without trivializing professional and medical intervention? And how can they uphold the scientific basis of psychological and psychiatric knowledge and expertise without trivializing cultural difference?

Led by University of Michigan faculty with expertise in psychology, psychiatry and social work, the Mental Health and Cultural Diversity project seeks to explore the intersection of these two imperatives. The team hopes to establish new evidence around the idea that culture is causal or constitutive of mental health and illness, and should be central to professional mental health services in a diverse society.