Cultural Competence in Canadian Mental Health Care

Given the increasing diversity of Canada, cultural competence is considered of paramount importance in practising mental health care effectively.

The term cultural competence refers to cultural “knowledge, skills, and problem solving” and encourages clinicians to consider clients' cultural background in every stage of treatment, including intake, assessment, conceptualization, and the delivery of intervention strategies.

First discussed by Sue and colleagues (1982), cultural competence includes open-mindedness, self-awareness, and integrating and applying cultural knowledge and skills.

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Cultural competence makes health care services more accessible and effective for people of different cultural backgrounds. It reduces the risk of misdiagnosis, improves compliance with therapy, and decreases health care disparities.

In a therapeutic context, cultural competence helps clinicians work effectively with culturally marginalized adults, children, and families and is integrated into each phase of psychotherapy.

Cultural competence also goes beyond the individual practitioner. It should be addressed at multiple levels, including the organization of healthcare systems and institutions, the diversity of the healthcare workforce, and the types of interventions available.

Mental health care providers should be familiar with diverse cultural norms and be aware of individual, systemic, environmental, and structural racism impacting the communities they serve. Although many people think that Canada is a multicultural paradise, Canadians seem to harbor just as must racial prejudice as their neighbours to the south.

Historically and currently, many Canadians of colour are traumatized by racism. And similarly to the U.S., the mental health profession and practice of psychology have also caused harm to racialized people and communities, most notably its Indigenous peoples (APA, 2021; Mikail & Nicholson, 2019).

Psychology as a discipline centres on whiteness through training and practice, which has led to the current demand for cultural competency training for all clinicians to prevent further harm to people of colour in need of mental health care (Dupree & Kraus, 2022). A working understanding of this unfortunate reality is necessary to interact authentically with racialized clients and avoid the mistakes of those less informed.

Racial dynamics must be considered in diagnosis and service provision. A lack of cultural competency can lead to clinicians misusing their power and privilege or failing to recognise it in a therapeutic setting in ways that harm vulnerable clients. Therapists learn to become aware of their own biases and actively work towards unlearning them.

As a first step, active listening skills can help, and therapists can incorporate cultural client feedback into their therapeutic approach. Further, cultural competency requires utilisation of culturally-tailored assessment tools and case conceptualisations that are inclusive of the client’s culture and the implications of their socio-racial and economic position.

It is impossible to become completely culturally competent in a culture that one was not born into. But although one may never reach it, cultural competency should always be a goal.

All therapists should seek continuing education, consultation and supervision, and personal experiences and reflection that reduce implicit bias, promote cultural humility, and encourage the exploration of the ways they can include advocacy and allyship in their work and professional identity.

Cumulatively, these practices enhance cultural skills, improve service provision, and facilitate client healing from the effects of racism. This process improves self-awareness, eliminates biases, and makes one more open to correction by culturally-diverse clients for the benefit of all Canadians of colour.

Learn more about the traumatizing impact of racism in Canadians of colour in our new paper just released in the journal Current Trauma Reports (Williams et al., 2022).