The importance of culturally competent care

Colleges are in the middle of a mental health crisis. The pandemic has increased rates of depression, anxiety, substance use, and suicidal thoughts in the general public – and emerging studies from college campuses show a similar and alarming pattern. 

Studies show that students of color tend to seek mental health services less as compared to their White peers, but are more likely to endorse feelings of hopelessness, anger, and thoughts of suicide; this was before COVID and the horrific events that inspired the racial justice movement of 2020. Students of all races have stepped forward to demand that college administrators do more to speak out against racism and implement diversity, equity and inclusion initiatives, including increasing access to mental health providers who can understand the nuances of how race impacts identity and mental stress. College leadership must be cognizant and proactive in understanding the challenges students of color experience when seeking mental health treatment. 

These challenges are rooted in historical, social, cultural, political, economic, and religious contexts. High levels of distrust toward medicine and mental health stigma result in students relying on family, community, and spiritual support, but foregoing medical or psychiatric treatment. On campus, experiences of racial hostility leave students feeling invalidated and unsupported by their institutions. 

Students are discouraged by the lack of diversity at counseling centers. Since the pandemic, they are facing financial challenges and therapy may seem like a luxury they cannot afford. Many are grieving the loss of loved ones, or stepped in to be the emotional support system for their own family members.

COVID has highlighted disparities between communities of color and the rest of the population. The internalization of this trauma, the murders of people of color, the repetitive implicit and explicit messages of “you don’t matter and you don’t belong here” are important factors for why students of color want a provider of the same race or cultural background.  This might present the biggest challenge for increasing access to a diverse mental health pool – the numbers of mental health providers of color are significantly fewer than White providers. 

Example: In 2015, the American Psychological Association completed a survey finding that 86% of psychologists practicing in the US were White, 5% were Asian, 5% were Hispanic, 4% were African-American, and 1% were multiracial or from other racial/ethnic groups. This reality is visible and presents an added layer of complexity for students seeking treatment. Colleges will not be able to meet the increasing mental health needs for their students unless they expand access to a diverse pool of mental health professionals.

Students across campuses nationwide have organized and emphasized the critical need for comprehensive interventions that can bolster support and increase access.  Telemedicine presents a practical, efficient, and effective solution for increasing access. Colleges that are implementing telemedicine have the opportunity to connect with skilled mental health providers from diverse backgrounds. 

Understanding that students of color may be hesitant to seek help, it is important for colleges to be proactive and engage their student body by fostering a positive attitude toward addressing health and wellness. Soliciting student feedback is crucial in facilitating this goal; student groups have called for interventions that include mental health training for faculty, staff and students, suicide prevention programs, peer-run student mental health organizations, mental health information during campus tours, orientation, health classes and other campus-wide events, walk-in student health centers, 24-hour crisis hotlines, ongoing individual counseling services, screening and evaluation services and comprehensive referrals to off-campus services and supports.

Recognizing that it might be especially difficult during this time to connect with a provider of color, we still must encourage all students to seek the help they need wherever it is available. Mental health professionals are trained to work with everyone and students of color need care now

My hope is that as more students of color seek care, then more stigma will be reduced. Perhaps that might lead to more minorities choosing careers in mental health, thereby increasing the pool of providers of color, which over time, might reduce some of these disparities.

 

1 Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study. J Med Internet Res. 2020;22(9):e22817. Published 2020 Sep 17. doi:10.2196/22817

 

2 Chen JA, Stevens C, Wong SHM, Liu CH. Psychiatric Symptoms and Diagnoses Among U.S. College Students: A Comparison by Race and Ethnicity. Psychiatr Serv. 2019;70(6):442-449. doi:10.1176/appi.ps.201800388

3 Lipson, Kern, Eisenberg, Breland-Noble. Mental Health Disparities Among College Students of Color. J Adolescent Health. 2018 Sept; 63:348-356. https://www.jahonline.org/article/S1054-139X(18)30191-5/abstract

4 Lin, Stamm, Christidis. How diverse is the psychology workforce? News from APA’s center for Workforce Studies. 2018 Feb; Vol 49; No.2