The Western Medical Model
The Western medical model is the framework used by healthcare professionals in the United States and many European countries (referred to as the “Western world”). Its emphasis on science and medicine has led to advancements in treating health conditions and reducing stigma.
Yet the Western medical model is far from perfect. It does not include the cultural practices and viewpoints needed to provide high-quality care in communities of color.
Diagnosis and Distrust
Poor cultural understanding can cause misdiagnosis of mental health conditions in BIPOC populations. This is partly due to the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM-V, the main handbook used to help diagnose mental health conditions, does not take into account the cultural presentation of symptoms. People from certain cultural backgrounds may talk about physical symptoms rather than feelings or behaviors when experiencing a mental health concern. A lack of cultural understanding, language barriers, and not having enough providers from communities of color all contribute to challenges BIPOC individuals face with Western medicine.
Distrust also prevents BIPOC individuals from seeking care from Western medical providers. The Western medical system has a history of conducting non-consensual research on people of color by white doctors. Furthermore, the dangerous ways that police have responded to 911 calls for people having a mental health crisis has also played a role in fear of the medical system.
One example of how issues with diagnosis and distrust play out is in Black and African American communities. Providers often overemphasize psychotic symptoms and overlook symptoms of major depression in Black and African Americans compared to clients with other racial backgrounds. For this reason, Black men, in particular, are over-diagnosed with schizophrenia.
Evidence-Based Practices Can Exclude Marginalized Identities
Evidence-based practice uses clinical expertise, patient values, and research evidence in patient care.
Implicit bias and lack of diversity in healthcare can mean that the values of BIPOC patients are neglected. BIPOC communities are also underrepresented in the research used to guide treatment. This means that the “evidence” from this research is not always relevant for people of color.
Many mental health supports used by BIPOC communities such as the use of healing or prayer circles, reiki, smudging, sweat lodge rituals, doulas, and traditional healers will rarely appear on lists of evidence-based practices. This is due to the rigorous research required by the Western medical model. A lack of evidence does not mean a lack of effectiveness, but without being considered evidence-based, the Western medical model often dismisses “non-medical” community and cultural practices. This means they continue to be under-researched and not covered by insurance.
Integrating the strengths of Western treatments with BIPOC cultural and community practices can help people living with mental health conditions to recover. While much work needs to be done at the systemic level, taking the time to choose providers who you feel understand your culture and being a strong advocate for yourself can help ensure quality of care.