Why Work Toward Cultural Competence?

It is clear from nationwide research and policy that cultural competence is critical to an effective mental health system. Most mental health agencies think that cultural competence is important. However, it can be difficult to find the time and resources to spend on improving organizational cultural competence. Rather than viewing cultural competence as a separate activity from the mission of an agency, it is best seen as a vital part.

Why Work Toward Cultural CompetenceIn ensuring overall quality of care. The NJ Division of Mental Health and Addiction Services has embraced the efficacy of cultural competence – which is why it has funded CultureConnections and is in the process of strengthening requirements for all contracted mental health agencies and self-help centers to have an active Cultural Competence Plan.

The Georgetown National Center for Cultural Competence and a joint report from the National Technical Assistance Center for State Mental Health Planning (NTAC) and the National Association of State Mental Health Program Directors (NASMHPD) point to a compelling need for cultural competence in mental health care in order to:

Respond to current and projected demographic changes
The number of foreign- born population in the United States continues to rise at a high rate and the Census Bureau predicts that by the year 2030, 60% of the U.S. population will self- identify as White, non-Hispanic, and 40% will self-identify as members of other diverse racial and ethnic groups.

New Jersey’s Racial and Ethnic Profile

Our northern N.J. Counties are among the most racially, ethnically, and linguistically diverse counties in the United States.  More than 20% of the population in 7 of the 9 northern counties speak a language other than English at home, with 56% in Hudson, 45% in Passaic and close to a third in Bergen and Essex.  Even within racial and ethnic groups, there is great diversity.  Census data on “Blacks” in Essex County, for example, include Caribbeans and Africans with varied languages from a dozens of countries, as well as African-Americans.  Essex is estimated to have 35% of N.J.’s 40,000 Haitian residents.  Latinos are from all over the Caribbean, Central and South America, with widely varying immigration circumstances, cultures, and dialects. Hudson County is 42% Latino, with its newest Latino immigrants from Peru, El Salvador, and Mexico. Paterson is 58% Latino, including many Peruvians.

New Jersey and Immigrants

Improving Organizational Cultural CompetenceOne cannot discuss cultural competence without considering the immigration status and experiences of consumers who were not born in the U.S.  Many areas in northern N.J. have large concentrations of recent immigrants who came to the U.S. for a better life or to escape life-threatening environments (i.e. religious and ethnic persecution, other forms of oppression, civil war.)  Knowledge about the specific circumstances surrounding certain groups’ immigration, the impact on their mental health needs, and strategies to serve them effectively are critical to the ability to improve outcomes for these populations. The American Psychological Association reported in 2009 that immigrants’ experiences of trauma in their native countries, “including extreme poverty, human trafficking, exposure to war, and natural disasters”, as well as their “difficulty acculturating to their new environments in the U.S.” can lead to “severe and long-lasting psychological and behavioral problems, including depression, anxiety, PTSD, and a high risk for suicide.

For information about additional cultural groups in New Jersey, click here.

Foster Social Justice

Cultural competence embodies the fundamental value of mental health professionals to ensure that services are accessible without discrimination or disparities in quality based on a person’s culture, language, and other cultural factors. Cultural competence is the right thing to do.

Eliminate disparities in the mental health status of people of diverse racial, ethnic and cultural groups.

It has been documented that there is a disparate health status among individuals of racial and ethnic minorities. This applies for mental health as well. The Surgeon General’s 2001 Supplement to its 1999 report on mental health documents that:

  • Minorities have less availability of, and access to, mental health services.
  • Minorities are less likely to receive needed mental health services.
  • Minorities in treatment often receive a lower quality of mental health care.
  • Minorities are underrepresented in mental health research

Research shows that receiving appropriate mental health care depends on accurate diagnosis. Racial and ethnic minorities have historically experienced disparate mental health care, which can lead to adverse events and inaccuracies such as misdiagnosis and inappropriate interventions, as well as inefficient or ineffective treatment.

Blacks, who have been historically underserved in the nationwide mental health system, are being served at or above their proportion in the northern New Jersey region’s mental health agencies. The same goes for Native Americans/Alaskan Natives, although their numbers are small. In general, other races / ethnicities are being underserved by funded agencies and self-help centers. Asians / Pacific Islanders are under-served in all northern region counties except Bergen in which agencies are serving A/PI 8% above their Census share. Because of their large numbers across the northern counties, Latinos are the group which is most significantly underserved; they are even more underserved in funded self-help centers than in other agencies’ contract programs. Only Hudson and Passaic (non-Self-Help contracts) serve Latinos above their demographics of 42% and 37% respectively.  There is less accurate data about Self-Help Centers use by various groups due to reporting gaps across most northern NJ counties. Census data do not include the undocumented and the estimated size of the undocumented in northern NJ counties is large (up to 100,000 in Hudson alone). It can be assumed that Latinos are even more underserved than than current county service utilization and demographics data suggest.

Improve the quality of services and outcomes

Georgetown’s National Center for Cultural Competence’s Policy Brief #1 states that “Despite similarities, fundamental differences among people arise from such cultural factors as nationality, ethnicity, acculturation, language, religion, gender and age, as well as those attributed to family of origin and individual experiences. These differences affect the health beliefs and behaviors of both patients and providers. They also influence the expectations that patients and providers have of each other. The delivery of high-quality primary care that is accessible, effective and cost-efficient requires providers to have a deeper understanding of the socio-cultural back ground of patients, their families and the environments in which they live. Recent studies have shown that culturally and linguistically competent primary care increases patient satisfaction, health outcomes, and higher levels of preventive care “(Lasater et al, 2001; Lee et al, 2002; Saha et al, 1999).

There is evidence that cultural competence training improves intermediate outcomes of provider knowledge, skills, and attitudes, as well as consumer satisfaction. A systematic review of educational interventions for providers concludes that these outcomes might ultimately impact consumer outcomes considering that  because improving providers’ confidence in their ability to understand the background of their consumers, having more positive attitudes toward their consumers, and having improved communication translates into improved consumer confidence, improved quality of service provision, and helps manage the risk of adverse events.

New Jersey’s Cultural Profile

New Jersey and Immigration

One cannot discuss cultural competence without considering the immigration status and experiences of consumers who were not born in the U.S. Many areas in northern N.J. have large concentrations of recent immigrants who came to the U.S. for a better life or to escape life-threatening environments (i.e. religious and ethnic persecution, other forms of oppression, civil war.) Knowledge about the specific circumstances surrounding certain groups’ immigration, the impact on their mental health needs, and strategies to serve them effectively are critical to the ability to improve outcomes for these populations. The American Psychological Association reported in 2009 that immigrants’ experiences of trauma in their native countries, “including extreme poverty, human trafficking, exposure to war, and natural disasters”, as well as their “difficulty acculturating to their new environments in the U.S.” can lead to “severe and long-lasting psychological and behavioral problems, including depression, anxiety, PTSD, and a high risk for suicide.

New Jersey and Lesbian Gay Bisexual Transgender Questioning (LGBTQ)

Cultural Competence WorkshopsIt is important to note that extrapolating data on this group poses difficulties for a number of reasons, particularly because all estimates are lower than reality. Some reasons for this include lack of disclosure due to stigma or cultural taboo, the complication of behavior vs. identity, and the lack of accounting for undocumented citizens. Same-sex attraction rates range between 4 and 25% of the general population (Savin-Williams and Dickson, N., Paul, C., & Herbison, P., 2003). ) and same-sex behavior rates range between 4 and 10% of the population (How Big is the LGBT Community: Why can’t I find this number? published by the National Gay & Lesbian Task Force).

The 2010 Census Data reports that several of our northern New Jersey counties rank in the top five in the state for the highest percentage of same-sex couples. Hudson County ranks first with 8.46 per 1000 couples and Essex County has the third highest percentage of same-sex couples in New Jersey with 7.43 per 1000.

According to the National Alliance on Mental Illness , the LGBTQ community is purported to be at a higher risk for depression, anxiety, substance abuse and other mental health concerns than other groups due to the societal stigmas, prejudices, and discriminations they face on a regular basis, not only from society as a whole but also from family members, peers, coworkers, and classmates. In particular, LGBT identified and questioning youth are vulnerable to victimization, whether emotional, physical, or sexual. Assaults occur at home and at school, causing LGBT youth to have higher truancy, drop out, and run-away rates. Between 3%-5% of the national population identifies as LGBT but the U.S. Department of Health and Human Services estimates that between 20% and 40% of all homeless youth identify as LGBT. Mental health providers working with this population can make life changing and lifesaving impacts by engaging the families of LGBTQ youth. Family acceptance of LGBT youth can lead to significant reduction in the risk for suicide, depression, illegal substance abuse, and unsafe sexual activity

New Jersey and Older Adults

The 2010 Census reported that an estimated 13.7% New Jersey’s population is 65 years and over. Our northern New Jersey counties are amongst the top in the state for highest percentages of the population being age 65 and older. Bergen County ranks 4th highest in the state with 21% of the population aged 65 years and older, followed by Warren County at 5th with 19.9% and Morris County at 6th with 19.6%.

Older adults are particularly susceptible to mental health problems such as dementia, Alzheimer’s disease, and depression . Often multi-symptomatic, these disorders may be confused with one another. In particular, depression often goes untreated either because the symptoms are unrecognized or because it is considered to be a natural part of the aging process. Cultural, ethnic, racial, and religious differences cause disparities in diagnoses as well as in treatment . Culturally dependent factors such as help-seeking patterns, stigma, and patient attitudes and knowledge may help contribute to disparities in the diagnosis and treatment of depression across different groups of older adults.

New Jersey and Persons with Disabilities

Cultural Competence WorkshopsAccording to the U.S. Census Bureau, people with disabilities constitute approximately 19% of the civilian non-institutionalized population in the U.S., making them the largest minority group in the country and the only group that anyone could become a part of at any time. Within New Jersey, disabled individuals account for approximately 9.7% of the population, including those with hearing, visual, cognitive, ambulatory, or self-care difficulties.  Researchers purport this to be an undercount, as the undocumented and the homeless populations are not included in census data. Our northern New Jersey counties’ disabled populations mirror the statewide data, ranging from 8.2% of Bergen County’s population to 9.9% of Passaic County’s population.

A report by the National Association of Mental Illness states that out of New Jersey’s 8.7 million residents, approximately 352,000 are living with mental illness. 259,000 adults suffer from serious mental illness and 93,000 children live with serious mental health disorders, including bipolar, schizophrenia, depression, and anxiety. As of 2009, New Jersey’s public mental health system was providing services to only 46% of adults who are living with mental illnesses. According to the Center for Disease Control  depression is projected to be the second leading cause of disability in the world by 2020.

New Jersey’s Racial and Ethnic Profile

Our northern N.J. Counties are among the most racially, ethnically, and linguistically diverse counties in the United States. More than 20% of the population in 7 of the 9 northern counties speak a language other than English at home, with 56% in Hudson, 45% in Passaic and close to a third in Bergen and Essex. Even within racial and ethnic groups, there is great diversity. Census data on “Blacks” in Essex County, for example, include Caribbeans and Africans with varied languages from a dozens of countries, as well as African-Americans. Essex is estimated to have 35% of N.J.’s 40,000 Haitian residents. Latinos are from all over the Caribbean, Central and South America, with widely varying immigration circumstances, cultures, and dialects. Hudson County is 42% Latino, with its newest Latino immigrants from Peru, El Salvador, and Mexico. Paterson is 58% Latino, including many Peruvians.

New Jersey and Religion / Spirituality

Cultural Competence WorkshopA 2010 report by the Association of Religion Data Archives shows that residents of northern New Jersey report a wide variety of religious affiliations, with 152 different religious sub sects. Furthermore, In a 2009 national poll by The Pew Forum on Religion and Public Life, 80% of New Jersey respondents said that religion was an important part of their lives, with 52% indicating it was very important.  In that same poll, 72% of respondents indicated that they attend religious services on at least a monthly basis, with 36% reporting that they attend a service once a week. As religious beliefs and spirituality influence one’s day to day lifestyle, they also affect one’s attitudes toward mental health treatment and care and influence accessing of services.

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