Culturally Sensitive Psychiatry for Minorities
ED GORDON, host:
People of color are hospitalized for severe psychiatric illness at a rate three times higher than the general population. Part of that growing number is the social and economic state of many blacks in America. Joblessness and discrimination are increasingly recognized as factors that could lead to breakdown. Hana Baba of San Francisco member station KALW reports on one program that's teaching mental-health professionals how to spot cultural signs of distress.
Unidentified Man: ...before you leave.
Unidentified Woman: Yeah, yeah. But you wanted me to get one...
Unidentified Man: But you wanted me to be there even.
Unidentified Woman: ...because this is final, yeah.
HANA BABA reporting:
This is a meeting of one of the psychiatric ethnic focus units at San Francisco General Hospital. It's not only the first group of minority-focused in-patient programs in the country, it's the only group. Dr. Francis Lu(ph) developed this approach to treatment by considering culture and ethnic background when treating people for mental illness. He's dedicated 25 years of his career to offering culturally sensitive mental health care.
Dr. FRANCIS LU (San Francisco General Hospital): Where the staff and faculty have the experience, commitment, interest, skills, knowledge to provide for patients that have, again, been traditionally underserved in a culturally competent manner.
BABA: That means speaking the patient's language, understanding his or her mannerisms, even observing cultural holidays on the ethnic focus unit.
Dr. HEATHER HALL (Psychiatrist, Black Focus Unit, San Francisco General Hospital): As you can see, we have pictures and artwork that is reflective of the black focus.
BABA: Psychiatrist Heather Hall works at San Francisco General's Black Focus Unit. In the occupational therapy room, the walls are adorned with African art. This unit holds Kwanzaa ceremonies and celebrates Juneteenth every year. Among American psychiatrists Dr. Hall is rare: Only 2 percent are black. And, she says, this shortage of minority mental practitioners keeps many patients from opening up.
Dr. HALL: We are comfortable with what's familiar, and so people who remind us of our parents, who remind us of our extended family--we're much more comfortable with them. We're much more able to open up to them and feel trusting.
BABA: Traditionally, psychiatry has been a culturally neutral discipline. But because it's the only branch of medicine that depends so heavily on what the patient communicates--what he says and how he acts--Dr. Francis Lu says misunderstandings can be a big problem.
Dr. LU: Whenever there is a doctor-patient relationship, there is non-verbal communication going on. And sometimes that can be very difficult and can be confused, so clinicians can call something psychopathological that might be more related to the person's culture. And sometimes there can be the other mistake of calling something cultural that might in fact be psychopathological.
BABA: To avert mistakes like that, the staff of San Francisco General's ethic focus units reflects the cultures of the patients they're treating. Since Lu started this one, other ethnically focused psychiatric programs have cropped up around the country. But they operate only in out-patient community health centers, not in locked wards. Dr. Lu says some hospitals regard his model as a form of racial segregation. That, he says, misses the point.
Dr. LU: We always need to look at the patient as an individual, as a person that brings together in his or her own particular way the various personal qualities that that person has, but that does include cultural factors. That is a part of every human being.
BABA: The debate over cultural competency in the medical field, and especially the idea of mandatory cultural training, has occupied the headlines of major American medical publications. A New Jersey law passed in April requires doctors to take these courses before they can obtain medical licenses. California's considering a similar bill. But some doctors are opposing it, including the president of the California Medical Association.
Dr. ANMOL MAHAL (Gastroenterologist; President, California Medical Association): Let me tell you, no 16-hour course will make a physician culturally competent.
BABA: Dr. Anmol Mahal, a gastroenterologist, believes doctors develop cultural competence best in one-on-one relationships with their patients. He maintains that doctors will want to attend courses when they're offered, but not if they're forced.
Dr. MAHAL: It is my personal belief that if we had good courses in cultural--and, for that matter, even linguistic competency--that physicians will flock to those courses because physicians do desire to be culturally competent.
BABA: Dr. Heather Hall of San Francisco General disagrees. She says even short courses can help develop cultural awareness. And she believes the issue is too important to be left to individual doctors. Hall has teamed up with Dr. Francis Lu to teach the hospital's cultural diversity training course to medical residents and nurses. She says contrary to popular assumption, it's not only about teaching cultural patterns.
Dr. HALL: It really is knowing yourself and knowing what kinds of prejudices you carry toward people who are different from you so that you can sort of consciously decide to put those aside when you're working with a person and help them sort of teach you who they are.
BABA: She shares an example that's grown a little too common for her.
Dr. HALL: If you have a black patient that's very angry, it isn't uncommon for a mental health provider who's not familiar with day-to-day realities of black people to just think that that's paranoia.
BABA: Other in-patient hospitals may copy the idea of cultural wards. Recently a team of doctors from New York City visited in the hope of establishing ethnic focus units for Asians and Latinos in Brooklyn and Queens. Six years ago, the American College of Psychiatry awarded San Francisco General's ethic unit for their creativity in medical education. And this year, they won the American Medical Association's award for excellence in patient-centered communications.
For NPR News, I'm Hana Baba in San Francisco.
GORDON: Thanks for joining us. That's our program for today. NEWS & NOTES was created by NPR News and the African-American Public Radio Consortium.
I'm Ed Gordon. This is NEWS & NOTES.
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