Know Your Biases: Behavioral Health across Cultures

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July is recognized as National Minority Mental Health Awareness Month and provides an opportunity to highlight the critical need to ensure diverse populations receive equitable behavioral health services. There is much improvement to be made in Ohio to reduce pervasive health disparities. Social determinants are crucial contributing factors, but an overall lack of cultural competence in the field is also to blame.

With innovative approaches such as the Affordable Care Act (ACA) aimed at improving access to care, the focus has now shifted to ensuring services are cognizant and respectful of cultural beliefs and practices. This is the foundation of providing culturally competent care. The catalyst for this change was the realization that disparities exist beyond socioeconomic status and are directly linked to racial, ethnic, and cultural background. For example, a child born to an African American woman in Ohio with a PhD is less likely to reach their first birthday than a child born to a Caucasian woman with no high school diploma.

Oftentimes it is assumed that a one size fits all approach is the most impartial; research on implicit bias has disproven this as it relates to health. Providers retain biases that impact their delivery of care resulting in disparate outcomes. In behavioral health, many providers have a higher propensity to diagnose diverse consumers as being schizophrenic or bipolar while their counterparts are thought to have a less severe anxiety disorders. Frequent misdiagnoses are also tied to prevalent over-prescribing tendencies that have afflicted minority communities.

Behavioral health services in Ohio must be tailored to meet the needs of all cultural and ethnic backgrounds. Franklin County continues to see significant growth in immigrant communities, namely the Somali and Bhutanese/Nepalese populations. Similarly, the Latino population is increasing in Northeast Ohio. New Americans face unique challenges related to behavioral health; many suffer disproportionately with trauma related disorders. The rapid diversification of the state underscores the urgency needed to implement practices rooted in cultural competence.

What are some actionable next steps? Conducting cultural audits and other self-assessments of systems and agencies must be the first step to improving the delivery of care to diverse communities. Implementation of the National Enhanced CLAS (Culturally and Linguistically Appropriate Service) Standards is also essential as they provide much needed framework. Standards listed under Theme II, Communication and Language Assistance, are federally mandated.

The Multiethnic Advocates for Cultural Competence (MACC) remains committed to providing the support necessary for behavioral health providers, agencies and systems to successfully incorporate best practices. Together with our partners and members across the state, MACC remains steadfast in the fruition of our mission- “Enhance the quality of care in Ohio’s health care system and incorporate culturally competent models of practice into the systems and organizations that provide services to Ohio’s diverse populations”.

Editor’s Note:  We encourage our readers to check out MACC’s upcoming 2016 Statewide Training Conference taking place October 6th and October 7th at the Columbus State Community College’s Center for Workforce Development.  For more information, please click here.


Simone Crawley currently serves as the Executive Director for the Multiethnic Advocates for Cultural Competence, Inc. (MACC). Throughout her career at The Ohio State University, Simone served as a Page in the Ohio House of Representatives. She earned her degree in Political Science. Expanding her public policy background, she served as an aide to Assistant Minority Leader Charleta B. Tavares for three years. During her time at the Ohio Senate, Simone was also elected President of the Ohio Young Black Democrats where she aided in the successful campaigns of several legislative candidates. In January 2015, Simone began working to ensure cultural proficiency and improved health outcomes in Ohio as the Program Coordinator for the Multiethnic Advocates for Cultural Competence, Inc (MACC). She has served as the Executive Director since March 2016.