Structural competency and the social determinants of health
There are many factors which affect the health of all individuals and specific factors unique to minority or underserved communities which place them at increased risk for challenges to their physical and mental health. This particular notion highlights the importance of structural competency and the intentional efforts of mental health and medical professionals to learn more about the impact of structural, environmental, and societal factors present within minority communities. Looking specifically at race, the American Academy of Pediatrics states that “racism is a core social determinant of health that is a driver of health inequities”. When looking at disparities across different groups, race stands at the forefront for the inequities that we see in access to healthcare, wealth, education, etc. Just the same, we tend to see a disproportionate number of racial and ethnic minorities with experiences of discrimination, poverty, intergenerational trauma, and juvenile justice involvement.
Supporting individuals dealing with racialized and historical trauma
The term historical trauma has been used to describe the trauma experienced by a specific cultural, racial or ethnic group across multiple generations. The National Child Traumatic Stress Network, along with other organizations, have specifically utilized this construct to describe the history of slavery and decades of institutionalized oppression toward African Americans, the impact of the Holocaust on the Jewish community, and the forced migration and the violent colonization of Native Americans. The NCTSN series on historical trauma implores all individuals to be mindful that “the pain children experience may be related to the pain that their parents, grandparents, and ancestors experienced”. When working with children, youth, and families, it is important to remember that in addition to the challenges faced due to decades of oppression, these groups are undoubtedly experiencing significantly higher rates of stress, trauma, and adversity.
Helping individuals cope with daily experiences of racism and discrimination
Experiences of racism and discrimination can be troubling, long-lasting, and traumatic. Even individuals who have not directly experienced discrimination by others may know someone in their family, school, job, or community that has had to deal unfair, unequal, or hostile treatment because of differences related to race, religion, socioeconomic status, etc.
One of the key things that we can do to support these individuals is acknowledging and validating their experiences and the range of emotions connected to these experiences. In addition to experiences anger or sadness, these experiences can lead to further challenges such as anxiety or depression. Constantly having to worry about mistreatment or judgement from others can be extremely debilitating. In addition to seeking professional help to deal with the stress associated with discrimination or being from a marginalized community, individuals may find that they are able to cope with these experiences by joining groups or organizations with others that have had similar experiences. Engaging in activism and identifying ways to be more vocal about issues of inequality occurring with in school, workplaces, or communities can also be helpful for individuals who hope to engage in efforts to bring about systemic change.
Barriers to treatment and service utilization among ethnic minorities
When looking specifically at the use of mental health services across racial and ethnic groups, it is known that African American and Latinx families often have fewer mental health visits, more difficulty engaging in services, and a shorter length of time in treatment. While there are a number of individual and contextual factors contributing to these disparities, cultural factors are having a major role as well. Along with the stigma related to mental illness, many individuals may be concerned about judgment from clinicians or that they are not able to truly understand the experiences that are unique to racial or ethnic minorities. Strategies that can be used to address these issues and enhance support for families seeking treatment include increasing the diversity of an agencies leadership and staff and utilizing treatment interventions and assessments that are designed to meet the needs and experiences of minority families. Last, allowing clients to be the expert on their own experiences and highlighting the strengths within the family can help clinicians gain a better understanding of the risk and protective factors present within a family.