With globalization, multicultural lifestyle is becoming common in societies. Migration has increased human interactions and populations tremendously. As a result, the demand for various services by culturally diverse populations has continually posed challenges in the provision of various resources. Among the basic services that have been affected is health care. In most countries, healthcare practitioners are not trained to handle people from multicultural groups. The realization that mental health professionals have to offer services to clients of diverse cultural backgrounds has come with the need for adjustments. Medical practitioners are faced with problems because of the conflicting nature of the cultures of their patients. Specific cultural aspects or barriers impede the efficacy of the service rendered to patients. This work will look at the various barriers that mental health professionals are working with multicultural populations face.
With the effect of globalization, many healthcare professionals have had to handle patients originating from different countries and cultural origins. In many cases, the kind of services offered to these patients depends on the skills, knowledge, and the willingness of the medical practitioners to handle patients with various cultural backgrounds. This comes with a number of challenges, which the medical practitioners are to overcome. Some of these challenges include communication difficulties due to the language barrier and the varying religious beliefs by patients on the possibility of them being cured. The barriers in mental health practice result in strong affiliation to persons' cultures resulting in ethnocentrism which is judging people based on one culture. The possibility of the patient practicing ethnocentrism is also present. Thus, a competent expert should be able to reverse the situation since such barriers have the ability of affecting the performance of mental health professions. Consistent failure in practice provides the likelihood of affecting even the most gifted mental players.
In training the medical practitioners, there is a need to see multicultural health practice as the ability to work effectively in a society with people from different cultural backgrounds. The current paper will discuss the barriers mental health professionals face while dealing with patients from different backgrounds. It demystifies multicultural barriers using supportive examples and statistics and subsequently recommends the suitable solutions to address the challenges in mental health practice (Jimenez et al., 2012; California State University, 2013).
Multicultural Social Factors and their Implications for Medical Professionals
Tew et al. (2011) conducted a study on the role social factors play in the onset of mental relating difficulties. Their concern was that little attention had been given to the kind of roles that such factors play in supporting patients' recovery. Therefore, the study sought to review the past international studies that had been done on the effect of social factors on recovery. It made it clear that irrespective of the efforts being put by the mental health professionals to see their patients recover, patients' interpersonal relationships as well as feeling of social inclusion were very important. The findings also showed that patients who enjoy strong interpersonal relationships and felt socially included or belonging were easy to help out of stigmatizing situations. Those who felt lonely and discriminated by society showed slow recovery. This means that mental health professionals are to engage with communities and families of their patients to find a way of encouraging their patients and making the society accept their members with various mental sicknesses. This is not easy because of the cultural beliefs about certain diseases, especially when families or communities associate a given mental disease with generational curses.
Leanza, Miklavcic & Rosenberg (2014) also found out that socio-economic factors affect access of mental services. They observed that patients from neglected cultural groups are not able to afford good treatment because of poverty rates. The related costs of medication in transportation and medical bills are often extremely expensive. The access is defined by patient's ability to pay for a suitable health condition. Thus, they note that people's culture might determine which kinds of health conditions are addressed via medical practitioners. Moreover, whenever patients cannot access health facilities, mental health personnel are not in a position of assisting them. The aspect access to medical health care is universal, however, the minority and the lower class are often disadvantaged. According to Furman (2008), nonwhites are likely to wait for severe symptoms before going for health serves. Equally, when they do, they always have limited access and the services offered to them are inferior. Minorities also lack medical insurance, meaning that medical professionals will only provide them with services within their financial reach.
On the other hand, Holmes (2013) conducted a study on the clinical gaze in the practice of immigrant health with a case study on the United Sates' Mexican migrants. The study involved a one and half years of interview and ethnographic research which had been conducted between 2003 and 2004 and its follow up which came later between 2005 and 2007. The aim was to determine how various socio-cultural factors affect the barriers as well as the interaction between the patients from the illegal Mexican migrants and the U.S biomedical professionals. Participants were drawn from Mexico, California and northwest Washington states. It incorporated nurses and the physicians who were staffing those who were attending to the mental patients in the considered clinics. The study revealed that economic and social structures in healthcare as well as the subtle cultural factors affecting biomedicine make the medical professionals not to be able to see the social determinants of the suffering of the patients who are of the unauthorized migrant groups. The barriers make the professionals put blame on their patients as part of their reason for their (patients') own suffering. The most blamed aspects are the patients' behavior and biology. The researchers concluded that the problem is never the cultures of patients but the putting of focus on mainstream cultural competency whenever medical professionals are to be trained. The training only works to make the culture and structure of biomedicine be a big barrier to effective provisional of healthcare services in a way that makes the professionals able to accommodate patients from various cultures.
Multicultural Religion and Health Beliefs and their Implications for Medical Professionals
Chiam et al. (2010) conducted a study on religion and health beliefs by different cultures and the effect it has on the way in which the elderly people use various mental health services. The study aimed to find out the effect of religious affiliations on the possibility of the elderly people seeking treatment for mental illness. They also found out the reaction of the elderly to the need to seek treatments which are not as well as those which are in line with their beliefs. The researchers recorded the religious affiliations of their participants as well as the prevalence of mental disorder as was experienced by their subjects within the one year of study. It was found out that culture/religion affected the health beliefs about the possibility of a patient being cured of mental illness, stigma and embarrassment, safety and effectiveness of treatment by the healthcare professionals, and the trust in the professionals attending to the patient. It was also revealed that people of various religions as well as those who are not ascribing to any religion all differ on their health beliefs. Therefore, it means that medical professionals may have to be trained on the kind of beliefs they are likely to encounter and overcome in order to attend to their multicultural patients effectively.
Morawska et al. (2013), add that the culture describes how people perceive religion. Certain societies relate to religion strongly, unlike others. Medical professionals have a problem of separating the effect of spirituality on physical and mental health. Consequently, the invitation on awakening religious beliefs, biases and perspective always looms. Religiosity also has an impact on worldview which affects both patients and health practitioners. In addition, it causes stereotyping and prejudices. For instance, the US 9/11 bombing has caused tension between the Americans and Arabs based in the Islamic religion in which such acts are presumably justified. The event caused mistrust with personalities from Middle East. The implication of this situation to American medical practitioners with a victim from the bombing can affect the patient. Religion also affects access and application of medication irrespective of the prescriptions by the medical professionals. For instance, some mental conditions might be presented as the work of God or gods, and an assumption built that nothing can be done to help the situation. In some cases, mental health practitioners deal with situations where patients have already accepted their fate and have no hope for improvement (Morawska et al., 2013).
Multicultural Ethnic/Racial Disparity and their Implications for Medical Professionals
On their part, Wood & Hooper (2014) conducted a study on cultural competency, the primary care setting and culturally tailored care. The aim of their study was to come up with the possible ways through which ethnic or racial disparities can be reduced in mental health care. They found out that ethnic and racial minorities are not as likely to receive psychiatric disorder related treatments compared to the white Americans. However, the commitment of the U.S government to reduce ethnic and racial disparities in the way in which medical professionals are providing treatment for mental health in primary healthcare settings is improving. It means that the medical professionals will have to accept the need for equal treatment of the minority cultures irrespective of their long term stereotypes. They must be culturally competence in their practices and to culturally tailor their treatment, diagnosis, and assessment; moreover, they should be able to serve all their patients without discrimination at any treatment level.
In another study, Furman (2008) also notes that the main base in the treatment of mental diseases is racial discrimination. It forms the premise under which almost all other factors are harbored. In America, the most affected patients are of African, Asian, Mexican and Indian origin. According to Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, individual and institutional racism affects the life of people of a different culture by causing anxiety and depression. This may also result in shorter life spans or immediate death irrespective of the efforts medical professionals put to help the affected patient (Furman, 2008).
On the other hand, aversive racism can also be practiced. It is a situation whereby the dominant culture (white for the case of US) always sees themselves as righteous, good and decent people who cannot discriminate against others based on race. However, these clicks of people have the capability of practicing racial discrimination based unconsciously. Consequently, there are brief, but common verbal, behavioral and situational characteristics that express negative or decretory comments to a race. Racial micro-aggression can happen consciously or unconsciously. The mental specialists can practice these modern racial discrimination models in the structuring of consultation room or conversations unknowingly.
According to Time to Change (2008), one in every four people experiences a mental health problem. Equally, nine out of ten patients suffering from mental ailments experience discrimination. Consequently, one in five every American develop a mental condition in a year. Nonetheless, two thirds of these people do not seek medical attention, especially the minorities. Generally, in the US, whites are still stereotyped, 56 percent of people hold the opinion that blacks deliberately do not hold health insurance while 51 percent associate them with violence. On the other hand, 44 percent thinks that they are lazy. The medical practitioners are not an exemption when it comes to such racial attributes (Ahmed et al., 2007).
The manifestations of the barriers in health practice result in continued discrimination that worsens the conditions already experienced by patients. According to Furman (2008), when Latinos are not accompanied by interpreters in seeking for social services in US, they either are sent away or end up waiting four times more compared to English patients. In 1999, an examination of 20 out of 25 studies revealed the existent of discrimination and distress against mental illness in health institutions. There was a positive association between anxiety disorders, early substance abuse, psychosis and anger with discrimination. No mental health study showed a negative association to discrimination (Williams, 2003). A mental health specialist should not run the risk of being in these statistics.
Multicultural Language and its Implications for Medical Professionals
Another culture-related challenge facing healthcare professionals working in a multicultural set up is the issue of language or effective communication. This was revealed through a study conducted by Mariro and Morgan in 2012. It took place in Australia, which is largely linguistically and culturally diverse with over 230 languages. This means that medical professional face challenges such as training of their undergraduate students who are also from very culturally diverse backgrounds. Apart from having to interact with these students, the medical professional trainers have to know and equip their students with the needed cultural differences among the mental health patients they are being trained to handle. Training in culturally influenced health behaviors requires proper understanding and acceptance of the practices on the various cultures. The researchers noted that at the time, dental students were contrasted with that of the patients they were being trained to treat. This means that their future interaction with patients of various cultures would be greatly impaired. It calls for trainings of both trainers and trainees on effective communication with patients of various cultures. The training should also enable them understand various health behaviors as are observed with people of different cultures. Part of the training can be on various cultural practices, values, attitudes and beliefs. This may be a toll order for most healthcare professionals yet it has to be done to improve their effectiveness in providing services to people with diverse cultures.
Brisset et al. (2013) also studied the effect of the language barrier in mental health care. The researchers noted that the majority of the migrants who are handled by the health care professionals are unable to communicate effectively with the official language of the countries hosting them. According to their findings, the challenge is the cause for the existing gap in the outcome of healthcare services and their access. The study found out that nearly 40 percent of the medical practitioners were encountering difficulties whenever they were to attend to allophone clients. They had to be interpreted for with interpreters having to step up to play a number of roles. With globalization, there is a need for healthcare practitioners to be trained on working with various interpreters. Such training must focus on the differences in the dynamics of communication as involved in the various roles to be played by interpreters. This is obviously an additional burden to the medical practitioners, but which has to be done.
Furman (2008) adds that the language is critical for communication in any facet of life. In a multicultural situation language, barriers are common. The reception of information received by mental professional is lowered, thus, medication can be variable because of the established facts. If a mental practitioner and patient fail to communicate efficiently or in the presence of a translator, there are chances of misinformation. Equally, the presence of a translator complicates the therapy session because the patient has to gain the trust of both the therapist and translator. Even though non-verbal communication skills can be adopted, different cultures have attached different meanings to the acts. Language affects how the mental specialists offer consultation, treatment, appointments, medication and emergency response. Due to this barrier, the therapies can worsen making the existing mental condition extreme. The patient may lose hope with the session which the possibility of reversing any gains made.
Multicultural competence can be characterized into three awareness, knowledge, and skill. The three characteristics offer insight mechanisms for addressing barriers in mental health. Awareness is about the understanding of people on characteristics of their own culture. On the other hand, knowledge enlightens on worldviews as perceived in a cultural diverse society, especially those that have an effect of counseling. Consequently, skill involves the ability to develop appropriately cultural strategies some of which might be sensitive, but necessary to overcome the conditions experienced by clients.
Mental health professionals draw awareness in acknowledging the sensitivities of their own cultures. Before a professional step into the cultural diversity, they must be equipped for the easy identification of the value, beliefs, stereotyping in their own cultures. As a result, a comparison derives the multicultural limits by identifying potential sources of barriers when dealing with a particular condition. Practitioners become aware of negative assertions that might affect the counseling practice. The specialist can then appreciate one's own values in practice and extend the reciprocity to the clients. Thus, the mental health officer develops the potentiality of overcoming the weaknesses of cultural perspectives (Yamada, Atuel & Weiss, 2013; Byatt et al., 2013; Alegra et al., 2012).
Specialists should have information from other cultural backgrounds. The knowledge should involve information about mental illness or cultural practices that are not common in the dominant or cultural affiliation. Some of these diseases include anemia, sickle cell, and thalassaemia, haemochromatosis. Other practices that cause stigma are female genital mutilation, early marriages, forced marriages, famines and so on. Professionals should also note the historical background attached the other cultures. It is to acknowledge the effect of war, discrimination and torture. The effect brought about by cultural conflict due to migration should also be an area of focus. In addition, any mental health professional should understand how a barrier could aggravate minor mental problems into serious situations. Some societies associate mental illness with mysterious myths and stereotyping which often results in discrimination and stigmatization of the affected (Yamada, Atuel & Weiss, 2013; Byatt et al., 2013; Kirmayer et al., 2011).
The principal way of handling multicultural cases is inscribed in ambiguity, empathy and objectivity. Mental health specialists have a holistic approach in the treatment of a patient. In skills, practitioners should consider three sub methodologies where applicable. They should offer insights about physical and emotional characteristics; family defined social relationships; and community, cultural and political characteristics. The use of certain techniques and the possible effect is established here. For example, the use of interpreters should be handled with care. The health specialist should realize how the culture, physical existence, telephone interpretation, age and gender affect the results on the patient. This aspect is critical while dealing with sensitive issues that affect privacy. The session should be directed to the patient and not the interpreter. Confidentiality is also critical and more sensitive in place when the counselor involves a family member in a session (Yamada, Atuel & Weiss, 2013; Byatt et al., 2013; Alegra et al., 2012).
Finally, in treating multicultural mental illness there are rare situation where details and procedures are of necessity. Here, specialists have to succeed by employing a lot of innovations, research and further education. In addition, they have to be up to date with the latest revelation in the field of mental health in research finding and through interactions, especially with cultures of minorities. The experience should not be limited to academic considerations. Skill development is also critical in shaping the worldview, judgments and in building a multicultural competent professional. On the other hand, it might involve adopting the healing ideologies and practices from the other culture. The other culture might develop a positive solution for the disorder. Thus, it is important to establish how treatment from a diverse culture impacts on the recovery of a patient of that culture but under councilor of a different culture.
In conclusion, it is evident that multicultural barriers affect the mental health officers in their line of duty. The variables affect access to mental services and the medication session in totality. Equally, the barriers can directly or indirectly manifest their influence on the patient. The consequence of a barrier worsening a condition experienced by the patient has to be emphasized. Most of the barriers in multicultural mental practice are drawn from racial and gender discrimination. The success of solving the dilemmas of multicultural conditions draws from historical developments that affect people's trust, behavior and thinking. Thus, in any session, establishing contact with clients is important. It can be done by breaking cultural barriers using of the three competence tools in awareness, knowledge and skill. Whichever the case, mental health professionals have to strategically figure out a way depending on the uniqueness of the situation.
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