Large variations of and inequalities in rates of mental health disorders, and access to mental healthcare exist within and between countries. Globally, disparities range from countries where there is little provision to those where, despite the availability of evidence-based mental healthcare, service access and outcomes are mediated by social factors such as socio-economic status, race/ethnicity and culture. This is salient because increasingly diverse populations are inevitably created with globalisation. We posit that, in multi-cultural contexts, effective therapeutic engagement requires therapists who are competent and confident to work with diversity and difference; utilising insights into their own as well as their clients’ internal and external worlds. Although there are many reasons why psychotherapies can be insensitive and harmful, e.g. the inherent power imbalance in therapeutic relationships, a lack of awareness of cultural and ethnic variation and needs are amongst them.
Acquisition of ‘cultural competence’ and increasing availability of culturally-adapted interventions should, in theory, enable practitioners to work with a range of individuals with whom they might have little in common. However, whilst cultural-adaptation appears promising, there are concerns regarding its viability as a strategy for tackling disparities in access to psychological care. Evidence for cultural competency is patchy at best. We show how and why delivering effective psychotherapy in the twenty-first century requires a paradigm shift from current approaches to truly integrated models, developed in collaboration with recipients of care. Co-producing interventions, training, and means of evaluating them with clients necessitates taking into consideration social contexts, alternative conceptualisations of mental health and disorders and difficulties and what constitutes appropriate helpful interventions for psychological distress.