xxAACP Newsletter, Volume 13, Number 2, Spring 1999
President's Column: Getting Culturally Competent
It is my land too, I too grew up near the same forests and beaches. I have shivered in awe with the power of these experiences and how meaningful they are for me as one who loves the land so much. I struggle to understand them and realize that I have touched a powerful cultural force I can only barely understand. My native friends smile at my delight and tease me for my naiveté. As a psychiatrist devoted to understanding the power of community and the cultural context of healing I am open to learning. Most of us in psychiatry truly intend to be. But I have wondered how I would regard my Skagit friends if I had met them as patients in the mental health center where I had worked for so many years. Could any of them ever have understood my practice with its set times for starting and stopping appointments. My extracurricular exposure to a piece of Native American culture has given me pause to consider what I don't know about those who did not grow up in my white Anglo frame of reference.
In Seattle we live next to many Asian cultures, we have a strong African American cultural tradition from the many immigrants from East Texas and Louisiana and we have a growing Hispanic community derived from migrant workers from Eastern Washington. No matter how open to these communities I am in my heart I am struck with the amount I don't know and how profoundly that may effect my treating individuals cross culturally. My recent cross cultural exposure has rededicated me to the mission of assuring cultural competence in programs that I share responsibility for in our county mental health system. I realize, as do most of you, that good will and openness alone doesn't assure that our patients coming from other traditions won't feel the chill of inadvertent cultural insensitive. In our county we have four mental health agencies devoted to the care of a minority population. For minorities who chose to receive services in mainstream agencies it is required that their case manager and team receive a cultural consultation. Our payment system is devised to compensate for this expense and our agencies are monitored to assure that the consultation occurs.
But good will mixed with consultation are not enough either. It is critical that minority mental health workers and psychiatrists be trained and encouraged to serve the communities from which they came. There are so many forces that work against this goal, but promoting a more diverse work force in community mental health systems is an agenda of the AACP. We need colleagues who can share with us the impact of public policies on minorities, and who can give us some idea of how members of their cultural tradition will experience programs we devise. The needs for this type of in-put goes beyond the traditional minority ) communities in the United States. We are witnessing massive dislocations of people as our world seems to explode in many different wars and catastrophes. People come to the United States with hellish trauma that we can relate to only from watching news clips from the comfort of our homes. International medical graduates have a role in informing us on the cultures and experiences of immigrant populations.
As you all know there is a move away from Affirmative Action, threatening the ability of minorities to access higher education and find their way into psychiatry and other mental health professions. We are also in a time when government policy is making it harder for international medical graduates to come to this country. The AACP has responded by intensifying its efforts to reach out to minority psychiatrists and to international medical graduates. We are very aware that these groups do indeed serve populations who are more vulnerable to mental illness as they experience discrimination and economic hardship. The AACP, through its Diversity Committee, has offered complimentary memberships to certain leaders in community psychiatry who are minorities and whom we hope will bring with them other new minority members. Stronger minority membership will inevitably be reflected in the composition of the board. Currently we have six minority members on a board of thirty. These include a foreign medical graduate and Hispanic, Asian and African American members. This is distinct progress towards our goal of having a board and a membership that reflects the work force who serve our patients. It is our goal to draw upon our minority membership to help the AACP achieve cultural competence in the way we do our committee work and advocate for clinical policy. I believe improved diversity in the AACP as well as in our workplaces will enable non-minority members to be more open to the delights and benefits of the diversity of our communities.
It is my belief that each of us will benefit from reaching out to international medical graduates and minority psychiatrists for membership in the AACP and from forming friendships and work relationships cross culturally. I can only imagine what further enrichment will come to my life through such efforts. What paradoxes we live with in understanding cultural differences. It is astounding how much we share the same core human circumstances while at the same time we may experience profound differences in some of our basic assumptions about our existence. My Skagit friends would smile at me knowingly and playfully as they tweak my awareness of ever greater mysteries as I ponder the enigmas of cultural competence.