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Taking Issue   |    
The Need for "Community Cultural Competence"
Greer Sullivan, M.D., M.S.P.H.
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.9.1145
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Recently, the southern United States has received a "double dose" of trauma. The psychological impacts of hurricanes Katrina and Rita are still present. And, because a disproportionately large number of Southerners volunteer for military service, towns and cities across the South are receiving many returning veterans, some of whom have seen more than one tour of duty. These overlapping events have increased the need for assistance with mental health problems in some of the most underserved and disadvantaged areas. Although some people turn to formal health care, many more call upon informal providers, including trusted community leaders, such as clergy and educators; officers and administrators in the National Guard; people in service industries, such as bartenders and hairdressers; employers; and of course, family members. These individuals can be seen as the "first responders" to community mental health needs.

Even though mental health providers have begun to view family members of consumers as partners in care, we have not typically reached out to this first-responder "network." Yet there has never been a greater need to do so, certainly in the South and perhaps in other geographic areas. Efforts are needed to bridge the gap between formal mental health providers and these informal, but often highly influential, caregivers in the community. As the article by Curlin and colleagues in this issue suggests, such gaps do exist and can be barriers to dialog and ultimately to receipt of appropriate care.

Helping community members understand our view of mental disorders is important. However, it is essential that we be willing to understand their views of mental health problems, even when they are at variance with the traditional medical model. Much of what falls under the blanket term "stigma" originates from these contrasting paradigms. The first step toward partnering across these paradigms is simply appreciating that they exist. Bridging differences will require that we develop better "community cultural competence." Although attention has been given to providers' cultural competence in treatment settings, there is far less recognition that significant cultural differences often exist between mental health care providers and the very communities in which we practice. These differences undoubtedly also contribute to disparities in service use along a variety of dimensions, including, but not limited to, race and income.

Partnering with communities may mean relinquishing our sense of ourselves as authorities so as to meet people where they are. This may not always be comfortable, but it is essential to developing the trust needed to make mental health care more acceptable and accessible.

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