The Importance of Cultural Competence in Mental Health Outcomes

By Katherine [Katu] Medina-Pineda, MHC-LP

Like most aspects of our society and the systems in place to ensure ‘order’ among people, the mental health industrial complex is no exception to the premise that there is one objectively healthy way of being (white, wealthy, able-bodied, cishet, Christian, patriarchal) and everything else can be interpreted as pathology or illness. As a result, so much of the way mental health is conceptualized in the work professionals do is rooted in maintaining the status quo and weaponizing or vilifying oppressed peoples’ natural nervous system reactions to oppression.

The truth is mental health is not experienced in a vacuum—it is deeply shaped by cultural values, social conditions, and historical contexts. Thanks to abolitionists throughout history, the colonized world has become increasingly more aware of white supremacy and its impact on the most vulnerable people. As a result, cultural competence has become an essential consideration in improving mental health outcomes. Cultural competence refers to the ability of practitioners and systems to provide care that is respectful of and responsive to the cultural identity, beliefs, and practices of clients. Without this nuance, individuals risk misdiagnosis, disengagement from treatment, and exacerbation of mental health disparities.

Why Culture Matters in Mental Health

Culture shapes how people understand, express, and cope with distress. According to Ogundare (2019), in many non-western societies, depression is often experienced through physical symptoms like fatigue or headaches as opposed to feelings of sadness or worthlessness- which dominate western and global north depictions of depression. Similarly, the understanding and expression of psychosis may vary depending on culture and social norm. For example, in the same study by Ogundare published in The Journal of Health and Social Sciences, he describes how psychosis in the western world often involves technology and a fear of being surveilled, whereas many cultures from the Global South may experience psychosis as related to the supernatural or spiritual world. These differences highlight the danger of applying Western diagnostic categories universally without considering cultural nuance.

Furthermore, misdiagnosis is one of the most significant risks of ignoring cultural context. When clinicians interpret symptoms solely through their own cultural lens, they may misunderstand patients’ experiences. For example, what may be a culturally normative spiritual belief in one community might be misinterpreted as delusional in another. Such errors can have devastating consequences, leading to unnecessary medication, stigma, or mistrust of the healthcare system.

The Limits of Standardized Evidence-Based Practices

Evidence-based practice (EBP) is widely promoted as the gold standard for mental health interventions. Yet, as Laurence Kirmayer (2012) points out, the research base informing EBP often excludes cultural minorities and relies heavily on white western populations. This gap means that treatments validated in majority populations may not be effective—and it is also often irrelevant—for marginalized groups. Furthermore, standardized measures of treatment success frequently ignore culturally valued outcomes such as community connectedness or spiritual well-being. Cultural competence bridges this gap by emphasizing adaptation of evidence-based treatments to cultural contexts and by expanding what is considered a successful outcome. However, tensions remain within the mental health field: EBP seeks universal generalizations, while cultural competence threatens white supremacy (objectivity and individualism) by de-centering standards in favor of nuance. While EBP can give us a sense that there is a tried-and-true way to be healthy, it is important to note that this is an illusion to streamline mental health services for profit and productivity.

True successful mental health outcomes for the global majority requires more than naming these discrepancies within EBP— it requires skill building. Therapy is itself an artform that requires training that challenges professionals to integrate with nuance what we know to be “objective” with the reality that there is no such thing as objectivity. A systematic review of cultural competence training for mental health providers published in Professional Psychology: Research and Practice in 2022 by Wippold and Becker found that cultural competence programs can significantly enhance practitioners’ attitudes, knowledge, and skills. Despite positive results, many trainings focus narrowly on race and ethnicity while neglecting other critical dimensions such as religion, immigration status, or socioeconomic background, gender or sexuality. Addressing this gap is vital because individuals’ identities are complex and intersecting, and cultural competence must extend beyond any single dimension of diversity.

From Cultural Competence to Cultural Humility and Safety

While cultural competence is important, some scholars caution against viewing it as a skill set to be mastered. Kirmayer (2012) and others argue for approaches like cultural humility, which emphasizes an ongoing process of self-reflection, openness, and recognition of the clinician’s limited understanding of a client’s cultural world. Similarly, the concept of cultural safety shifts attention to systemic issues, urging practitioners and institutions to acknowledge historical injustices and power imbalances that shape clinical encounters. These perspectives remind us that cultural competence is not a box to check but a lifelong practice requiring institutional support, continuous training, and systemic change.

Conclusion

Cultural competence is not just an ethical imperative but a practical necessity in improving mental health outcomes. When mental health providers account for cultural influences in diagnosis, treatment, and communication, they can foster trust, increase treatment adherence, and reduce disparities. Conversely, when culture is ignored, the risks include misdiagnosis, disengagement, and worsening inequities.

Ultimately, integrating cultural competence with evidence-based practice offers the most promising path forward. This integration requires expanding the evidence base to include diverse populations, training providers to deliver culturally responsive care, and addressing structural inequities that underlie health disparities. By doing so, mental health services can better serve the diverse communities that depend on them.

Sources:

Chu, W., Wippold, G., & Becker, K. D. (2022). A systematic review of cultural competence trainings for mental health providers. Professional Psychology: Research and Practice, 53(4), 362–371. https://doi.org/10.1037/pro0000469

Kirmayer, L. J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social Science & Medicine, 75(2), 249–256. https://doi.org/10.1016/j.socscimed.2012.03.018

Ogundare, T. (2019). Culture and mental health: Towards cultural competence in mental health delivery. Journal of Health and Social Sciences, 5(1), 23–34. https://doi.org/10.19204/2019/cltr6