Culture refers to identifiable and shared -- although not identical -- patterns of beliefs, values, behaviors, communication, attitudes, learning, healing, and other aspects of social interaction.                                     

Culture shapes feelings and actions related to prevention and treatment.                                             

Sociological perspectives may be incorporated into psycho-pharmacological intervention models of mental illness and substance abuse.

Culture is a fundamental context within which people live and function, and through which they define themselves and are defined by others.

Culture may have beneficial or harmful elements.

Individuals may have to perform multiple and competing cultural roles.

 One needs to be able to negotiate the demands of one's culture(s) or competing cultures. Successful negotiation is a form of cultural competence. It is crucial for social interaction, as well as a stable, positive and coherent sense of self.  

Culture is often confused with biological ethnicity or race. It includes history, values, group and self-identity, language, beliefs, thought patterns, and behaviors.  

Culture involves non-verbal communication, forms of knowledge and ways of knowing, clinical practices, and social relations.

Mental health treatment and research should include measures of affective competence, behavioral competence, cognitive competence and cultural competence.

Culture may be explicit or implicit.

Culture may be understood in a political context. Examining culture involves studying the effects of power on people's perceptions of empowerment, social legitimization and self-validation.  

Culture affects individuals, e.g., administrators, clinicians, consumers (patients/clients), researchers, friends, relatives. It also affects processes and systems, e.g., institutional culture, policies, service delivery systems, and patterns of service utilization.

Cultural conditioning and institutional relationships tend to devalue, isolate, and marginalize persons with severe mental illness.  

Diversity exists between and within cultural groups. The broad category of African Americans or Blacks, for example, contains folks from varied cultural, ethnic and historical heritages who speak languages, different forms of patois, and numerous dialects from the Caribbean, Latin America, Europe and Africa.

Achieving cultural competency has the following benefits:

Enhancement of communication styles (oral, non-verbal and written)

Improved interviewing methods

More effective interaction between staff and consumers

Greater engagement and retention of consumers

Assessment of managerial styles of supervisors and case managers

Improved case management functions

Grappling with issues of cultural competency is significant for several reasons:

Cultural competence encompasses interpersonal, clinical, administrative and consumers levels. It requires knowledge about mental health and healing, communication skills, adaptive behavior, flexible approaches, self-awareness/consciousness.  

Cultural competence requires knowledge of and respect for consumers and practitioners' attitudes towards health status, medications and therapies .

Cultural competence is a process of awareness, sensitivity, knowledge and application to address a client's needs and interests. Along with physical and psychological assessments, the clinician should have basic knowledge of the consumer's cultural background.  

Trust and empowerment of consumers and clinicians are related to the clarity of purposes, goals, objectives and values of the service agency.

Organizational development, ideological development and political consciousness are linked to service delivery. Community-based mental health service agencies require clinicians who are not resistant to and are themselves committed to the heritages, needs and interests of consumers.

 Patients/clients/consumers with severe mental illnesses require witnessing and partnership, as well as validation and shared power. Many dispossessed persons have common symptoms of structural devastation, ideological assault and cultural oppression. These signs may include: Family fragmentation, erosion of support structures for working class women, men and children;

Historical and official dismissal of grievances

Delayed entry into treatment;

Disparities in health care;

Greater morbidity and mortality rates;

 Ineffective service delivery; and

Under-utilization of services.

Recognition of and respect for cultural differences

Cultural introspection by administrators, supervisors, case managers, vocational specialists and support staff  

Awareness of the differences and issues brought by consumers and service providers

 Knowledge about the role of culture in treatment

Adaptation of services which incorporate diverse cultural realities

Each client is a unique individual.  

Individuals exist within a cultural context.

Treatment involves a holistic perspective of mental, social and physical health care.

Attention to cultural details and knowledge helps to inform and facilitate engagement and retention of consumers.

Mental health treatment involves a relationship between the consumer and clinician.

The care relationship views the consumer as a partner, an advocate, of the treatment process.

Communication between consumers and clinicians is two-way.

Both consumer and clinician learn from each other.

Families and support groups can promote treatment.

Differences and similarities between clinicians and consumers are recognized, honored, respected and validated.

Develop cultural portraits of consumers and personnel, including practitioners, supervisors, administrators and support staff.

Conduct cultural competency workshops for staff.

Incorporate values clarification sessions among staff.

Identify and utilize `cultural informants' who are articulate and have a mental illness.

Assess cultural inoculation and resilience, i.e., evaluate familial and community factors which help protect persons from experimentation with and abuse of drugs.

Hire a culturally diverse staff, and provide regular education.

Minimize judgments of others.

Identify and confront one's own biases and prejudices.

Identify cultural clues which enhance cultural competence, e.g., non-verbal communication through body language and facial clues; bilingualism.

Commitment displayed by policy makers and administrators

Clarity of the agency's goals, objectives and procedures

Generation of support from staff and consumers

Collaborative planning and communication between consumers and practitioners

Creation of structural mechanisms to monitor and reinforce accomplishments (e.g., advisory board)

Identification of cultural attributes of the agency, staff and consumers

Assessment of how cultural factors affect service delivery and utilization

Development of and access to resources and educational opportunities

Cultural matches between consumers and clinicians, when appropriate and feasible

Attentiveness to consumers' perceived spiritual/religious needs and supports

Use of culturally sensitive and relevant materials