Abstract
Evidence suggests that the current mental health system is failing in the provision of quality mental health care for diverse children and families. This paper discusses one critical domain missing to improve care: serious attention given to diversity, culture, and context. It discusses what we mean by understanding culture and context at the individual, family, organizational, and societal level. Focusing on key predictors of children’s adjustment in natural contexts would increase attention to building community and family capacities that strengthen children’s mental health. To conclude, we suggest changes in organizational culture to build natural supports to enhance children’s mental health.
Similar content being viewed by others
References
Alarcón, R. D. (2003). Mental health and mental health care in Latin America. World Psychiatry, 2(1), 54–56.
Alegría, M., Canino, G., & Pescosolido, B. (2009). A socio-cultural framework for mental health and substance abuse service disparities. In B. J. Sadock, V. A. Sadock, & P. Ruiz (Eds.), Comprehensive textbook of psychiatry. Baltimore: Wolters Kluwer Health, Lippincott Williams & Wilkins.
Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D., et al. (2002). Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatric Services, 53(12), 1547–1555.
Alegria, M., Sribney, W., Woo, M., Torres, M., & Guarnaccia, P. (2007). Looking beyond nativity: The relation of age of immigration, length of residence, and birth cohorts to the risk of onset of psychiatric disorders for Latinos. Research in Human Development, 4(1–2), 19–47.
Alem, A., Jacobsson, L., Araya, M., Kebede, D., & Kullgren, G. (1999). How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia. Acta Psychiatrica Scandinavica, 100, 40–47.
Baker, D., & Taylor, H. (1997). Inequality in health and health service use for mothers of young children in Southwest England. Journal of Epidemiology and Community Health, 51, 74–79.
Becker, E. R., & Roblin, D. W. (2008). Translating primary care practice climate into patient activation: The role of patient trust in physician. Medical Care, 46(8), 795–805.
Belsky, J., Steinberg, L., & Draper, P. (1991). Childhood experience, interpersonal development, and reproductive strategy: An evolutionary theory of socialization. Child Development, 62(4), 647–670.
Bigby, J. A., & Perez-Stable, E. (2004). The challenge of understanding and eliminating racial and ethnic disparities in health. Journal of General Internal Medicine, 19(2), 201–203.
Blau, P. M. (1974). Presidential address: Parameters of social structure. American Sociological Review, 39(5), 615–635.
Borg, M. B. (2002). The Avalon gardens men’s association: A community health psychology case study. Journal of Health Psychology, 7(3), 345–347.
Bronfenbrenner, K. (1997). The role of union strategies in NLRB certification elections. Industrial and Labor Relations Review, 50, 195–212.
Browman, C. L. (1996). The health consequences of racial discrimination: A study of African Americans. Ethnicity and Disease, 6, 148–153.
Burgess, D., Fu, S., & van Ryan, M. (2004). Why do providers contribute to disparities and what can be done about it? Journal of General Internal Medicine, 19, 1154–1159.
Burkard, A. W., Ponterotto, J. G., Reynolds, A. L., & Alfonso, V. C. (1999). White counselor trainees’ racial identity and working alliance perceptions. Journal of Counseling and Development, 77(3), 324–329.
Bussing, R., Schoenberg, N., & Perwien, A. (1998). Knowledge and information about ADHD: Evidence of cultural differences among African-American and. white parents, 46(7), 919–928.
Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., et al. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
Cheng, D., Leong, F. T. L., & Geist, R. (1993). Cultural differences in psychological distress between Asian and Caucasian American college students. Journal of Multicultural Counseling and Development, 21(3), 182–190.
Cheung, F. K., & Snowden, L. R. (1990). Community mental health and ethnic minority populations. Community Mental Health Journal, 26(3), 277–291.
Cicchetti, D., & Rizley, R. (2006). Developmental perspectives on the etiology, intergenerational transmission, and sequelae of child maltreatment. New Directions for Child and Adolescent Development, 1981(11), 31–55.
Cinnirella, M., & Loewenthal, K. M. (1999). Religious and ethnic group influences on beliefs about mental illness: A qualitative interview study. British Journal of Medical Psychology, 72(4), 505–524.
Connect for Kids (2006). Children of immigrants: What does the future hold? Retrieved November 9, 2009, from http://www.connectforkids.org/node/4016.
Dean, R. (2001). The myth of cross-cultural competence. Families in Society: The Journal of Contemporary Human Services, 82(6), 623–630.
Desjarlais, R. R. (1995). World mental health: Problems and priorities in low-income countries. USA: Oxford University Press.
Draper, P., & Harpending, H. (1982). Father absence and reproductive strategy: An evolutionary perspective. Journal of Anthropological Research, 38(3), 255–273.
Dressler, W., & Badger, L. (1985). Epidemiology of depressive symptoms in black communities. A comparative analysis. Journal of Nervous and Mental Disease, 173(4), 212–220.
Erikson, K. T. (1966). Wayward puritans: A study in the sociology of deviance. New York: Wiley.
Farmer, T. W., & Farmer, E. M. Z. (2001). Developmental science, systems of care, and prevention of emotional and behavioral problems in youth. American Journal of Orthopsychiatry, 71(2), 171–181.
Farmer, T. W., Farmer, E. M. Z., Estell, D. B., & Hutchins, B. (2007). The developmental dynamics of aggression and the prevention of school violence. Journal of Emotional and Behavioral Disorders, 15(4), 197–208.
Ferrada-Noli, M. (1997). Health and socioeconomic indicators in Psychiatric Catchment Areas with divergent suicide rates. Psychological Reports, 81, 611–619.
Figueroa, R. A., Fradd, S. H., & Correa, V. I. (1989). Bilingual special education and this special issue. Exceptional Children, 56(2), 174–178.
Flores, G., & Tomany-Korman, S. C. (2008). Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children. Pediatrics, 121(2), e286–e298.
Frazier, S. L., Cappella, E., & Atkins, M. S. (2007). Linking mental health and after school systems for children in urban poverty: Preventing problems, promoting possibilities. Administration and Policy in Mental Health and Mental Health Services Research, 34(4), 389–399.
Freedenthal, S. (2007). Racial disparities in mental health service use by adolescents who thought about or attempted suicide. Suicide and Life-Threatening Behavior, 37(1), 22–34.
Freudenberg, N., & Ruglis, J. (2007). Reframing school dropout as a public health issue. Preventing chronic disease, 4(4). http://www.cdc.gov/pcd/issues/2007/oct/2007_0063.htm.
Frick, P. J., & Kimonis, E. R. (2005). Externalizing disorders of childhood and adolescence. In J. E. Maddux & B. A. Winstead (Eds.), Pscyhopathology: Foundations for a contemporary understanding Mahwah. NJ: Lawrence Erlbaum Associates.
Furstenberg, F., & Hughes, M. E. (1997). The influence of neighborhoods on children’s development: A theoretical perspective and a research agenda. In J. Brooks-Gunn, G. Duncan, & J. L. Aber (Eds.), Neighborhood Poverty: Volume II: Policy implications in studying neighborhoods (pp. 23–47). New York, NY: Russel Sage Foundation.
Geertz, C. (1973). The interpretation of cultures. New York: Basic Books.
Glisson, C., & Green, P. (2006). The effects of organizational culture and climate on the access to mental health care in child welfare and juvenile justice systems. Administration and Policy in Mental Health and Mental Health Services Research, 33(4), 433–448.
Glisson, C., & Hemmelgarn, A. L. (1998). The effects of organizational climate and interorganizational coordination on the quality of outcomes of children’s service systems. Child Abuse and Neglect, 22(5), 401–421.
Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23(6), 767–794.
Glisson, C., & Schoenwald, S. K. (2005). The ARC organizational and community intervention strategy for implementing evidence-based children’s mental health treatments. Mental Health Services Research, 7(4), 243–259.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall, Inc.
Gureje, O., & Alem, A. (2000). Mental health policy development in Africa. Bulletin of the World Health Organization, 78, 475–482.
Hedden, T., Ketay, S., Aron, A., Rose Markus, H., & Gabrieli, J. D. (2008). Cultural influences on neural substrates of attentional control. Psychological Science, 19(1), 12–17.
Hoberman, H. M. (1992). Ethnic minority status and adolescent mental health services utilization. The Journal of Behavioral Health Services and Research, 19(3), 246–267.
Hofstede, G. (1998). Attitudes, values and organizational culture: disentangling the concepts. Organization Studies, 19(3), 477–493.
Huang, F., Chung, H., Kroenke, K., Delucchi, K., & Spitzer, R. (2006). Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine, 21(6), 547–552.
Institute of Medicine. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press.
Institute of Medicine. (2009). Focusing on children’s health: Community approaches to addressing health disparities. Workshop summary. Washington, DC: National Academy Press.
Jaycox, L. H., Stein, B. D., Kataoka, S. H., Wong, M., Fink, A., Escudero, P., et al. (2002). Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1104–1110.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.
Katz, A. M., & Alegría, M. (2009). The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context. Social Science and Medicine, 68(7), 1238–1246.
Katz, A., & Shotter, J. (1996). Hearing the patient’s voice: Toward a ‘social poetics’ in diagnostic interviews. Social Science and Medicine, 43, 919–931.
Kirmayer, L., Groleau, D., Guzder, J., Blake, C., & Jarvis, E. (2003). Cultural consultation: A model of mental health service for multicultural societies. Canadian Journal of Psychiatry, 48(3), 145.
Kirmayer, L. J., & Minas, H. (2000). The future of cultural psychiatry: An international perspective. Canadian Journal of Psychiatry, 45(5), 438–446.
Kleinman, A., Eisenberg, L., & Good, B. (2006). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Focus: The Journal of Lifelong Learning in Psychiatry, 4(1), 140–149.
Kreider, R. M., & Fields, J. (2005). Living arrangements of children: 2001: US Census Bureau.
Laird, J. (1998). Theorizing Culture. In M. McGoldrick (Ed.), Re-visioning family therapy (pp. 20–36). New York: Guilford Press.
Lauritsen, J. L. (2005). Racial and ethnic differences in juvenile offending. In Our children, their children: Confronting racial and ethnic differences in American juvenile justice (pp. 83–104).
Logan, J. R., Stults, B. J., & Farley, R. (2004). Segregation of minorities in the metropolis: Two decades of change. Demography, 41(1), 1–22.
López, S., & Hernandez, P. (1987). When culture is considered in the evaluation and treatment of Hispanic patients. Psychotherapy, 24(1), 120–126.
Magnusson, D., & Cairns, R. B. (1996). Developmental science: Toward a unified framework. In R. B. Cairns, G. H. Elder, & E. J. Costello (Eds.), Developmental science (pp. 7–30). New York: Cambridge University Press.
Malgady, R. G., & Zayas, L. H. (2001). Cultural and linguistic considerations in psychodiagnosis with Hispanics: The need for an empirically informed process model. Social Work, 46(1), 39–49.
Maxie, A., Arnold, D., & Stephenson, M. (2006). Do therapists address ethnic and racial differences in cross-cultural psychotherapy. Psychotherapy: Theory, Research, Practice Training, 43(1), 85–98.
National Federation of Families for Children’s Mental Health. (2008). Working definition of family-driven care.
Nisbett, R. E., & Masuda, T. (2003). Culture and point of view. Proceedings of the National Academy of Sciences, 100(19), 11163–11170.
Novins, D. K., Bechtold, D. W., Sack, W. H., Thompson, J., Carter, D. R., & Manson, S. M. (1997). The DSM-IV outline for cultural formulation: A critical demonstration with American Indian children. Journal of the American Academy of Child and Adolescent Psychiatry, 36(9), 1244–1251.
Oades-Sese, G. V., & Esquivel, G. B. (2006). Resilience among at-risk Hispanic American preschool children. Annals of the New York Academy of Sciences, 1094(1), 335–339.
Odom, S. L., McConnell, S. R., & McEvoy, M. A. (1992). Peer-related social competence and its significance for young children with disabilities. Social competence of young children with disabilities: Issues and strategies for intervention, 3–36.
Olfson, M., Gameroff, M., Marcus, S., & Jensen, P. (2003a). National trends in the treatment of attention deficit hyperactivity disorder. American Journal of Psychiatry, 160(6), 1071–1077.
Olfson, M., Gameroff, M., Marcus, S., & Waslick, B. (2003b). Outpatient treatment of child and adolescent depression in the United States. Archives of General Psychiatry, 60(12), 1236–1242.
Pumariega, A., Glover, S., Holzer, C., & Nguyen, H. (1998). Administrative update: utilization of services. II. Utilization of mental health services in a tri-ethnic sample of adolescents. Community Mental Health Journal, 34(2), 145–156.
Razali, S. M., Khan, U. A., & Hasanah, C. I. (1996). Belief in supernatural causes of mental illness among Malay patients: impact on treatment. Acta Psychiatrica Scandinavica, 94(4), 229–233.
Rousseau, D. M. (1990). Normative beliefs in fund-raising organizations: Linking culture to organizational performance and individual responses. Group and Organization Management, 15(4), 448–460.
Rousseau, C., Hassan, G., Measham, T., Moreau, N., Lashley, M., Castro, T., et al. (2009). From the family universe to the outside world: Family relations, school attitude, and perception of racism in Caribbean and Filipino adolescents. Health and Place, 15(3), 751–760.
Saeed, K., Gater, R., Hussain, A., & Mubbashar, M. (2000). The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan. Social Psychiatry and Psychiatric Epidemiology, 35(10), 480–485.
Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277, 918–924.
Schooler, C., Farquhar, J. W., Fortmann, S. P., & Flora, J. A. (1997). Synthesis of findings and issues from community prevention trials. Annals of Epidemiology, S7, S54–S68.
Simmons, P. A. (2001). Changes in minority homeownership during the 1990s. Fannie Mae Foundation Census Notes.
Singer, A. (2002). America’s diversity at the beginning of the 21st century: Reflections from census 2000. The Brookings Institution.
Singh, N. N., McKay, J. D., & Singh, A. N. (1999). The need for cultural brokers in mental health services. Journal of Child and Family Studies, 8(1), 1–10.
Snowden, L. R., & Yamada, A. M. (2004). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166.
Sorensen, G. (1998). The effects of a health promotion-health protection intervention on behavior change: The well works study. American Journal of Public Health, 88(11), 1685–1690.
Surgeon General, U. S. (2001). Mental health: Culture, race, and ethnicity. A supplement to mental health: A report of the surgeon general. Washington, DC: U.S. Department of Health and Human Services.
Suurmond, J., & Seeleman, C. (2006). Shared decision-making in an intercultural context Barriers in the interaction between physicians and immigrant patients. Patient Education and Counseling, 60(2), 253–259.
Takeuchi, D., Bui, K., & Kim, L. (1993). The referral of minority adolescents to community mental health centers. Journal of Health and Social Behavior, 34, 153–164.
Vega, W. A., & Rumbaut, R. G. (1991). Ethnic minorities and mental health. Annual Review of Sociology, 17(1), 351–383.
Wagner, E. H., Wickizer, T. M., Cheadle, A., Psaty, B. M., Koepsell, T. D., Diehr, P., et al. (2000). The kaiser family foundation community health promotion grants program. Health Services Research, 35(3), 560–589.
Ware, N. C., Lachicotte, W. S., Kirschner, S. R., Cortes, D. E., & Good, B. J. (2000). Clinician experiences of managed mental health care: A rereading of the threat. Medical Anthropology Quarterly, 14(1), 3–27.
Weist, M. D., & Schlitt, J. (1998). Alliances and school-based health care. Journal of School Health, 68, 401–404.
Wenger, E., McDermott, R., & Snyder, W. (2007). Cultivating communities of practice: A guide to managing knowledge. Boston, MA: Harvard Business School Press.
Whyte, S. R. (1991). Attitudes towards mental health problems in Tanzania. Acta Psychiatrica Scandinavica, 83(S364), 59–76.
Williams, D., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116(5), 404–416.
Woolard, J. L., Cleary, H. M. D., Harvell, S. A. S., & Chen, R. (2008). Examining adolescents’ and their parents’ conceptual and practical knowledge of police interrogation: A family dyad approach. Journal of Youth and Adolescence, 37(6), 685–698.
Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research, 5(2), 65–77.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alegria, M., Atkins, M., Farmer, E. et al. One Size Does Not Fit All: Taking Diversity, Culture and Context Seriously. Adm Policy Ment Health 37, 48–60 (2010). https://doi.org/10.1007/s10488-010-0283-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-010-0283-2