New book: Cultural Consultation

The MMHRC is pleased to share news of the release of a new book edited by members of the MMHRC steering comittee. Cultural Consultation: Encountering the Other in Mental Health Care is edited by Laurence Kirmayer, Jaswant Guzder, and Cécile Rousseau and is published by Springer.

Cultural diversity is a global challenge for mental health services. The changing demography of communities requires rethinking approaches to cultural competence for health professionals and institutions. Cultural consultation is a way to improve the quality of mental health care by providing a nuanced understanding of the predicaments that prompt diverse clients to seek help, and the social contexts of their mental health problems, to guide clinical assessment and intervention.

Cultural Consultation explores the practice of cultural consultation as a strategy to improve the quality of mental health care for diverse populations. The contributors, who have worked together at an innovative clinical service, frame best practices in psychiatry clinical psychology, and social work in relation to empathy, human rights, and culturally responsive and ethically sound care. A detailed model of the process of cultural consultation, from initial intake, through assessment, to recommendations and referrals, provides guidelines for clinical practice. Expert contributors examine specialized settings (medical, psychiatric emergency, inpatient, social/legal services), populations (remote, indigenous, child and youth), and contextual issues in the care of people with a wide range of mental health problems.

Numerous case examples, charts, and tools add depth for readers interested in developing similar services or enhancing existing practice. Among the key areas covered:

  • Working with interpreters and culture brokers.
  • Family systems in cultural consultation.
  • Gender, power, and ethnicity in cultural consultation.
  • Consultation and mediation with racialized and marginalized communities. Collaborative care and primary care consultation.
  • Cultural consultation with refugees.

A unique guide to challenges and opportunities in contemporary practice, Cultural Consultation will be immediately useful for health care professionals, clinical psychologists, and cultural consultants and provide a versatile knowledge source for years to come.

Contents
Introduction: The Place of Culture in Mental Health Services.- Development and Evaluation of the Cultural Consultation Service.- The Process of Cultural Consultation.- Cultural Consultation in Child Psychiatry.- Working with Interpreters.- Culture Brokers, Clinically Applied Ethnography and Cultural Mediation.- Family Systems in Cultural Consultation.- Gender, Power & Ethnicity in Cultural Consultation.- Community Consultation and Mediation with Racialized and Marginalized Minorities.- Addressing Cultural Diversity Through Collaborative Care.- Consultation to Remote and Indigenous Communities.- Cultural Consultation for Refugees.- Consultation to Youth Protection and Legal Settings.- Cultural Consultation in General Hospital Psychiatry.- Cultural Consultations in Medical Settings.- Conclusion: The Future of Cultural Consultation.
To review sample pages of the book, please visit the book’s website.

Cécile Rousseau: A Relational Story

VIDEO

“It’s not only about the migrants, it’s about the migrants and us as a majority… just like in a couple we’re part of the equation.”

Cécile Rousseau, Director of the Transcultural Child Psychiatry Clinic at the Montreal Children’s Hospital proposes a widening of focus when we think of immigrants and mental health to include the majority population. How does a host population feel about immigrants? Is the host community welcoming to this group? Dr. Rousseau discusses inter-community tensions between immigrant groups and the majority population and the tendency, when either group is feeling threatened, to close inwards, exacerbating tensions. Integration and adaptation into a new community is an important factor in the mental health of new Canadians and Dr. Rousseau stresses that all Canadians, new and established, play a part in it.

Refugee Mental Health: Trauma and Resilience

Dr. Laurence Kirmayer was interviewed by Dr. Sofie Bäärnhielm, Director, Transkulturellt Centrum, Stockholms läns landsting, Stockholm February 2012.

Background Reading:

Adeponle, A. B., Thombs, B. D., Groleau, D., Jarvis, E., & Kirmayer, L. J. (2012). Using the cultural formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients. Psychiatric Services, 63(2), 147-153. doi: 10.1176/appi.ps.201100280

Afana, A.-H., Pedersen, D., Rønsbo, H., & Kirmayer, L. J. (2010). “Endurance is to be shown at the first blow”: Social representations and reactions to traumatic experiences in the Gaza strip. Traumatology, 16(4), 73-84.

Beiser, M. (2009). Resettling refugees and safeguarding their mental health: lessons learned from the Canadian Refugee Resettlement Project. Transcultural Psychiatry, 46(4), 539-583. doi: 46/4/539 [pii] 10.1177/1363461509351373

Cleveland, J., Rousseau, C., & Guzder, J. (2013). Cultural consultation for refugees. In L. J. Kirmayer, J. Guzder & C. Rousseau (Eds.), Cultural Consultation: Encountering the Other in Mental Health Care (pp. 245-269). New York: Springer.

Kidron, C. A. (2012). Alterity and the particular limits of universalism: Comparing Jewish-Israeli and Canadian-Cambodian genocide legacies. Current Anthropology, 53(6), 723-754.

Kinzie, D. (2007). PTSD among traumatized refugees. In L. J. Kirmayer, R. Lemelson & M. Barad (Eds.), Understanding Trauma: Biological, Psychological and Cultural Perspectives (pp. 194-206). New York: Cambridge University Press.

Kirmayer, L. J. (1996). Landscapes of memory: Trauma, narrative and dissociation. In P. Antze & M. Lambek (Eds.), Tense Past: Cultural Essays on Memory and Trauma (pp. 173-198). London: Routledge.

Kirmayer, L. J. (1996). Confusion of the senses: Implications of ethnocultural variations in somatoform and dissociative disorders for PTSD. In A. J. Marsella, M. J. Friedman, E. T. Gerrity & R. M. Scurfield (Eds.), Ethnocultural Aspects of Post-Traumatic Stress Disorders: Issues, Research and Clinical Applications (pp. 131-164). Washington: American Psychological Association.

Kirmayer, L. J. (2001). Failures of imagination: The refugee’s narrative in psychiatry. Anthropology & Medicine, 10(2), 167-185.

Kirmayer, L. J. (2002). The refugee’s predicament. L’Évolution Psychiatrique, 67, 724-742.

Kirmayer, L. J., Guzder, J., & Rousseau, C. (Eds.). (2013). Cultural Consultation: Encountering the Other in Mental Health Care. New York: Springer.

Kirmayer, L. J., Kienzler, H., Afana, A. H., & Pedersen, D. (2010). Trauma and disasters in social and cultural context. In D. Bhugra & C. Morgan (Eds.), Principles of Social Psychiatry (2 ed., pp. 155-177). New York: Wiley-Blackwell.

Kirmayer, L. J., Lemelson, R., & Barad, M. (Eds.). (2007). Understanding trauma: Integrating biological, clinical, and cultural perspectives. New York: Cambridge University Press.

Kirmayer, L., Narasiah, L., Muñoz, M., Rashid, M., Ryder, A., Guzder, J., . . . Rousseau, C. (2011). Common mental health problems in immigrants and refugees: General approach to the patient in primary care. Canadian Medical Association Journal, 183(12), E959-967. doi: 10.1503/cmaj.090292

Kirmayer, L. J., Rousseau, C., & Crepeau, F. (2004). Research ethics and the plight of refugees in detention. Monash Bioethics Review, 23(4), 85-92.

Kirmayer, L. J., Rousseau, C., & Measham, T. (2010). Sociocultural considerations. In D. Benedek & G. H. Wynn (Eds.), Clinical Manual for the Management of Posttraumatic Stress Disorder. Washington: American Psychiatric Publishing, Inc.

Lemelson, R., Kirmayer, L., & Barad, M. (2007). Trauma in context: Integrating cultural, clinical and biological perspectives. . In L. Kirmayer, R. Lemelson & M. Barad (Eds.), Understanding trauma, Integrating biological, clinical, and cultural perspectives (pp. 451-474). New York: Cambridge University Press.

McFarlane, C. A., & Kaplan, I. (2012). Evidence-based psychological interventions for adult survivors of torture and trauma: A 30-year review. Transcultural Psychiatry, 49(3-4), 539-567. doi: 10.1177/1363461512447608

Quirk, G. J., Milad, M. R., Santini, E., & Lebrón, K. (2007). Learning not to fear: A neural systems approach. In L. J. Kirmayer, R. Lemelson & M. Barad (Eds.), Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives (pp. 60-77). New York: Cambridge University Press.

Rousseau, C., & Measham, T. (2007). Posttraumatic suffering as a source of transformation: A clinical perspective. In L. J. Kirmayer, R. Lemelson & M. Barad (Eds.), Understanding Trauma: Biological, Psychological and Cultural Perspectives (pp. 275-294). New York: Cambridge University Press.

Silove, D. (2007). Adaptation, ecosocial safety signals, and the trajectory of PTSD. In L. J. Kirmayer, R. Lemelson & M. Barad (Eds.), Understanding Trauma: Biological, Psychological and Cultural Perspectives (pp. 242-258). New York: Cambridge University Press.

Ali Mohamud on the Opening Doors Project in Toronto

Ali Mohamud on the Opening Doors Project in Toronto Initiated in 2009 by the Toronto branch of the Canadian Mental Health Association, The Opening Doors Project is a Train-the-Trainer project designed to promote strengthened participation of immigrants and refugees in civil society. It does this by offering skills and work experience to newcomers living with mental health issues. These individuals are called Peer Trainers and lead workshops about anti-racism/anti-discrimination within host and newcomer communities. The Project consists of 10 activity-based workshops on mental health, stigma, anti-discrimination/anti-racism and settlement experiences and stresses. The workshops are delivered by Peer Trainers in organizations, institutions and communities throughout Toronto and a variety of cities across Ontario. As of March 2012, Peer Trainers have facilitated 463 workshops with 5,929 participants in 30 cities across Ontario. These workshops challenge the stigma surrounding mental health and mental illness. They explore the diverse struggles many immigrants face and speak to strategies for dealing with racism and other forms of discrimination that affect individuals and communities. As one of the Peer Trainers on the project, I am sharing my own journey through recovery. This is a journey that I draw from when I facilitate workshops. This journey starts in Somalia. I was eight years old and my family fled the horrors of a war. Not long after our arrival at a refugee camp in Holland, we were relocated to a house of our own in a small town near the German border. In this town we were the only family of colour and I experienced my first taste of racism. For the first time in my young life, I discovered the painful lesson of what it was to be black. Back home in Somalia the question of race and colour had not come up—I had been just another face in the crowd. In Holland it mattered and it was hurtful and I was trying to find ways to survive it. As I was getting adjusted to life in Holland, we took flight once more. In Canada I was an immigrant all over again but this time as teenager. The burden of having to learn a new language and adjust to a new culture is hard enough for any young newcomer and dealing with the stress of puberty was exasperated by an unwanted discovery—the frightening realization that I was attracted to the same sex. I say frightening because of the homophobia I faced both at home and at school. I used to hate hearing the sing-song whispers of “faggot, faggot!” at school. It did not matter to me that I’d never heard of the word before coming to Canada; what mattered to me was that this newest of labels instilled the same fear and shame I’d come to associate with the “N” word, that older and all-too familiar daily reminder of my difference and undesirability. I don’t know the exact moment when I lost the will to live, but I do know that I felt increasingly and overwhelming isolated. I felt so hopeless that I tried to overdose on sleeping pills when I was in my final year of high school. My limbs felt heavy, my thoughts felt sluggish, and a sort of paralysis enveloped my body. Just as I was beginning to fade away, slipping ever deeper down a dark and all-encompassing hole, I recovered something precious—the will to live. I thought of my family. I thought of my mother, whom I love the most in the world. I thought of all that I had to live for, all that I hoped I would accomplish. Suddenly I found the strength to call out for my brother. And somehow, he heard my call. I got lucky. I found what I was looking for and found my way out of the rabbit hole. I started my journey to recovery—living well in the presence of my mental illness—on the night I chose life in the face of death. Being alive, however, is not the same as living life. I started to live actively when I embraced a holistic approach to wellness. I started to pay attention to the interconnectedness of my physical, mental, emotional and spiritual aspects of self. Working is part of my living. Working as a Peer Trainer for The Opening Doors Project makes use of my lived experience with recovery, migration and mental health challenges. This means that what I have lived through makes me a valuable source of info on immigrating and mental health issues. Being an effective Peer Trainer requires me to embrace the lessons learned from my painful experiences with migration and discrimination. I embrace my strengths: empathy in relating effectively to others, resilience in the face of my ongoing challenges with depression and anxiety, the ability to communicate effectively with others, a firm commitment to anti-racism and anti-oppression, as well as a holistic-centered approach to mental health. Because my lived experience is valued at work, I feel I have dignity. Facilitating the workshops throughout the province makes me feel a though I am part of society, and this helps me to move forward.

Video: The Opening Doors Project in Toronto

Initiated in 2009 by the Toronto branch of the Canadian Mental Health Association, The Opening Doors Project is a Train-the-Trainer project designed to promote strengthened participation of immigrants and refugees in civil society. It does this by offering skills and work experience to newcomers living with mental health issues. These individuals are called Peer Trainers and lead workshops about anti-racism/anti-discrimination within host and newcomer communities.

The Project consists of 10 activity-based workshops on mental health, stigma, anti-discrimination/anti-racism and settlement experiences and stresses. The workshops are delivered by Peer Trainers in organizations, institutions and communities throughout Toronto and a variety of cities across Ontario.

As of March 2012, Peer Trainers have facilitated 463 workshops with 5,929 participants in 30 cities across Ontario. These workshops challenge the stigma surrounding mental health and mental illness. They explore the diverse struggles many immigrants face and speak to strategies for dealing with racism and other forms of discrimination that affect individuals and communities.

Seeking summer intern!

The MMHRC is looking for a part-time summer intern to work in our office at the Jewish General Hospital in Montreal. The work will involve researching organizations that deal with mental health for Canadians of diverse backgrounds and marketing our website to relevant organizations and communities. The position would suit a student in marketing or communications who has an interest in public health. Please help us spread the word! Interested candidates should send their CVs to antonella.clerici@mail.mcgill.ca.

Dr. Jaswant Guzder: Culture and working with families

VIDEO

“The whole trajectory of development is shaped by cultural expectations”

Dr. Jaswant Guzder, head of Child Psychiatry at the Jewish General Hospital discusses the influence of culture in her work with families. In her practice, she often encounters children and parents negotiating between two cultures, a Western one which often emphasizes individualism and the patient’s culture of origin which may put emphasis on interdependence. Dr. Guzder suggests strategies for clinicians to create a culturally safe space to share differing cultural opinions without shame or judgement. In order to provide the best care for children and families, how can clinicians understand families’ interpretation of their cultural ideas ? What is the best way forward in instilling cultural competence amongst clinicians to identify their own cultural blind spots?

Schizophrenia and social defeat in the immigrant population

There are many pressures when resettling in a new country: the stress of immigration, the search for employment, getting recognition for training undertaken in another country, and dealing with a new language and culture. Inpsired by a 2005 study conducted by Dr. Cantor-Graae that found that immigrants have a 2-3 times higher chance than the average population of developing schizophrenia, Drs. Danni Li, Lisa Andermann, and Samuel Law at the University of Toronto conducted a study to look at the relationship between feelings of social defeat and types of delusions within schizophrenia. In this podcast, Drs. Andermann and Law share their findings and suggest possible approaches to working with immigrants with schizophrenia; they discuss implications for immigration policy and post-immigration social policies.

The Clinical Ethnographic Interview: opening up the diagnostic process

St_Arnaud

“Depression questionnaires were never set up for the world’s population. They were set up in the West,” says Denise St Arnault, professor in the University of Michigan School of Nursing. For decades researchers have shown the degree to which there is cultural variation in the experience of mental illness, and yet clinicians continue to mostly ignore this fact in their practice. With a background in psychiatric nursing, Saint Arnault has developed what she hopes will be a pragmatic solution, the Clinical Ethnographic Interview. It encourages the opening up the diagnostic process so that patients can introduce the clinician to their own cultural frames and understandings. She talks us through the steps of the interview, which includes exercises to draw the patient’s social networks, map out their body and sensations, and construct a lifeline.