Addressing mental health disparities through clinical competence not just cultural competence: The need for assessment of sociocultural issues in the delivery of evidence-based psychosocial rehabilitation services

Abstract

Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…The relevance of cultural factors to both diagnosis and treatment suggests potential benefits of identifying personal and cultural factors and integrating that understanding into the provision of care, including psychoeducation and other interventions to address culturally related stigma and shame. Such an approach has been recommended by experts (Mezzich et al 2009;Yamada and Brekke 2008) and organizations, including the APA (DSM-5 Cultural Formulation Interview; American Psychiatric Association 2013a), The Joint Commission (2010,2011), and the Office of Minority Health of the U.S. Department of Health and Human Services (2014).…”

The Assessment, Diagnosis, and Treatment of Mental Disorders among Muslims

“…A clear guideline for a Cultural Formulation (CF) is presented in the DSM-IV-TR (APA, 2000). The CF, however, has challenges in its implementation (Rohlof, Knipscheer, & Kleber, 2009;Smart & Smart, 1997;Yamada & Brekke, 2008).…”

“…The distance between the client's identity (primary cultural identity, values, philosophical assumptions, and culture of origin) and host culture will determine how the client will approach life, and the formation of a postmigration identity in the host culture. Addressing sociocultural factors in understanding the client's concerns, specific to privilege, oppression, and disparities in services is essential (Ibrahim, 2010;Yamada & Brekke, 2008).…”

Psychosocial rehabilitation in a chronic care hospital in South Africa: views of clinical staff

“…16 Research has also demonstrated the significance to developing competence in the context of the various socio-cultural issues that need to be embedded into PSR programmes in order to ensure their effectiveness. 17 This is especially relevant in multicultural South Africa.…”