By Susan Winston, LCSW
|Cultural Sensitivity at an Outpatient Mental Health Clinic|
|Case Study – Boris S.|
|Case Study – Svetlana K.|
Although we may think of the United States as cultural melting in which most of us share the same values and cultural beliefs, the reality is that America is made up of many diverse groups of people. When we talk about social workers providing culturally competent or culturally sensitive services we are talking about the relatively recent trend of providing services that are sensitive and responsive to these cultural differences.
The impact of a person’s unique cultural differences – including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical ability – on their care is now being taken into account. Social workers are adapting their skills to fit a family’s ethics, values and customs.
Social workers assisting diverse populations should be acutely aware of the dilemmas they may encounter when they recognize the needs of the diverse clients regarding behaviors, advocacy, controversial issues (such as abortion, gay rights, or women’s rights), and dual relationships.
An examination of an outpatient mental health clinic in New York City which serves a diverse population provides a good illustration of the need for cultural sensitivity. Many of the clinic’s clients are immigrants and refugees from Central Asian countries that made up the portions of the former Soviet Union (i.e., Uzbekistan, Turkmenistan, etc.). Russian is the first language for many of them.
Most of the families served are considered to be part of the Bukharian culture, a very close-knit community. Arranged marriages still occur in the Bukharian culture. Any known incidences of mental illness, substance abuse or family conflicts can tarnish a family’s standing in the community. Therefore, privacy and confidentiality is of the utmost importance.
A common practice at the clinic has been to use staff with similar backgrounds as the populations they serve. However, such practices are not always meeting the needs of the individuals. Because privacy and confidentiality are so important to Bukharian clients, they will often request a social worker who is in no way connected to the Bukharian community. Other Russian speaking staff is available and culturally competent, it should not be assumed that speaking a client’s language ensures cultural competence. The Bukharian culture is closer to Central Asian cultures of Uzbekistan and Turkmenistan while, Russian culture is more European in nature.
Boris S. is a 35-year-old Bukharian man of the Jewish faith. He came to the clinic complaining of anxiety, irritability, anger, and serious marital problems. Mr. S. has been married for 15 years. His problems started six to seven years ago after he immigrated to the United States. His wife’s adaptation to life in the new country was greater as she learned English faster and graduated from college, and began working sooner. As a result Mr. S. started feeling guilty and saw himself as a poor provider.
He began to listen to his wife’s phone conversations, checking telephone bills, accusing his wife of being unfaithful, and other apparently jealous behaviors. He attempted to control his wife’s behavior by criticizing her clothes, the amount of money she spent, and the number of times she could talk to her parents and friends.
Boris had poor anger management skills and would yell at his wife and children. His communication with his teenage children suffered because he was unable to accept the way they dressed or spoke to him.
In his case, education about cultural differences was key for Boris to better accept the issues causing him conflict in his new environment. Social workers were able to help him become more comfortable with these cultural differences.
Family support was key to identifying cultural expectations and norms of behavior and how immigration may have affected his conflict with family members. Often, children of families who have immigrated become “parentified”. They are depended upon to translate the English language and negotiate various systems for their parents. This situation is usually temporary but for parents who have difficulty adapting to the new environment or otherwise impaired, the road can to cultural transition can be long and difficult.
Svetlana K., a 72-year-old Bukharian widow of the Jewish faith, lives with a single son. She is anxious to see that he gets married. Mrs. K. began experiencing agitated depression and she had suicidal thoughts. She was accompanied by her oldest son to the appointments, especially when her symptoms began worsening. Following discussions between the social worker and her other children, hospitalization was recommended for Svetlana. Cultural sensitivity was required to help the family work around the stigmatizing issues of mental illness, respect to elders in the family, and concerns related to marriage prospects should a family member become psychiatrically hospitalized.
While hospitalized Mrs. K’s younger daughter had a newborn son, and she did not want to miss the Jewish newborn ceremony of bris. Her son organized a twenty-four hour watch over his mother using the entire extended family and supervised her medication closely. Treatment dilemmas in considering cultural factors included a conflict between the decision to immediately transport her to the nearest emergency room which might alienate the family from future treatment and the consideration of their cultural beliefs and norms. In this case, they requested a well-known Jewish hospital and voluntary admission outside their immediate community. Out of respect for their need for privacy, religion, and treatment engagement, as well as the family history of protecting their mother from harm, this choice was made.
In closing, providing useful services to diverse populations requires much more than having caregivers with similar backgrounds and languages of client population. Cultural considerations are far reaching. Cross cultural knowledge, leadership, language, and skills are often not enough and, in some ways perhaps, inadequate and limiting. In being truly culturally competent, social workers look beyond the obvious and incorporate all their knowledge and competencies in the field to professionally and adequately address the needs of all people.