Being Seen: Why Racial Affinity Matters for Mental Health Providers and Their Patients

Recruiting more providers of color is one way to create stronger affinity and cultural context to make it easier for patients of color to open up.
A Black mental health professional sits in a chair with a clipboard. She is talking to another Black woman patient who is seated on a couch.
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Providers of color make up a very small percentage of mental health professionals. The dearth of providers of color is often attributed to systemic inequities, such as expensive graduate degrees coupled with low pay. This can create yet another obstacle for people of color looking for mental health support. Having a provider from one's own culture or background is connected to better patient outcomes and experiences.

Liliana Torres-Bonilla, PhD, LMHC, Boston Medical Center's clinical manager of Outpatient Psychiatry is a Latina provider who has made it her mission to support other mental health providers of color at BMC, and she works hard to integrate anti-racism, cultural humility, and empathy into her practice. HealthCity sat down with Torres-Bonilla to discuss her perspective on how the healthcare system can support clinicians of color and how all mental health providers can integrate cultural competence and humility into their practice.

HealthCity: What are some of the primary mental health challenges facing communities of color?

Liliana Torres-Bonilla, PhD, LMHC: Mental health for communities of color is rooted in the struggles and disparities that these groups have faced across history in this country. It's not easy to trust a system that historically hasn't provided their needs and has done harm. If we are working toward racial equity and are aware of intersectional identities, we need to look closer at communities that historically have not been understood or honored.

It's not easy to trust a system that historically hasn't provided needs and has done harm [to people of color]. If we are working toward racial equity and are aware of intersectional identities, we need to look closer at communities that historically have not been understood or honored.

Historically, the access of high-quality mental health care is very limited because of different factors: there's cultural stigma around mental health, there's discrimination toward all of these groups, and there's lack of awareness on the part of providers that the system is often set up to fail marginalized folks. The mistrust of mental health is woven in with the history. And as mental health providers, we must ask ourselves how we can honor the unique experiences that these groups have carried with them.

HC: Why does it matter for patients of color to see a provider from their background?

LT: When a provider shares their background or understands their language or the context of their culture, patients find it easier to open up. This common ground provides space for patients to understand why they were advised to seek therapy or how trauma affects them. It is a place where conversations about healing can begin. From here we can hope to see more engagement from these communities.

Providers are committed to holding space for patients with whom they share similarities because they can more easily relate. For example, I am a Latina woman from Puerto Rico. That's the experience that I can share with patients that have a similar background. Sometimes this can be a lot to hold, because we are all intimately aware of our historical struggles and traumas. Patients see themselves in me and believe they can trust me because I "get it."

Providers are committed to holding space for patients with whom they share similarities because they can more easily relate...Sometimes this can be a lot to hold, because we are all intimately aware of our historical struggles and traumas.

HC: What are some of the challenges that providers face in helping patients of color with their mental health?

LT: It's important to honor the unique experiences of each patient, which is why it's frustrating when all patients of color are put in the same basket. In order for providers to truly hold space for these patients, they must try to fully understand the context and the history of each and every patient — and that looks different for each culture.

With that in mind, we want to listen to patient requests for providers that speak their language or that look like them. It's so important to honor that. But sometimes we don't have enough resources or providers to provide those specific, requested services. If only one provider meets that criteria, they will quickly receive a large caseload of patients who asked specifically for them. This can be overwhelming and create burnout. So, all providers need to integrate cultural competence and humility into their practice. And we need to create more opportunities for people of color to advance in the mental health field through financial support and equal access to educational opportunities.

HC: What more can be done to improve the current system for patients seeking out mental health providers?

LT: It's important to identify how we can work together to change the system — not just for providers of color, but for all providers to learn how to approach mental health among patients from different cultures. The best providers come from a place of wanting to learn and respect patients, not discriminate against or judge them. Patients appreciate when providers have that curiosity and respect from where they are coming.

While we should always try to match providers to patients who ask for them, sometimes we don't have the resources. Patients often worry their provider may not be helpful if they don't share a language or culture, but this can be avoided if the provider comes from a place of respect and honors the experience of each patient. It's more than just knowing the language of the patient — it's also understanding where they're coming and having the humility to know what you don't know. All providers should have curiosity to learn from the patients they are serving.

HC: What can providers do to better understand the lived experiences of their patients — especially patients of color?

LT: When we talk about mental health and awareness, we know that there's stigma. A lot of my patients don't want to admit that they need help because it feels like admitting they aren't strong. That cultural stigma comes from our history.

I think that as providers of color, it's important for us to learn from our ancestors and learn how colonization played a role in creating fear. Before colonization, my ancestors had strong ways of coping. They created their own ways to teach, to help, to be mentally strong, to cope with mental health issues, and to be resilient. As mental health providers that represent various communities of color, we represent these groups that have struggled through history and we represent all their strength.