Cultural Humility in Action: Redesigning Municipal Mental Health

I recall a pivotal moment early in my role as a clinic director in a midsize urban municipality, when we received a referral for a Somali refugee woman experiencing postpartum depression. Initially, our clinical team approached her care using standard therapeutic methods, including weekly cognitive behavioral therapy sessions and a psychiatric evaluation. However, she consistently missed appointments and declined prescribed medications. Frustrated staff began labeling her as “noncompliant.” It wasn't until a Somali community liaison joined one of our staff meetings that we learned how her cultural and religious beliefs viewed mental illness differently. The stigma, combined with language barriers and past trauma from displacement, made our Western-centric approach not only ineffective but alienating.

In response, we adapted her care plan. We coordinated with a local imam to provide supportive counseling, integrated storytelling and poetry—common in Somali healing traditions—and offered home visits with a Somali-speaking therapist. Within weeks, her engagement improved. This change didn’t just help one client; it catalyzed a shift in our clinic’s policies. We initiated a cultural consultation protocol and built relationships with ethnic community-based organizations. This experience reinforced that culturally responsive mental health care is not only ethical—it is essential to effective service delivery. It also reminded our team that cultural humility, not cultural mastery, is the foundation of trust-building in diverse communities.

Building Competence through Staff Education and Community Collaboration

Sustained training in cultural competence is not a checkbox—it is a continuous process requiring institutional commitment. At our agency, we developed a quarterly staff development series that combines didactic instruction with community-led panels. These sessions include local cultural leaders, clients with lived experience, and bilingual clinicians who provide insight into cultural customs, idioms of distress, and patterns of help-seeking behavior. For example, in working with Latinx populations, understanding the role of "familismo" and spiritual beliefs like "susto" has helped reframe diagnoses and treatment strategies in ways that resonate with clients’ worldviews¹.

Beyond formal training, we embedded cultural responsiveness into our hiring practices and supervision. We revised job descriptions to include cultural knowledge as a core competency and adjusted performance evaluations to assess staff on their ability to work across cultural differences. Supervisors conduct reflective consultations where staff are encouraged to explore their biases, missteps, and growth areas. We’ve also partnered with local Indigenous and immigrant-led organizations to co-develop group counseling models and outreach materials. These collaborations not only enhance service accessibility but also reinforce shared ownership of wellness outcomes, making the system more accountable to those it serves².

Authentic Client Partnership in Program Design

One of the most impactful shifts we made was integrating clients as partners in program design. We launched a Community Advisory Council made up of clients, family members, and cultural representatives who review program changes, provide feedback on outreach strategies, and co-create wellness initiatives. This structure has allowed us to avoid common missteps, like translating materials without cultural adaptation or scheduling groups during religious holidays. When we designed a youth mental health program, council members advised us to replace the term “therapy” with “wellness circles,” which improved enrollment among Southeast Asian and African immigrant youth.

The advisory model also helps us uncover systemic barriers that go beyond clinical care. For instance, council members highlighted how lack of