Culture dictates who we are and bow we respond to the world around us.
As the U.S. population ages, it is also becoming more ethnically and racially diverse. The Bureau of the Census (1992a, b) predicts that between 1990 and 2050, the population 65 and older among African Americans, Native Americans, Hispanics, and Asians will increase 150 percent, 200 percent, 500 percent, and 625 percent, respectively. Population aging and multicultural changes have major implications for the mental health field, particularly issues pertaining to access, the cultural competency of practitioners and agencies providing the mental health services, and the need for a solid foundation of research-based knowledge about culture and mental health. In order to better serve the range of culturally diverse older adults and provide quality mental health services, service providers must sharpen their skills in relation to cultural issues and expand their use of research-based practice in the planning and implementation of policies and programs. For professionals to become more competent and better able to meet the needs of this emerging population, it is necessary to understand the impact that culture has on mental health, barriers to service, issues arising between client and therapist, and the strategies necessary in
developing culturally appropriate skills.
UNDERSTANDING CULTURE AND MENTAL HEALTH
If effective mental health care is to be provided, practitioners must consider, address, and understand the culture from which a client comes. Culture dictates who we are and how we respond to the world around us. Culture also influences the prevalence of mental disorders, symptom manifestation, the degree of stigma attached to mental illness, and whether people seek help. Culture also sets the stage for how and what people believe; how they behave, solve problems, and communicate; how their identity and interpersonal relationships develop; how they adjust to change, handle stressors, and ultimately cope with mental health problems.
Anderson (1991) broadly defined culture as a "framework of values and practices that forms a context for people's lives and which they adapt in changing historical and regional circumstance." The interaction between culture and health is often quite complicated. While the relationship between cultural variations and mental health variations is often an interesting focal point, such variations can also veil the fundamental social, political, and economic differences between people (MacLachlan,1997). For clients to receive culturally appropriate care, mental health professionals must know about more than beliefs alone. They must also comprehend the older adults world view, historical experiences, and basic organization of life. Cultural variations, historical and environmental factors, perceptions, beliefs, values, and level of acculturation affect the level of suspicion or discomfort that the older person has with the mental health field. Such factors subsequently affect the course of overall mental health treatment, including the effectiveness of assessment of mental status, determination of source of symptomatology, and the interventions utilized (Tsai and Carstensen, 1996).
A theoretical framework that can be used to understand how culture and related factors affect health-and thereby the mental health of older people-is known as the "Mandala of Health" (Hancock and Perkins, 1985). This model sees human ecology as a constant interaction of culture and environment. The interaction between culture, community, and family results in variations in the biological, spiritual, and psychological experiences of individuals. These experiences are often interdependent and interrelated (Hancock and Perkins, 1985). An individual's perspectives and beliefs related to illness, health, and mental health are shaped by the individual's culture and community,
BARRIERS TO OBTAINING SERVICES
The literature has well documented barriers preventing "mainstream" older adults from seeking and obtaining mental health services. …