Cultural and structural competence

Abstract Cultural competence is an essential aspect of providing mental health care in any setting. An understanding of culture is even more important in correctional settings, as several unique factors may lead to conflict and misunderstanding if not adequately addressed. First, minority ethnic groups are vastly overrepresented in prisons and jails, so a familiarity with the predominant culture of those groups is necessary to engage incarcerated persons in treatment and diagnose them accurately. Second, mental health clinicians may be unfamiliar with law enforcement culture, which heavily influences the practices of corrections officers and differs significantly from health care culture. Third, psychiatrists bring their own cultural beliefs about crime and punishment into clinical encounters within the correctional system. In addition to cultural competence, the concept of structural competence has emerged over the past decade as an equally important framework for health care, instructing treatment providers to consider social forces that may produce and exacerbate illness. Structural competence requires an understanding of health-related factors that represent the downstream effects of larger policy, legal, and economic systems. These forces may not be visible during the clinical encounter but operate constantly in patients’ lives. This chapter reviews the evolution of cultural and structural competence, guiding clinicians in their application to correctional settings.