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Seeking multicultural awareness in mental health through language, representation

Seeking out counseling for mental health can be difficult for anyone, but students from underrepresented backgrounds sometimes must navigate additional barriers surrounding language and identity. As a result, UW Mental Health Services is working towards building multicultural awareness into their practice. 

Seeking out counseling for mental health can be difficult for anyone, but students from underrepresented backgrounds sometimes must navigate additional barriers surrounding language and identity. As a result, UW Mental Health Services is working towards building multicultural awareness into their practice. 

Image By: Max Homstad

Throughout her freshman year, Madeline Noreika struggled adjusting to life at the University of Wisconsin-Madison. But instead of seeking help, the stigma associated with needing mental health services led her to spend her first couple years of college handling her anxiety and depression alone.

Although Noreika herself doesn’t identify as a student of color, when she finally sought out help and began volunteering in a peer support group, she observed a lack of diversity among members.

Despite mental health’s growing presence in everyday discussions, making the decision to seek help and find the right resources can be hard for anyone. However, students from underrepresented backgrounds may face additional logistical hurdles. 

Language barriers

For students whose native language is not English, communication with a mental healthcare provider may present a barrier to accessing competent care.

“I think individuals feel a lot more comfortable when they can communicate directly with their provider, and especially being able to communicate in their [native] language just allows for a much better experience for the patient,” neuropsychologist Melissa Castro said. 

As the only Spanish-speaking provider in her field in Minnesota and Wisconsin, Castro noticed her patients feel more comfortable communicating their concerns to her.

“You just see the patient get so excited that they can finally communicate directly with their provider, so they just feel like they want to tell them everything,” she said. “It just goes to show how appreciative they are when they have the opportunity to express themselves directly.” 

Although Castro herself is not a therapist, she added that she believes the same would be true in therapy.

Throughout the last year, Mental Health Services and the broader University of Wisconsin-Madison community have been making changes to mitigate the influence that language or identity can have on students’ experience seeking out mental health resources.

MHS provides UW-Madison students with mental health resources, including counseling, psychiatric care and various spaces to engage with mental healthcare providers on campus.

Starting last fall, MHS began actively publicizing services available in Mandarin and Spanish. In the past, language services had been provided on a case-by-case basis to students seeking out individual counseling in another language. 

Tiffany Jones, a student representative on UW-Madison’s mental health task force and a doctoral candidate in counseling psychology, said even more could be done to assist students in getting the help they need — like sharing additional resources located in the greater Madison community that provide these services.

“What’s often happening is that we’re not communicating, we’re not talking,” Jones said. “There’s no real system in my opinion and in my experience to link students with resources in the community if we’re not able to meet them on campus.” 

However, English language competency can be a tricky subject to navigate when not approached with the appropriate cultural sensitivity.

Fewer Latinx speak Spanish across successive generations born in the U.S., according to a 2018 report from Pew Research Center. 

This may be partly due to the long history of segregation against Mexicans and Mexican-Americans. Since fluency in Spanish tends to be a sort of litmus test for identity, many Latinx have described complicated feelings regarding their proximity to Spanish. 

“I think there’s a nuance to it, and I think the way that I see the services I provide is as just an option,” MHS provider Rachel Bitman-Heinrichs said. “I find that giving students that autonomy feels really important, so I never impose a suggestion on a language.”

Bitman-Heinrichs and her colleagues often discuss the importance of checking assumptions and understanding that not everyone who identifies as a person of color needs language services, she added.

“I’ve encountered students who identify as Latinx but may not speak Spanish or may not want services in that language,” Bitman-Heinrichs said.

Feeling seen

Beyond language, navigating the campus of a predominantly white institution as a student of color can pose other barriers to accessing mental health care.

Those of certain cultural backgrounds are less likely to label and address mental health issues; even if an individual is struggling with depression or anxiety, they might not seek out help right away, Jones explained.

“I think a lot of folx suffer in silence for a long time until they reach that peak level of distress,” she said. “I can’t say that that’s unique to every black or African-American person, but I know for myself that when I was in college, I didn’t seek out mental health services even though I could have benefitted from it. But I just didn’t have a label for what I was experiencing.”

From her perspective, Bitman-Heinrichs said she’s seen more students from underrepresented backgrounds distrust authority.

These concerns have translated into a mistrust of UHS providers and stronger opinions about wanting to see a provider of color, she added.

“That initial connection or sharing an identity with a therapist can lessen some of the hesitation that folks have about seeking out services,” Jones said. “That’s a real concern [for POC students]: is this person who’s different from my lived experience going to understand?”

In response to student feedback, MHS has hired more providers of color and providers with experience working in community outreach for under-served populations. Staff attend different trainings on their own time and MHS has developed a Diversity, Equity and Inclusion committee that does its own multicultural competence training.

“That committee works hard to provide support to the staff here around exploring their own biases and assumptions about interacting with other people as well as examining our own histories,” Bitman-Heinrichs said. “Our own histories shape how we view the world and may or may not impact the work that we’re doing with the students.” 

Finding services on campus

While MHS has a 10-session limit per calendar year on individual counseling, they do offer unlimited group therapy options for all students — with several POC-specific groups — and a student of color interpersonal process group, where students can share and get feedback on their experiences. 

Although group therapy requires a great deal of vulnerability, it is a space that can provide students support and validation.

“I think therapy doesn’t have to be a one-stop shop. Oftentimes we have to maybe access mental health resources from different spaces or places,” Jones said.

Beyond MHS, other counseling services options on campus include the Psychology Research Training Clinic and the Counseling Psychology Training Clinic, which offers affiliated students unlimited, free, individual counseling sessions with community support specialists from underrepresented backgrounds through a partnership with the Division of Diversity, Equity and Educational Achievement.

Regardless of one’s background, Bitman-Heinrichs said that navigating such a big institution with many agencies and services can be challenging for all students, especially when paired with the internalized shame that often accompanies acknowledging and seeking out help for mental health concerns. 

But, she is optimistic that MHS is working towards easing this process.

“We have done a lot of internal work here on a structural and institutional level,” she said. “I hope means that we’re heading in a direction that is helpful and supportive for the student body.”

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