1) Is the systematic neglect of culture in healthcare the biggest barrier to the advancement of a standard of care worldwide?

Culture matters greatly in healthcare. The systematic neglect of culture in healthcare is the biggest barrier to the advancement of a standard of care worldwide according to an expert that Dr. Jessica Dere cites in her Ted talk. People know stereotypes of cultural characteristics and assume that all people from a culture share those characteristics. This can be limiting and comparisons and distinctions are then made that can cause even further limits. Even just focusing on an individual is not good enough to address cultural care. In order to develop a full understanding of mental health, healthcare providers must understand not only the individual but also the culture from which they come.

Culture awareness is minimized in mental health. Learning to be culturally informed can be overwhelming and people can tend to avoid becoming culturally aware. Dr. Dere offers 2 suggestions about how to go about becoming educated in cultural awareness in the mental health field. The first suggestion is to take a stance of informed curiosity. Clinicians should not work from the perspective that individual of a cultural group share characteristics in every case. A stance of informed curiosity is to be humble and encourages asking questions.

The second suggestion is to ask different questions and ask questions differently. This forces a person to re-evaluate ideas that they held previously. This is good to establish different perspectives that help to bring cultural awareness into mental healthcare. Healthcare providers should also develop cultural knowledge, but should ask questions about the differences and learn what they are. They should also never assume something about a person based on their perceived culture. People can think differently about the world based on culture and on their experiences, so there can be a wide range of differences that may or may not be based on culture.

2) How do cultural factors influence the plan of care for children/adolescents with Autism Spectrum Disorders (ASDs)?

Since ASD touches all cultures, it is important to know what affects culture can have on the way ASD is perceived by a community. Some cultures will view ASD differently than the white American culture does, but white American culture is often assumed as the standard much to the detriment of some patients perhaps. There may be cultural myths about ASD in some cultures that can stop people from seeking help for their child who is suffering from it. They may be ashamed of the child or they may think the child is blessed with special powers depending upon their culture. This may delay treatment, which can be detrimental. It is important for people of all cultures to understand what ASD is. However, the information that can be shared with families how have a child with ASD may be right for some cultural groups but completely wrong for others. Recent immigrants and non-white families may delay getting help for people from several different cultural groups for several different reasons such as language, geographic location, religion, nationality, socioeconomic status, gender, beliefs and values, family structure and ethnicity. Cultural differences in the way ASD is viewed can take place within ethnic groups as well as among them.

Understanding culture when treating patients with ASD can help to establish a good relationship with the patient and his or her family. Some of the ways to go about becoming more culturally aware include learning about culture and heritage from as many diverse communities as possible. This includes learning what is considered “normal” psychological or emotional health in the various cultures. Also understanding that there may be a language barrier can help to be prepared when treating patients with ASD especially when it comes to communicating with their families. Finally, taking time to listen is very important also.

3) What is the relationship between a culturally-informed approach to care and an interprofessional team approach to care?

We neglect culture at our own peril. If we do not understand how a specific culture views sadness, then knowing whether a person is depressed or sad is difficult. Also, the way that a culture views sadness (or any other emotion) can also play into what is considered mental health to the individual from that culture. However, that cultural awareness about sadness or other emotion should not be assumed because the patient comes from a specific culture. In an interprofessional team approach, the hope is that someone on the team is culturally aware enough to point out the assumptions being made about the patient in terms of his or her culture. Collaboration between the members of an interprofessional team means a coordinated approach to healthcare and shared decision-making around health and social issues with the goal of improving the patient’s health and quality of life. One member of the team at minimum should have enough cultural awareness to be able to add that knowledge to the collaboration on decision making so that the patient does not suffer from assumptions about them that do not fit.

For mental health patients, cultural knowledge may be especially relevant because their emotional or psychological issues may or may not be considered abnormal in their culture. Knowing enough about the culture of which the patient is a part will be useful to provide the patient’s perspective to the interprofessional team. Having that information can help the team approach treatment of the patient perhaps with something similar to the patient’s perspective. Providing that level of understanding can help the patient to see that the healthcare team caring for him or her is trying to help. They can see that they have made an effort to be empathetic and this can encourage the patient to participate in the treatment.