Cultural competency “hugely important” in providing mental health care: Q&A with therapist Robin Dial

July 30, 2021

Venice Family Clinic is dedicated to building health equity for our patients, the majority of whom are racial and ethnic minorities and come from historically underrepresented and underserved communities. That’s why we give our patients quality comprehensive health care that takes into account external factors – where they live, how they grew up and how they’ve been treated by others – knowing that every aspect has an impact on their mental and physical well-being.

The Clinic’s Behavioral Health department is dedicated to deepening its capacity to be culturally competent, to embrace conversations on racial trauma and to create space for healing. Therapist Robin Dial, ACSW, recently joined our Behavioral Health team and explains the unique mental health issues people of color have and specifically how racism affects their overall health. 

Venice Family Clinic: How often do our patients bring up racism when talking about their mental health?

Robin Dial: Most of my patients are African American, and until recently most haven’t been aware of how racism has impacted their mental health. Racism has just always been a part of their lives. But during the pandemic it has been more apparent that my patients are triggered by social injustice. We all have had more time to tune in to that and think about how we’ve seen more overt racism over the past four years or so, especially with social media providing constant exposure to the things that have always existed but are more accessible now, including for my patients.

VFC: What kinds of experiences are our patients having, and what are the impacts?

RD: White supremacy in our culture has a huge impact on why people feel the way they feel. They’re dealing with everything from microaggressions at work to worrying about their safety when going out. They’re having intrusive, worrisome thoughts about just doing everyday activities. This can lead to being in a constant state of high alert, trouble sleeping, anxiety or depression.

Especially with anxiety, there’s a psychosomatic experience where you think something is wrong physically but then realize it’s more of a mental health issue. Some people are aware of feeling uneasy and how that might show up physically, but they’re not always aware how intensely that can affect the body. They’re not recognizing the tension they’re holding. When I model some techniques to address and manage these feelings, my patients can see the difference in their bodies between being tense and not being tense. 

In general, for people of color, life expectancy is shorter. Even successful people of color have higher mortality rates because of the higher levels of stress they experience. 

VFC: Racial trauma is caused by external events or someone else’s actions, so it’s not on the patient to have to change their behavior in order to live a healthier life. So what do we counsel our patients to do?

RD: I validate their anger and rage, which a lot of the time is largely repressed. I say it’s OK to be angry, but encourage them to consider how they can utilize it to help themselves and the people around them. I tell my patients to seek out health care providers they feel safe with. I tell them to find things at home that make them feel at peace and to be in the moment and resist the things that make them want to feel bad. You can’t change what happens to you, but you can respond to it in a way that gives you peace and relaxation. I teach a lot of self-care.

VFC: How important is having cultural competency in providing mental health treatment? 

RD: It’s hugely important. Being Black, I understand that historically there has been a lot of stigma within the Black community when it comes to mental health and seeking those services. While that stigma has decreased and Black people are more open about it these days, just knowing and understanding the stigma is important.

Having cultural competence is important in diagnosing a patient’s symptoms, too. For example, if someone seems to be paranoid, saying they’re often being followed by the police, and if we don’t understand that experience, a therapist might diagnose that person incorrectly. Maybe that person isn’t paranoid after all, which means the solutions to help them would be different.

Also, many patients seek out providers that look like them because they don’t have to explain as much of their story or risk seeing their provider’s shock when they share their experiences with racism. Reliving those experiences can be triggering and retraumatizing. That’s why it’s important to have diversity among providers, as well as cultural competence.

VFC: When a patient brings up their experiences with racism and you don’t happen to be of the same race or from the same community as that person, how do you approach the subject with them?

RD: I try to approach the situation with as much humility as possible. The patient is the expert on their experience. I validate what they are feeling and support them and how they feel. And I try to help them find ways to work through managing that discomfort and those feelings.

VFC: How do you bring your lived experience to your work at the Clinic?

RD: When it’s appropriate, I’ll share my own experiences with mental health challenges and how therapy helped me. Doing so validates patients’ experiences and shows that I’m not just a therapist who has been trained to listen, but that I’ve actually had my own experiences like theirs, and I’m just as human as they are. It balances out the power dynamic so the patient doesn’t feel like I’m just going to tell them what to do. Sharing similar feelings shows the patient that this is a space where we can collaborate in finding healthier ways to cope that are unique to them.