Diversity in counseling: Closing the mental health gap

Understanding a range of backgrounds is crucial for mental health counselors. The world is diverse in culture, language, and socio-economic backgrounds, and effective counseling requires a clear understanding of these differences. This ability not only helps create a space where all clients feel understood but also improves the quality of care by acknowledging and leveraging the strengths and unique challenges of diverse populations.

This article takes a comprehensive look at mental health care disparities, emphasizing the inequities of care across different groups. We explore the meaning of diversity in counseling, highlighting the importance of how multicultural counseling involves both understanding diverse client backgrounds and promoting diversity within the field. The discussion includes an examination of key issues related to diversity, the critical role of diversity training in counseling programs, and strategies for implementing cultural diversity in counseling practices. Finally, we will touch upon the future of diversity in counseling, with a focus on how evolving technologies and approaches to care can address the needs of underserved populations.

Diversity in counseling: What does it mean?

Diversity in counseling, or multicultural counseling, extends far beyond the acknowledgment of different backgrounds; it involves a deep understanding and respect for cultural nuances, individual identities, gender identity, and the various factors that shape a person's experience and worldview. At its core, it signifies the counseling profession's commitment to recognizing the profound impact of cultural, social, and economic factors on mental health and well-being.

Multicultural counseling requires the ability to adapt therapeutic practices to meet the unique needs of each client, considering their cultural background, experiences, and values. In "One Size Does Not Fit All: Taking Diversity, Culture and Context Seriously," the authors explain,

“A cultural open perspective...can help clinicians and researchers become aware of their hidden assumptions, biases, stereotypes and limitations of current practice and can help them identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.”¹

This openness from counselors ensures that counseling is not only accessible but also resonates with the client's personal and cultural identity, fostering a therapeutic relationship built on trust and understanding.¹

Moreover, the multicultural counseling approach acknowledges the importance of having a diverse body of counselors. When the counseling workforce mirrors the society's diversity, it enhances the profession's ability to offer relatable, culturally competent care. This representation of diverse cultures is essential in breaking down barriers to accessing mental health services, such as mistrust and misunderstanding, and in promoting a more inclusive approach to mental health care.¹

The significance of diversity in the counseling field also lies in its ability to combat the one-dimensional view of mental health issues. By integrating a multicultural perspective, counselors can better recognize and address the varying manifestations of mental health conditions across different cultures. This approach not only enriches the counseling process but also contributes to more effective, personalized treatment outcomes.¹

Ultimately, diversity in counseling means embracing the totality of an individual's identity, including their cultural, ethnic, gender, sexual orientation and socioeconomic background, among other aspects. It involves a commitment to continuous learning and adaptation to address and respect the vast spectrum of human diversity. Such a holistic approach is crucial in advancing the counseling profession's ability to meet the evolving needs of a diverse global population, ensuring that everyone has access to mental health services that are respectful, culturally informed, and deeply effective.

The current state of mental health disparities

The disparity in mental health services access across different groups underscores concerns about health equity, which is significantly influenced by social determinants of health.² Prior to the pandemic, Black adults with moderate to severe symptoms of anxiety or depression were less likely to receive mental health services compared to their white peers—a disparity that starkly outlines the broader issue of access and the underlying social determinants affecting it.^2,3

Social determinants of health such as economic stability, neighborhood and physical environment, education, food, community, and social context profoundly affect mental health disparities. These determinants play a pivotal role in shaping the availability, accessibility, and quality of mental health services across different societal groups. Racial and ethnic minorities, for instance, often face systemic barriers rooted in these determinants, which exacerbate disparities in mental healthcare access and outcomes.²

Further adding to these disparities, white adults are more likely to have received mental health services than their Black and Hispanic counterparts, presenting a significant gap in the accessibility and utilization of mental health resources.³ Additionally, disparities extend to socioeconomic factors, as U.S.-born adults and those with health insurance report receiving mental health services at higher rates than immigrants and uninsured individuals, highlighting the impact of economic stability and health care access as social determinants.⁴

A core issue exacerbating these disparities is the scarcity of culturally sensitive mental health care—which includes screening tools and treatment options—that fails to account for the culture's distinct characteristics and values. This oversight leads to underdiagnosis or misdiagnosis, particularly among people of color, and underscores the essential need for integrating a thorough understanding of social determinants of health into mental healthcare delivery.³

Barriers to accessing mental health care are further complicated by difficulty in finding a care provider who can understand and relate to diverse cultural backgrounds and experiences. This challenge is significantly pronounced among Asian and Black adults, who report finding culturally competent providers at rates considerably lower than their white peers.²

Moreover, individuals experiencing severe mental health crises, such as homelessness, hospitalization, or incarceration, often fall within younger age groups and lower-income brackets. This trend again highlights the intricate relationship between socioeconomic factors as part of the social determinants of health and access to mental health services.²

To address the current state of mental health disparities, you need to have a comprehensive understanding of the social determinants of health. Tackling these disparities requires more than just expanding access to healthcare; it demands a structural overhaul to ensure the provision of culturally and socially sensitive care that recognizes and addresses the wide array of factors influencing mental health outcomes across different populations. Such efforts are key to breaking down the myriad barriers—ranging from cost and availability to systemic stigma and discrimination—that discourage individuals from seeking the mental health support they need.³

Diversity issues in counseling

The quest for diversity in the counseling industry goes beyond simply recognizing differences across cultural, racial, and socioeconomic spectrums. It involves tackling deep-seated issues that hinder the effective provision of mental health services to all segments of society. Despite efforts to enhance inclusivity and understanding within the profession, several systemic challenges persist, influencing both the counseling workforce and the individuals they aim to serve. Here, we overview the primary diversity issues confronting the counseling field today:^1,2,3,4

• Insufficient representation: A lack of diversity among mental health professionals makes it challenging for clients from varied backgrounds to find therapists with whom they can culturally and racially identify.
• Cultural competence gap: A shortfall in comprehensive cultural competence training for counselors leads to misinterpretations and misapplications of therapeutic practices.
• Access barriers: Economic, geographic, and systemic obstacles prevent significant portions of the population, particularly those from minority and low-income backgrounds, from accessing mental health services.
• Stigma and distrust: Cultural stigma surrounding mental health and a historical mistrust in the healthcare system deter individuals from seeking the help they need.
• Language limitations: The scarcity of multilingual counselors adds an additional layer of difficulty for non-English speaking or limited English proficiency clients seeking counseling services.
• Inadequate training on intersectionality: Counseling programs often do not adequately address the complex ways in which various aspects of identity (e.g., race, gender, socioeconomic status) intersect and how this impacts mental health and counseling approaches.
• Overlooked socioeconomic factors: Socioeconomic disparities are not sufficiently accounted for in counseling strategies, leading to one-size-fits-all approaches that do not address specific individual or community needs.
• Technological divide: The increasing reliance on teletherapy and digital mental health tools risks widening the gap for clients with limited access to technology.

Addressing these issues requires a concerted, ongoing effort from counseling professionals, educators, and policy-makers to foster a more inclusive, understanding, and effectively supportive counseling environment for all.

The need for diversity training in counseling programs

The persistent racial and ethnic disparities in behavioral health across the United States underscore the critical need for diversity training within counseling education programs. This training is vital to prepare health care providers, including counselors, to meet the increasingly diverse needs of the society we live in. Cultural competence in health care has been recognized as an essential aspect of delivering high-quality services and is paramount in a society growing ever more culturally diverse.

Implementing cultural competence education in healthcare, particularly in integrated care settings mixing primary care and behavioral health, is shown to improve professional knowledge and attitudes while increasing patient satisfaction. Despite this, there is scant empirical evidence on the impact of culturally competent care on health outcomes within these settings, highlighting the gap and the opportunity for counseling programs to lead in this area. By focusing on both cultural awareness and competence training, counseling programs can play a significant role in reducing behavioral health disparities and improving the health care experiences of underserved and diverse populations.⁵

Strategies for upholding cultural diversity in counseling

To uphold cultural diversity in counseling effectively, strategies for multicultural competence must be put in place throughout the education and practice of counselors. These strategies start with the integration of cultural competence training within counseling programs, emphasizing the wide array of cultural perspectives and the critical social determinants of health that shape health outcomes.⁵

One such approach is the CRASH Course in Cultural Competence, which guides practitioners in considering culture (C), showing respect (R), assessing and affirming cultural differences (A), showing sensitivity and self-awareness (S), and doing it all with humility (H). This mnemonic encapsulates a set of skills aimed at enhancing provider confidence in effectively communicating with racially and ethnically diverse patient populations.⁵

Further, the inclusion of cultural competency curricula in counseling education is essential for ensuring that emerging health care professionals and those already practicing are well-prepared to meet the needs of a racially and culturally diverse clientele. Integrating multicultural counseling competence into such curricula requires the support of institutional and community resources, leadership, and clear accountability and evaluation processes. It's also important for these programs to have practical implementation strategies that can overcome common barriers such as the limited evidence of impact on patient outcomes and the perceived low feasibility of training implementation.⁵

Implementing these strategies requires a concerted effort from educational institutions, counseling professionals, and policymakers to place a stronger emphasis on diversity and cultural competence within counseling practices. This concerted effort will pave the way for an environment where all individuals, regardless of their racial or ethnic backgrounds, feel valued, understood, and adequately supported in their mental health journeys.⁵

The future of diversity in counseling

As the counseling profession evolves, it faces an array of emerging challenges and opportunities. One of the most commonly addressed opportunities, teletherapy, has long been highlighted as a promising avenue for expanding mental health access. Advocates have supported telehealth for its potential to make counseling more accessible, particularly beneficial for individuals in health care deserts or with logistical challenges to transportation, finances and more. The pandemic underscored telehealth's importance, shifting a largely in-person system online rapidly. Despite its growth, telehealth has not radically changed mental health care usage, especially among underserved populations. Structural barriers, including financial constraints and a shortage of therapists, particularly those from diverse backgrounds, still prevent telehealth from fully democratizing mental health services.

From addressing systemic injustices to embracing technological advancements, counselors are called to adapt and grow in various dimensions. Here are key topics that are shaping the future landscape of multicultural counseling based on the responses of a group of clinicians, educators, researchers and leaders in the counseling profession.⁶

• Intersectionality and advocacy: Emphasizing the importance of counselor self-awareness and understanding of client and community worldviews to address intersectional oppression and promote the well-being of clients with multiple marginalized identities.
• Impact of white supremacy: Recognizing how white supremacy affects the counseling profession, including barriers to counseling access for those with marginalized identities, and the need for greater diversity among counselors.
• Relationship-building in counseling: The necessity for counselors to build authentic relationships with themselves and clients to address systemic and intersectional racism effectively.
• Trauma-informed care: Highlighting the prevalence of trauma in various health conditions and the need for counselors to be well-versed in identifying and treating trauma.
• Research engagement: Stressing that counselors should engage more in outcome and process-based research to evidence the effectiveness of counseling interventions and advocate for the profession.
• Telehealth adoption: Identifying the necessity and growth of telehealth in counseling to bridge access gaps, and the need for advocacy on issues like reduced-cost internet for broader access.
• Medicare policy advocacy: Urging counselor involvement in advocacy efforts for Medicare policy changes and preparing the profession to meet the needs of an aging population with an anticipated increase in Medicare-insured clients.

Develop your expertise in counseling diversity at OCU

From recognizing the current disparities in mental health care to highlighting the invaluable role of diverse counseling practices, it's clear that fostering cultural competence within the counseling profession is not optional—it's essential. The online Master of Education in Clinical Mental Health Counseling at Oklahoma City University stands as a beacon for those aspiring to make significant inroads into this transformative field. This program is meticulously designed to arm you with the necessary skills, knowledge, and cultural sensitivities to serve as a force of positive change within various communities. By prioritizing ongoing cultural competence training, you're not just advancing your career—you're committing to break down long-standing barriers and promote a more inclusive understanding of mental health.

If you're ready to take a decisive step towards championing diversity and inclusivity in mental health counseling, Oklahoma City University's distinguished program could be your next move. Connect with an admissions outreach advisor today to discover how you can contribute to reshaping the landscape of mental health care, ensuring that individuals from all backgrounds receive the empathetic support they deserve. Embark on a journey that promises not only professional fulfillment but also the opportunity to profoundly impact lives and communities.