Language and culture influence health care response

A lot has been written about the explosion of the Hispanic/Latino community in the United States over the past 10 years. But very little attention has been given to the linguistic and cultural challenges this growth brings to the field of mental health and addiction - also known as behavioral health.

When it comes to providing culturally competent behavioral health care services, more providers are recognizing the challenge of caring for patients from diverse linguistic and cultural backgrounds.

In 1990, the U.S. Census reported 31.8 million residents of the United States, 14 percent of the total population, spoke a language other than English at home. The 2005 U.S. Census estimate now places that figure at 51.9 million or 19.4 percent of the total population. Georgia ranks 22nd in the nation with 11.4 percent of its residents reporting that they speak a language other than English at home.

Many behavioral health care facilities in Georgia are serving diverse patient populations, and even as some of them have arduously sought and retained bilingual providers, many struggle with meeting that need, which in turn leaves any client with limited English proficiency facing many barriers to services. It is not easy to call a behavioral care facility and ask for help. Clients with LEP may delay calling for an appointment because of the difficulty communicating over the telephone.

Meanwhile, the mental health or substance abuse problem may become more severe or advanced, which in turn may cause more social chaos or require intensive and expensive inpatient hospitalizations. Misunderstandings about the time, date and location of appointments are more likely to occur if the patient does not understand English. Even when patients arrive at the facility on time, they may be late for appointments because of difficulty communicating with the intake staff. Furthermore, the medical interview and examination present unlimited possibilities for confusion. In addition, potentially serious misunderstandings can occur since complete and accurate medical and behavioral health history is crucial to an accurate diagnosis.

Miscommunication can result if patients are not given instructions in a language they can understand. They may not be adequately prepared physically or psychologically to undergo these sometimes emotionally painful interviews. Culturally based beliefs and traditions can also affect the course and outcome of a behavioral health problem. Both providers and patients bring their respective cultural backgrounds and expectations to the clinical setting. These cultural differences can present barriers to appropriate behavioral health care.

Americans function under the Western general medical view where the emphasis is placed on the individual. However, in many other cultures, the family plays the central role in managing illness. Many individuals carry cultural assumptions that may influence the presentation of symptoms or the response to diagnosis and treatment. A patient whose culture does not have a model for behavioral health may not respond to traditional interviews and treatment plans. A provider who does not understand that a client may not share their world view on behavioral health and simply expects the client to comply with the recommendations is actually setting up that client to fail.

In Georgia we continue to have a tremendous amount of growth, not only from the Latino community, but from many other cultures and countries. Behavioral health providers need to continue to strive for linguistic and cultural competence in their agencies in order to make the acculturation process easier and not more difficult for those who are suffering while they assimilate to the United States.

Pierluigi Mancini is the Executive Director of CETPA, a nonprofit agency and Georgia's only Latino behavioral health agency to earn a state license by the Georgia Department of Human Resources and national accreditation by CARF for behavioral health services in Spanish. CETPA provides affordable, linguistic and culturally competent behavioral health services to the Latino community in Georgia. CETPA has offices in Norcross 770-662-0249 and Sandy Springs 770-452-8630. www.cetpa.org.

"People Helping People" is a weekly column written by the executive directors of nonprofit organizations in Gwinnett County. Today's article was written by Pierluigi Mancini of CETPA.

Need help or know someone who does? The Gwinnett Helpline directs callers to the appropriate nonprofit agency. Call 770-995-3339.