Cultural competence in health care spaces goes a long way to supporting the well-being of the U.S. Haitian population, says Judite Blanc, Ph.D., assistant professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine.

Consider the case of a Haitian immigrant who works up the courage to seek mental health support. “This only comes after deep suffering, and what that individual expects in that moment of vulnerability is empathy,” says Dr. Blanc.

Instead, they are asked for a date of birth and insurance card when they walk in a clinic door.

The intake system and insurance-based care system that’s expected by any long-time U.S. resident can feel shocking to someone new to the American health care system.

“I have all that pain, and when I come to you, it’s a big step. It’s because it’s impossible for me to bear, and the first question you’re asking after I say why I’ve come is what insurance do you have,” says Dr. Blanc, who is from Haiti and completed her education there and in France.

Dr. Blanc’s outsider’s view of the American system where she works and her intimate knowledge of the community she serves make her deeply motivated to improve the mental health care system. What she’s learned in her research about navigating cultural complexities in the Haitian community in the United States is a model for supporting other minoritized communities as well.

Understanding the background of a community is fundamental to working effectively with Haitian people or anyone from a minority community.

There are 1.5 million people living in the United States who were born in Haiti or have a parent born there, according to the Census Bureau’s 2022 American Community Survey (ACS). Over half of them (51%) live in Florida.

Understanding this community’s history, culture, and worldview is key to meeting mental health care needs.

Dr. Blanc describes the Haitian community as “a minority among the minorities, which makes them more affected by intersectional stress.”

Haitians are predominantly Black, are non-native English speakers and come from a country that’s impoverished by a history of colonialism, bad governance and natural disasters.

Cultural barriers to accessing health care also include the following:

• Low literacy
• Low health literacy
• Religious and spiritual beliefs about health
• Mental health stigma

Understanding cultural barriers and social determinants of health is critical to meeting mental health needs of any population. “People interpret what’s happening to them from their own vision of the world. You need to respect that, learn it, understand it and then receive it,” says Dr. Blanc.

Inevitably, there are times when a provider doesn’t have deep knowledge of a patient’s community.

In this case, Dr. Blanc says, “Show cultural humility by not approaching people with the assumption that you know better.”

This means starting from a more inclusive and flexible place that respects the client’s background, history and cultural beliefs.

Dr. Blanc gives the following example of a patient who expresses fear of someone coming after her. Rather than quickly concluding that the person is delusional, try to understand where this narrative comes from. “Maybe in the past, that person has been experiencing this or has relatives who spoke about this,” says Dr. Blanc.

Support community mental health care education in minority communities.

The Haitian community, says Dr. Blanc, is more vulnerable to mental health issues because most of them aren’t familiar with the role of a psychologist or therapist.

For example, when working with Haitian children, parents may show signs of stress or anxiety about an issue for reasons that may not be obvious. “It’s because the first thing that comes to their minds is they’re worried DCF will become involved,” says Dr. Blanc.

Knowing this underscores the need for health education. Dr Blanc recommends explaining how therapists can help and how therapy works with any new patient or family member.

5 ways mental health experts can better support patients from minority groups who seek care

To better support mental health care in the Haitian community, Dr. Blanc recommends five tips for mental health care providers. These apply to any patient who comes from a minority community.

Practice humility

Mental health practitioners should approach each interaction with intellectual humility. Fostering a more respectful and effective therapeutic relationship requires recognizing the limits of their knowledge and being open to listening and learning from patients about their experiences, challenges and perspectives.

Cultural competence training

Continuous education and cultural competence training should include ways to understand how the following factors impact mental health and treatment:

• Cultural differences
• Worldviews
• Ways of being and knowing
• Biases
• Historical trauma

Improve accessibility

Make accessing care easier by going to communities rather than expecting patients to come to you, such as when UMiami’s mobile health clinic stops at the Center for Haitian Studies several times a week.Provide access to interpreters, multilingual staff and translated materials to minimize language barriers. This can help patients feel more comfortable and understood during their care.

Community engagement

Build relationships with minority communities to build trust and understand their specific mental health needs. Engaging with community leaders and organizations can facilitate outreach and create a supportive network.

Advocacy for equitable care

Advocate for inclusive research and equitable and accessible mental health services to address the cumulative effect of social determinant stressors on minority populations’ global health. Policies and practices that mitigate these stressors can create a fairer mental health care environment and healthier communities.

Working with Haitian clients requires a deep understanding of their cultural background, social context and the barriers to accessing care they face.

Providers can offer more effective and compassionate care with a culturally competent approach. Addressing these challenges is not only essential for the well-being of Haitian clients but also for creating a more equitable healthcare system for everyone.

Wendy Margolin is a contributor for UHealth’s news service.

Tags: Dr. Judite Blanc, empathetic care, improve health care, mental health care in Miami, minority communities