Culturally Responsive Psychiatric Care Starts With Trust

Hispanic patients did not constitute a homogenous clinical population, and Roger Rivera, PMHNP, cautioned against treating them as one. Cultural backgrounds differed substantially among patients, he said, but the underlying diagnostic criteria did not change; what changed was the language patients used to describe their experiences.¹

Several overlapping barriers limited care: access, insurance coverage, financial limitations, language barriers, and a shortage of clinicians who understood patients' cultural backgrounds.² Rivera identified self-awareness as the most important element of psychiatric care, for prescribers and therapists alike, and noted that many patients lacked it and stayed stuck in certain behaviors and patterns. Many patients had spent years normalizing their symptoms, minimizing their distress, and functioning through adversity because that was all they had known. Rivera cautioned against confusing this lack of awareness with unwillingness to receive treatment, noting that many patients never had the opportunity to understand their symptoms or discuss them in a comfortable environment.

Trust, according to Rivera, begins before prescribing. A common clinician error was assuming that explaining the pharmacology alone had addressed the patient's concerns. "We might discuss receptor activity, efficacy, adverse effects, while the patient is wondering whether the medication will change their personality, affect their ability to work," Rivera said. Patients also may arrive having lost belief that they could get better, whether because of previous psychiatric treatment or concerns about taking medication.

Rivera described a collaborative model in which the clinician contributed the science and the patient contributed knowledge of their own body. "I know the science part, you know your body, and we're trying to find that happy medium," he said. Treatment planning began by establishing the patient's baseline and the goal. For a socially isolated patient, the first step might be feeling comfortable enough to talk with someone; after a death or other loss, treatment might focus on restoring chemical balance and then work backward. Clinicians should review evidence, explain rationale, set realistic expectations, and remind patients that treatment could be adjusted, Rivera said. Rivera concluded that trust was built through transparency, shared decision-making, and ongoing communication.

Dr Rivera is a dual board-certified mental health and family nurse practitioner, and the medical director of Mente Suave psychiatry and medicine in Central Florida.

References

1. González HM, Vega WA, Williams DR, et al. Depression care in the United States: too little for too few. Arch Gen Psychiatry. 2010;67(1):37-46.

2. Alegría M, Chatterji P, Wells K, et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008;59(11):1264-1272.