From Competence to Humility: Advancing Culturally Responsive Mental Health Care
Cultural humility offers a more inclusive, dynamic approach to mental health care that emphasizes an ongoing process of self-reflection, collaboration, and adaptation.
Data on disparities in mental health care highlight significant differences in both access to and the quality of care received across diverse populations. These disparities stem from a multifactorial set of issues, including structural and interpersonal barriers that hinder the utilization of mental health services. For example, challenges such as the cost of care, lack of insurance, transportation difficulties, pervasive stigma, and limited access to culturally and linguistically appropriate resources significantly impact access to care. Additionally, negative experiences within the health care system, such as bias and discrimination, further discourage individuals from seeking evidence-based, high-quality care for mental health conditions like anxiety and depression (McGuire & Miranda, 2008).
These intersecting factors underscore the urgent need for mental health providers to adopt culturally responsive and equitable practices that address the unique needs of all patients, ensuring care that is inclusive, effective, and accessible.
While cultural competence has historically been the foundation of training programs aimed at improving cross-cultural interactions, this approach has notable limitations. Cultural competence often assumes that cultural knowledge is finite and can be mastered, a perspective that risks reinforcing stereotypes and perpetuating a sense of otherness for patients (Lekas, et al., 2020). In response to these limitations, the concept of cultural humility, introduced by Tervalon and Murray-García, offers a more inclusive, dynamic, and reflective approach to mental health care that moves away from cultural competence, which focuses on accumulating knowledge about specific cultures.
Cultural humility emphasizes an ongoing process of self-reflection, collaboration, and adaptation. These are factors that enhance our emotional intelligence, which, when coupled with humility, not only improves our ability to serve patients but also leads to work and leadership success (Caldwell & Okpala, 2019; Albrecht, 2015). This framework acknowledges that no provider can fully understand another person’s lived experience. Instead, it promotes relationships built on mutual respect, curiosity, and learning (Tervalon M & Murray-García, 1998).
Tenets of Cultural Humility
1. Lifelong Learning and Self-Reflection: Cultural humility requires an enduring commitment to self-examination and personal growth. Mental health care providers must critically assess how their own cultural identities and biases influence their interactions with patients (Caldwell & Okpala, 2019). This introspection deepens understanding of how cultural contexts and systemic inequities shape patients’ mental health experiences (American Psychiatric Association, 2023).
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In practice: Learn about implicit bias and strategies to address this such as individuating and perspective-taking.
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Ongoing: Engage in workshops, seminars, and other learning opportunities that explore cultural humility and diversity in mental health care.
2. Acknowledging Power Dynamics: The provider-patient relationship is inherently influenced by power imbalances that can hinder trust and communication. Cultural humility calls for recognizing and mitigating these dynamics to create a therapeutic environment based on equity and collaboration (Tervalon M & Murray-García, 1998). Providers who actively address these imbalances empower patients to express their needs and preferences without fear of judgment.
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In practice: Actively acknowledge and discuss power imbalances with patients, creating an environment that encourages dialogue and shared decision-making.
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Ongoing: Implement practices that promote patient autonomy, such as validating their experiences and collaboratively setting treatment goals.
3. Patient-Centered Care: A culturally humble approach recognizes the interplay of intersecting identities, such as race, gender, ethnicity, and socioeconomic status, in shaping each patient’s mental health journey. By tailoring care to meet individual needs, providers strengthen therapeutic alliances and improve treatment outcomes (Hook, et al., 2013).
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In practice: Encourage patients to share their cultural beliefs and values while approaching their perspectives with genuine curiosity and openness.
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Ongoing: Regularly seek input from both colleagues and patients to identify areas for improvement in cultural responsiveness.
4. Advocacy for Systemic Change: Cultural humility extends beyond individual interactions to encompass efforts to address structural barriers to care. Providers are encouraged to challenge discriminatory practices, advocate for policy reforms, and promote initiatives that foster inclusivity and equity within mental health care systems (Stubbe, 2020).
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In practice: Support community-based initiatives and policy changes that enhance access to inclusive mental health services.
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Ongoing: Advocate for policy changes that address structural inequities and promote equity within your respective health systems.
APA Cultural Congruency Symposium
Cultural humility represents a transformative shift from traditional cultural competence models, moving toward a patient-centered, adaptable approach that celebrates diversity and fosters equity. By committing to lifelong learning, addressing power imbalances, and advocating for systemic change, mental health care providers can cultivate meaningful relationships and deliver care that respects the complexities of their patients’ lived experiences.
How can we operationalize this concept? What do we need to successfully incorporate cultural humility into our work to effectively impact care? APA’s upcoming Cultural Congruency Symposium will help illuminate tools, strategies, and resources to support participants in bringing this not only to their patient care but to systems, policies, and institutions.
To learn more and deepen your commitment to advancing culturally responsive mental health care, we invite you to join us on January 10, 2025, at APA’s headquarters in Washington, D.C., for the Improving Cultural Congruency Across the Mental Healthcare Delivery Network Symposium. This full-day event is designed to strengthen your dedication to culturally responsive mental health care by providing an unparalleled opportunity to connect with leading experts, acquire practical strategies to enhance patient-centered care, address health care inequities, and foster self-reflection and professional growth.
The keynote address will be delivered by Yolanda Lawson, M.D., immediate past president of the National Medical Association, followed by insightful presentations from renowned experts on topics such as:
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Understanding Cultural Competency: Advancing Toward a Culturally Humble Approach in Mental Healthcare Delivery
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Navigating Cultural Intersectionality: Lessons in Adaptability and Inclusion
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Applying an Equity-Minded Approach to Mental Healthcare Delivery
Register today—seats are limited. CME is available.
Benefits of Cultural Humility
Adopting cultural humility as a guiding framework in mental health care has profound implications for improving both patient experiences and outcomes. First, it fosters stronger therapeutic relationships by creating an environment of trust and mutual respect. When patients feel understood and valued, they are more likely to engage openly with their providers, enhancing communication and collaboration (Plaisime, et al., 2023). This foundation of trust not only strengthens the provider-patient bond but also contributes to more effective care.
Second, cultural humility actively addresses systemic inequities, helping to reduce mental health disparities that disproportionately impact marginalized populations. By acknowledging and tackling these structural barriers, providers can create a more inclusive and equitable mental health care system (Gopalkrishnan, 2018).
Lastly, integrating cultural humility into clinical practice empowers providers to create interventions that deeply reflect the cultural contexts of their patients’ lives. By prioritizing an understanding of individual cultural identities and experiences, this approach ensures treatments are both relevant and effective. It seamlessly aligns with item 16 of APA’s Cultural Formulation Interview and the guidelines in Part D of the DSM-5-TR’s Outline for Cultural Formulation, which advocate for tailoring care to meet each patient’s unique needs and values. Collectively, these efforts highlight the transformative impact of cultural humility in advancing patient-centered care, strengthening therapeutic relationships, and enhancing treatment outcomes. ■
References
McGuire TG, Miranda J: New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Aff (Millwood) 2008; 27(2):393-403.
Lekas HM, Pahl K, Fuller Lewis C: Rethinking cultural competence: shifting to cultural humility. Health Serv Insights 2020; 13:1178632920970580.
Caldwell C, Okpala C: Humility and emotional intelligence, in Humility As Enlightened Leadership. Nova Science Publishers 2019.
Tervalon M, Murray-García J: Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved 1998; 9(2):117-125.
Hook JN, Davis DE, Owen J, et al.: Cultural humility: measuring openness to culturally diverse clients. J Couns Psychol 2013; 60(3):353-366.
Stubbe DE: Practicing cultural competence and cultural humility in the care of diverse patients. Focus 2020; 18(1):49-51.
Plaisime MV, Jipguep-Akhtar MC, Belcher HM: ‘White People are the default’: a qualitative analysis of medical trainees’ perceptions of cultural competency, medical culture, and racial bias. SSM Qual Res Health 2023; 4:100312.
Gopalkrishnan N: Cultural diversity and mental health: considerations for policy and practice. Front Public Health 2018; 6:179.
American Psychiatric Association: Mental Health Disparities: Diverse Populations. psychiatry.org 2023.
Albrecht K: The paradoxical power of humility. Psychol Today 2015 [accessed December 6, 2024].
Biographies
Madonna Delfish, M.P.H., is senior program manager for diversity and health equity for the American Psychiatric Association.
Puja Chadha, M.D., is assistant director of education for the UC Davis Center for Reducing Health Disparities.
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Published online: 7 January 2025
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