Reconciling diverse clientele with non-diverse staff
Our public agency serves individuals who are primarily African American. Yet we do not have enough African American therapists to see everyone who requests one. We offer to have them see another therapist in the meantime, but most prefer to wait. I am concerned that a person with a behavioral health problem is worse off seeing no one than seeing someone who may not be a good fit for them. Suggestions?
Increased need for mental health services due to the pandemic, compounding social stressors, and reimbursement for public health services that has not kept pace with the market contribute to this situation.
Add to this, the disparity between the mental health workforce and the general population. The 2020 US Census identifies approximately 12.4% of the US population as African American. Yet the percentages of African Americans among large mental health practitioner groups (clinical social workers, licensed professional counselors, and clinical psychologists) fall at that level or lower. And the distribution of these practitioners is uneven. Happily, latest trends show increases in the representation of black, indigenous and people of color (BIPOC) in all these mental health fields. But that doesn’t help you today.
Your interventions should have three elements: manage risk, build trust, and train staff.
Manage risk: We presume that as a public agency you cannot turn away anyone who requests services. Your focus, then, is on managing risks – namely self-harm and harm to others. Suicide is one of the highest causes of death among African Americans, particularly youth.
Therefore, schedule check-in calls with these people until they are assigned to a therapist. Make sure they have a card with the new 988 crisis intervention numbers.
Deploy peer specialists, persons with lived experience, who can offer support by explaining the course of therapy, what worked for them, the reasons for medication, the things to keep in mind during hospitalization.
Build trust: Your statement, “someone who is a good fit” brings out a key point. What exactly makes a good fit between a mental health practitioner and someone seeking help? Must one have a personal experience with mental illness to help someone who is undergoing that pain? Can a person work therapeutically with someone of a different gender or sexual orientation? These questions continue to be debated and researched.
Every meaningful therapeutic encounter depends on trust. Trust is built on honest, genuine, and consistent communication. And it is based on being present – meeting the other person where they are emotionally and physically (not where you think they ought to be). Therefore, educating your clients about the core elements of therapy and what to expect may allow some of them to consider working with a wider range of therapists.
Train staff: It is desirable to have a behavioral health workforce which resembles the client population, not simply so that more requests from participants can be accommodated but also because staff members can learn from each other.
But training is a continual process. Taking a course, reading a book, or having resource materials related to clients who are African American or other subgroups (including subgroups of white persons) is not enough. And just being a person of a particular group does not confer qualifications to provide mental health services even if it may lead to better initial connections.
One must have time to internalize what is learned, to have supervision and continue to learn. Therefore, in this challenging behavioral health recruitment era, do provide training to your cohort of therapists, particularly in issues related to the population and communities you serve. But accompany the training with ongoing supervision and monitoring of work.
Effective diversity in behavioral health services is not a garment that one puts on or takes off – it must become part of the cultural fabric of your services and values.
If you would like to have a consultation or staff training to help you build trust and confidence with your clients and staff to best meet the needs in a diverse service environment, please contact us at email@example.com
Photo: Clay Banks, unsplash.com