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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Is the Problem Cultural Incompetence or Racism?

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Behavioral health providers hear the call for culturally competent and responsive services. But, there’s another important call to action less discussed — the disparities caused by racism.

There is a rising tide of public awareness about the effect of racial bias on public services and the lives of people of color. News stories like those covering the recent death of Sandra Bland, an African-American woman, in a Texas jailhouse following a highly-charged arrest for a traffic violation, illustrate the tragic consequences of racism. For Ms. Bland, racism was compounded by a lack of urgency and compassion regarding mental illness.

In Ms. Bland’s case, there was neither ambiguity nor a lack of warning signs. She informed authorities of her history of suicidality. A 15-page screening form completed at the time of her incarceration included questions about her mental health. It documented that she suffered from depression and that she had attempted suicide. In addition, during an interview, the Waller County sheriff said that Ms. Bland mentioned a suicide attempt to the two officials who processed her into jail. Yet, no one intervened and the jail elected not to place her on suicide watch. As of August 2015, her case is being investigated as a homicide. But as New York Times columnist Roxane Gay remarked, “Even if Ms. Bland did commit suicide, there is an entire system of injustice whose fingerprints left bruises on her throat.”

In 2001, Former Surgeon General David Satcher warned that minorities in the United States “suffer a disproportionate burden of mental illness” because they often have less access to services than other Americans, receive lower quality care and are less likely to seek help when distressed. Stories like Ms. Bland’s remind us how far we still have to go in creating truly equitable service structures.

Ethnic and racial minorities face illnesses earlier, deal with more rapid progression of illnesses and suffer higher rates of impairment and death than white Americans. Other historically disenfranchised groups like lesbian, gay, bisexual and transgender people have been similarly affected. The statistics are undeniable.

  • African-American babies are nearly 5 times more likely to die before reaching their first birthday than white babies.
  • Suicide attempts for Hispanic girls in grades 9-12 are 70 percent higher than for white girls in the same age group.
  • Lesbian, gay and bisexual adults are about 5 times more likely than heterosexual men and women to have a mental illness in their lifetime such as those related to mood, anxiety or substance use.
  • Death rates from suicide among Native Americans and Alaska Natives are 50 percent higher than among whites.
  • Up to 39 percent of all transgender people face some type of harassment or discrimination when seeking routine health care.
  • Smoking rates are highest among Asian American women who have a mental illness.
  • African-Americans are more likely than whites to be involuntarily committed for outpatient psychiatric care.

These are just a few of hundreds of statistics that illustrate the price paid by those who are too often viewed as less worthy. The crack-cocaine epidemic that plagued black communities was dealt with by building more prisons. The surge in opioid addiction among whites has spurred a call for treatment, not incarceration. Until we deal with institutional bias, disparities will persist.

Clinical competence — including asking about and understanding the impact of a patient’s culture — should be what we all expect when we seek treatment. Unfortunately that is not the case for too many. But we can change that. Most of the organizations that provide services to people with mental and substance use disorders were founded on social justice principles and are today’s community problem-solvers. Now we can honor our history and broaden our impact by adding our voices to the rallying cry — black lives matter.


Editor’s note: As the voice of community behavioral health organizations, the National Council works hard to foster a diverse mental health and addictions workforce, while simultaneously working to eliminate health-related disparities. One way we do this is through the Addressing Health Disparities Leadership Program, which helps mid-level managers working in mental health and addiction service organizations gain the awareness, knowledge, and leadership skills to help eliminate health disparities in their communities. Open for enrollment now, the Addressing Health Disparities Leadership Program helps create clinically competent systems of care, led by diverse and compassionate leaders from throughout the United States.