This study demonstrated that issues surrounding race and ethnicity are important to ethnic minorities in the context of mental health treatment, and, in fact, clients are less satisfied when such elements are not included in their care. To our knowledge, this is one of the few empirical investigations of the effects of race and ethnicity elements on client satisfaction and perceived outcomes. The three culture-specific elements assessed in this study i.
Provider discussion of race and ethnicity was marginally more important for minorities than Whites. More noteworthy, when mental health clients felt like a cultural element was important in their care, but did not perceive it to be present, they were less satisfied with aspects of their treatment. However, this was the case only for ethnic minority clients, not for White clients.
Again, this was true only for ethnic minority clients, confirming the literature that highlights the value of including these elements in treatment for ethnic minority individuals e. Additionally, various cultural elements were related to different types of client service evaluations for clients. For example, racial match appeared to be a strong predictor of the service experience across access, quality of care, and marginally for general satisfaction.
Although a host of studies has debated the importance of racial match on ethnic minority mental healthcare Karlsson, , studies continue to demonstrate the significance of racial match for minorities. Research has indicated that experiences with racism and discrimination affect the well-being of ethnic minorities e. In view of these findings, it is not surprising that those minority clients who were with care providers who did not acknowledge and process the reality of living in a racialized society Jones, experienced poorer quality of care. Similarly, Thompson and Jenal found that African American clients paired with White providers who stressed the commonalities among individuals, while failing to address the ethnic issues related to being African American, perceived these providers as denying the influence that race has on their lives.
Chang and Berk found that clients praised therapists who demonstrated culture-specific knowledge and an awareness of the importance of race and culture in shaping individual experience and identity and criticized those who displayed cultural ignorance or insensitivity. Although racial match and provider knowledge of prejudices and discriminations was significantly related to aspects of the client service experience, neither was related to perceived treatment outcomes.
These results seem to corroborate those of other studies that concluded that cultural elements e. The findings should be considered within the limitations of the study.
First, the study did not obtain clinician perspectives or information. Another limitation of the study is the sampling of outpatients in only one urban community; thus, the results may not be generalizable to other community mental health agencies or consumers. For instance, findings from this study may have been different if the sample had been drawn from an inpatient clinic where clients tend to be more clinically impaired. A third limitation involved the aggregation of the various ethnic minority groups because the small sample sizes of each prevented separate ethnic group analyses.
African Americans constituted the majority of the ethnic sample, and the findings of this study may be more specific to this ethnic minority group. However, inequitable treatment is a problem that most ethnic minority group members encounter DHHS, ; therefore, we wanted to study the ethnic minority experience with treatment in general and not for any one particular group.
There were no significant differences in terms of ethnicity or gender between the private and community-based clients and type of participant was controlled for in this study. Another limitation of the study was its correlational design, thus, there was ambiguity with respect to causality or temporal sequence. It may be that clients formed their attitudes about importance of a cultural element based on previous questions. For example, the nature of the questions in the study about race and ethnicity may have led some clients to believe these elements should be important to them.
Future studies utilizing a longitudinal design would help clarify any causal relationship between attitudes about importance and inclusion of cultural elements and satisfaction. We also did not have information regarding the nature of the problems that clients were seeking help for, and this may have been a factor in how salient issues of race and ethnicity were to clients.
It may be that clients with more severe psychological problems were not as concerned about racial match as others with less severe issues.
A final limitation of the study involved the use of self-report measures and the fact that some clients reported on current experiences while others reported on previous experiences. As with all client surveys, the clients sampled were susceptible to biases in recall and this may have affected their satisfaction ratings. Despite these limitations, an implication of the study is that addressing issues related to race and ethnicity may be critical to the quality of care for many ethnic minority mental health clients.
The exclusion of race and ethnicity elements was consistently related to lower client evaluations regarding accessibility, quality of care, and satisfaction for ethnic minority clients. Mental health practitioners working with minority clients may want to assess client perspectives and preferences regarding race and ethnicity issues in treatment. Failing to do so could result in lower client satisfaction. Chang and Berk encouraged therapists working with clients high on race salience to actively demonstrate their comfort and willingness to broach topics involving race, ethnicity, and culture REC.
On the other hand, the same approach may alienate clients who view REC issues as irrelevant to their presenting problem. At the same time, the findings strongly suggest that training programs in the allied mental health professions need to develop more empirically validated clinical strategies for addressing issues related to race and ethnic minority status when treating ethnic minority clients. Moreover, there should be a particular emphasis on how to manage and cope with life experiences involving prejudice and discrimination. We acknowledge the Sacramento County Department of Health and Human Services and the two community-based mental health agencies for granting permission to collect data at their sites.
We also thank Dr. Marya Endriga and the California Institute of Mental Health for their support during the initial phases of the study. For the purposes of this paper however, we are using race to encompass ethnicity e. National Center for Biotechnology Information , U. Author manuscript; available in PMC Nov Meyer and Nolan Zane. Please address correspondence to: The publisher's final edited version of this article is available at J Community Psychol. See other articles in PMC that cite the published article.
Abstract Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Client Experiences in Treatment Mental health researchers have long recommended the use of a consumer perspective on care provider cultural competency Pope-Davis et al. Racial Match Racial match, or concordance, has been described as one element of culturally responsive care and a potential factor in reducing mental health disparities for ethnic minorities. Addressing Race and Ethnicity in Treatment Although a host of research studies has centered on the topic of racial differences e.
Procedure Clients from the private sector were either currently receiving or had at some point received mental health services for their problems. Open in a separate window. Relationship Between Cultural Element Discrepancy Scores and Client Experience Table 3 summarizes the results from the regression analyses, using the cultural elements discrepancy scores as predictors and each of the four types of service evaluations i. SE is the standard error of B. Acknowledgments We acknowledge the Sacramento County Department of Health and Human Services and the two community-based mental health agencies for granting permission to collect data at their sites.
Footnotes 1 Studies reviewed include both racial and ethnic match studies.
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Handbook of racial and ethnic minority psychology. Ethnic matching between therapist and patient in psychotherapy: An overview of findings, together with methodological and conceptual issues. Cultural Diversity and Ethnic Minority Psychology. How can we be aware of individual is "speaking from the heart"? In talking From the center, Stephanie Shields makes use of examples from way of life, modern tradition and the newest examine to demonstrate how culturally shared ideals approximately emotion are used to form our identities as men and women and he or she exposes the traditionally moving and tacit assumptions those ideals are in line with.
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According to Bulhan, the majority of Africans explain health or illness, diagnosis or treatment in relational rather than intrapsychic terms.
Afrocentric psychology is systemic and relational rather than individualistic, states Bulhan.