Championing Culturally Competent Care in Mental Health

Guest blog by Quartet Health

Quartet Health is committed to bringing speed to quality care to everyone across the country. Access to care is a vital part of Quartet’s mission. We believe that part of quality care is offering culturally competent care. We also know that in the United States, policies have systematically prevented Black communities from accessing quality care.

To help more people get to culturally competent providers, in 2021, Quartet acquired innovaTel Telepsychiatry. innovaTel currently has 130 clinicians on staff, 27 percent of whom are clinicians of color, and is currently onboarding an additional 50 providers. We recently sat down with Dr. Mia McNeil, innovaTel’s Clinical Director of Nurse Practitioner Services, to discuss cultural competency in the mental health space. 

Quartet: Tell us about your background and training?

Dr. McNeil:I’m from Montreal, Quebec. My ethnic background is Haitian, and both my parents are immigrants. I’ve been in the behavioral health space since 2009. I started my career as a registered nurse. I completed my graduate studies and earned a Doctorate of Nursing Practice from Rutgers University in 2016. I’ve worked as a psychiatric nurse practitioner since that time.

Tell me about your job at innovaTel. What is it that you do?

I joined innovaTel two years ago as Clinical Director of Nurse Practitioner Services. I oversee the Nurse Practitioner clinical group and am involved in interviewing, clinical support and performance evaluations. I am also growing culture around Diversity, Equity, and Inclusion (DEI).

One year ago, our CEO, Jon Evans, called a meeting for anyone interested in engaging in a conversation around diversity. That came out of the George Floyd murder and the following civil protests in Summer 2020. Terica Toliver and I have been leading the charge as co-chairs of the Diversity, Equity and Inclusion committee for over a year, and it’s been a great experience.

How do you define culturally competent care?

Culturally competent care is defined as practicing with a worldview that is inclusive of other cultures and also developing knowledge of diverse and cultural backgrounds to influence the care we provide. Cultural understanding should be reflected in every aspect of our interactions with patients. Cultural competency has a lot to do with seeing the world through the lens of that patient. Because everyone has a story, and that story is integrated with who you are from a cultural, ethnic or racial standpoint. As a provider, being able to render culturally congruent care and understand the culture of my patients is essential.

Why is cultural competency important for mental health?

Research shows that cultural competency leads to better health outcomes. Additionally, patients are able to develop a strong therapeutic alliance when their provider shares a similar cultural background. Of course, there is still a lot of stigma, especially among minoritized groups, and we must gain an understanding of where that stigma is coming from. As the provider, I have a set of skills, and medical knowledge to support my patient’s mental health, but if I don’t understand who my patient is from a cultural perspective, I may be unsuccessful in providing the support and care they desperately need.

You mentioned how it’s important when a patient looks like their provider. But we know that there is a shortage of providers of color. How can a provider deliver culturally competent care when they are not of the same background as their patient?

No matter who’s sitting across from me, I strive to provide holistic care. It’s important to pay attention to nuances and to the patient’s non-verbal cues during that interaction, especially if you know that your cultural background is different from that person. Diversity goes beyond race and ethnicity. If I am caring for a transgender person, that might not be my reality from a gender identity perspective, but I still need to meet that person where they are. If my knowledge is limited, I want to hear from my patient. Patients appreciate it, and they will not frown upon a provider seeking to understand their reality.  If there’s a true mismatch, that is okay. It’s not a rejection. It’s an opportunity to get the person the best possible care and service. I would add that, as providers, we are challenged to ensure that we’re constantly educating ourselves, better understanding our limitations, and bridging those gaps. We do have a responsibility to get that knowledge. As leaders at innovaTel and Quartet, we want to offer these learning opportunities to our providers.

What are some specific ways you have championed cultural competency at innovaTel?

As part of our annual competency training, we introduced two distinct tracks of training, one for clinical providers and one for administrative staff. We have a cultural competency module for the administrative staff that they must complete every year. For our clinical providers, we also have a module. Last year’s topic dealt with racial disparities and racial trauma. In the context of the DEI committee, we also developed a clinical pathway that is specific to diversity. That clinical pathway has seven courses, which allow the provider to earn continuing education credits. It will enable them to learn more about Diversity, Equity, and Inclusion and support their clinical practice. Upon completion of this training the provider earns a certification.

What tips do you have for people looking to identify a culturally competent provider?

Patients need to know that they have options. We want to know about past experiences with providers. Even past negative experiences. The more information we have, the more equipped we are to do the right thing for the patient. We empower patients to know that they have a say in the matter and that they don’t have to get matched with the first person who has an opening. This level of empowerment is necessary.  As we receive the referrals, we need to ensure we ask all the right questions when we schedule that first evaluation. It’s no different than if you have someone who needs a therapist with trauma expertise. You would want someone who has a specialized trauma training to meet the patients’ specific needs and preference.  Race must also be a consideration in the matching process because we know that it impacts health outcomes. This needs to be more of a front door discussion than an afterthought.

What role does access to care play in providing culturally competent care?

Since the start of the pandemic, we’ve seen a lot of positive changes around payment for telehealth services, and that’s part of the solution.  Telehealth services were reimbursed 100% in rural areas prior to the public health emergency which was not the case in urban areas. Now remote providers can get paid for their services regardless of serving a rural or urban area. This is a very exciting time in tele behavioral health space. InnovaTel and Quartet are in a position to increase access to care to individuals from diverse racial and socio-economic backgrounds and I am enthusiastic about being part of the solution.

What barriers do we still need to overcome to provide culturally competent care?

The shortage of providers is a big problem, but there’s also such a lack of education on the patient side. There’s such a misunderstanding of mental health and of the services offered. During the COVID-19 pandemic, we saw a surge in anxiety disorders and depression. It affected everyone, whether it was directly or indirectly. We all felt the pressure one way or another – mental health conditions do not discriminate. I think there can be more outreach in Black communities. For example, many churches have been instrumental in helping people understand that it’s okay to get mental health help. I like to tell people if you’re a diabetic you’re okay taking insulin. When you have a headache, you take Tylenol, and somehow, it’s okay. Why would taking medicine for depression or anxiety be any different? In my current roles, I strive to finding a path forward and solution to these barriers.