Behavioral Health & Recovery Services Blog

Isn’t it true that “everyday life” teaches us lessons we didn’t know we needed to learn?  Or, that there are events that happen as a part of our daily lives that shine a light on things that need to be seen?  I think so.   Recently, I’ve had the opportunity to spend a lot of time with a healthy, vibrant, joyful 76-year-old with no major health problems, my mother*, a Black woman who, as a teenager, migrated with her family from the American South to East Palo Alto in the 1960s.  Lately, she has been experiencing pain and other symptoms that are far outside her normal daily living experiences.  The symptoms were starting to take a toll on her emotionally.  She asked me to “sit in” on a virtual Doctor’s appointment with her.  When she described the pain and swelling, she is experiencing, the Doctor asked her several follow up questions which Mom answered succinctly without much elaboration.  Based on Mom’s answers and her upbeat, cheerful tone, the Doctor suggested compression stockings.    That would have been the end of the appointment.  Instead, Mom has two upcoming medical procedures that are going to improve her life both physically and psychologically.  So, what happened? Why does she have two medical procedures instead of compression stockings? After all, Mom reported her experience.  The Doctor who has a good relationship with Mom, listened closely and did an assessment. What had happened was, the Doctor was not aware of Mom’s deft use of African American English and code-switching.  Since I had seen the swelling and knew her actual level of discomfort, I asked Mom some additional questions and asked her to share her answers with the Doctor. Once the Doctor heard the additional information, she insisted that Mom come for an in-person visit.  The result of the in-person visit revealed two significant problems which would have otherwise been missed.

Consider this. Several years ago, a local Black psychiatrist was called to the emergency room of a Bay Area hospital. The ER staff did not know what to do to support or contain a man absolutely overcome with grief. His grandmother had been shot by a stray bullet, just a few houses down from her own home, and now, she lay dead on a gurney in the ER, despite the efforts of determined physicians. The Grandson was not screaming or shouting epithets or kicking over furniture. He was not violent by any definition. He was doubled over weeping, rocking back and forth, and humming amazing grace. ER staff had alerted security because he would not leave his grandmother’s side. He continued to weep, rock and sing. He was not going to leave her. The psychiatrist went to the emergency room, was briefed by the staff, and left them to be with the young man. He stood and watched from a distance for a few minutes and understood exactly what he was seeing. Grandson was expressing grief in the only language that he knew–the gospel music of his home and community–and rocking his body for comfort. In the aftermath of that trauma, he needed to be exactly where he was, doing exactly what he was doing.

Why does this matter?  At BHRS our mission is to embrace diversity, improve quality, and eliminate health disparities. We live into our mission by providing effective, equitable, welcoming, and compassionate behavioral health and recovery services. We strive to be responsive to individuals’ cultural health beliefs and practices. We are focused on health equity, bridging gaps, and meeting the needs of marginalized communities throughout San Mateo county. In fact, we have a policy of providing services to clients in their preferred or primary language. The two scenarios above highlight situations that often happen to African Americans and go unnoticed. Both scenarios were the result of well-meaning providers who did not understand the language-African American English dialect their clients were using. BHRS has done a solid job of increasing access to our services by addressing the needs of our identified threshold languages, but does that include other dialects which are very similar to Standard American English? Could this gap in culturally and linguistically appropriate services adversely impact African American community members? Yes. When community members are in distress and can’t seem to find a solution, they suffer–physically, mentally, emotionally, and spiritually. Unaddressed suffering is detrimental to behavioral health and well-being and can hasten decline.  Is it possible that the metrics used to calculate what is considered a threshold language misses entire communities of people?  Not to mention that the data, the analysis, and the metrics themselves often fall short of fully capturing the communities’ felt misery-their actual lived experiences.  Could it be that one of the most marginalized populations in the history of this county whose numbers are so small in the county because of economic, social, and cultural factors are further marginalized because there are not enough of them with access to opportunity structures, social capital, and advocacy to merit attention to their deepest needs. I believe that a gap has been revealed.  Can we begin to bridge this gap? Do we at BHRS have African American providers and staff who can interact with African American clients as cultural brokers and interpreters of African American English?  How about providing services in African American English which is a dialect of Standard American English?  I believe we can do it because we are dedicated to living into our mission.  So, let’s get to it.

Dr. Erica Britton (She/Her/Dr)

Workforce, Education & Training Director

BHRS Office of Diversity & Equity