New video on the Cultural Consultation Service

“We live in a time of mass migration and of displaced populations and receiving countries are really strained to accommodate and understand new arrivals and it is causing questions, soul-searching questions around the world. Governments and medical institutions struggle to understand how to help people.”

Using examples from previous patients drawn from an incredibly diverse population in Montreal, Dr. Jarvis walks us through what cultural consultation is; how it is different from the Cultural Formulation Interview (CFI) and Cultural Competence; why Cultural Consultation is important; how a Cultural Consultation session is conducted; what does the service achieve; and what the future holds for the Cultural Consultation Service.

Minorités sexuelles, minorités culturelles

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Entrevues
Entrevue avec Edward Ou Jin Lee, membre de l’organisme AGIR et étudiant au doctorat, travail social, Université McGill et Habib El-Hage, chercheur METISS, intervenant social, Collège de Rosemont, par Andréanne Boisjoli.

« Il faut préparer les intervenants à bien comprendre la question LGBTQ dans un contexte d’immigration, et la complexité sociale dans laquelle ces personnes vivent. »

Lire l’article ici.

Formations de base en interculturel

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Nos partenaires au CSSS de la Montage offrent le formations de base en interculturel pour tous les intervenants du CSSS de la Montagne ou de ses partenaires (groupes  communautaires et autres établissements du réseau de la santé et des services sociaux)
travaillant en milieu pluriethnique. La formation est générale; elle ne vise pas à former
des intervenants spécialisés en accueil, mais plutôt à fournir les connaissances et
habiletés nécessaires pour toute intervention de première ligne. Cette formation est
également offerte aux bénévoles des organismes communautaires.

 

“Interculturel I : Les mots pour dire et pour intervenir” se déroule les lundis le 7 et 14 avril 2014 de 8h30 à 16h30 au CLSC Métro, 1801 de Maisonneuve ouest, Salles 5A- 5B.

“Interculturel II : Connaître ses clients : Statuts, trajectoires et vécus migratoires” se déroule les jeudis le 10 et 17 avril 2014 de 9h00 à 17h00 au CLSC Métro, 1801 de Maisonneuve ouest, Salles 5A- 5B.

 

Ces formations se donnent sur deux jours complets. Elles visent à outiller les participant-es dans leurs contacts avec la clientèle immigrante, réfugiée ou issue de l’immigration. L’accent est mis sur une clarification des notions de culture, ethnie, ethnicité, identité, et autres termes fréquemment utilisés dans la pratique et dans le langage courant, avec des significations variées.

Objectifs de ces formations :
Au cours des journées de formation, nous aimerions que les participant-es :
– se retrouvent dans les exemples de situations d’intervention qui ont été présentées;
– s’approprient les balises théoriques qui facilitent les interventions;
– acquièrent ou développent une attitude de décentration favorable à l’intervention;
– puissent réutiliser les acquis de cette formation dans la pratique quotidienne immédiate.

Ces formations font partie du projet de transfert de connaissance subventionné par le FRQSC (Fonds de recherche du Québec – société et culture) et est co-animée par un formateur du CRF et un intervenant du CSSS. Il n’y a donc pas de frais d’inscription. Elle a été développée spécifiquement suite à une demande collective de notre CSSS, de nos partenaires CSSS et organismes communautaires, pour l`offrir à leurs employés (es) (incluant leurs bénévoles).

Inscription et information auprès de :
Sylvie Robert
514-934-0505, poste 7609
sylvie.robert@ssss.gouv.qc.ca

MMHRC March 2014 Newsletter

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The March 2014 newsletter is out! It previews the content of the newly relaunched site, features an article, “Potential Contributions of Cultural-Clinical Psychology to a Revisioned Psychiatry” by Dr. Andrew G. Ryder & Dr. Yulia E. Chentsova-Dutton, highlights one of our favourite MMHRC podcasts, Dr. Cécile Rousseau talking about the two-way relationship between immigrants and the host community, and features artwork by Dr. Jaswant Guzder.  The newsletter can be read online here.

Jaswant Guzder on Child Cultural Consultations

Jaswant Guzder, head of Child Psychiatry at the Jewish General Hospital, talks about Cultural Consultation sessions with children. What are the principles of child cultural competence, what are some typical agendas during child cultural consultations, and what are some themes of concern?

Article: Potential Contributions of Cultural-Clinical Psychology to a Revisioned Psychiatry

Potential Contributions of Cultural-Clinical Psychology to a Revisioned Psychiatry

Andrew G. Ryder, Ph.D.
Department of Psychology, Concordia University
Culture and Mental Health Research Unit, Jewish General Hospital

Yulia E. Chentsova-Dutton, Ph.D.
Department of Psychology, Georgetown University

Cultural psychiatry has long aspired to be more than a subdiscipline of psychiatry, but rather a superordinate perspective that ideally would inform all of mental health research and practice. As mainstream psychiatry is by no means so informed at present, cultural psychiatry necessarily offers a necessary critique. This critique is vital, but it is not enough – it must be accompanied by aspiration, by an alternative vision of what psychiatry ought to be. We will argue here that a revisioned psychiatry is inherently interdisciplinary, and that psychology has an important contribution to make. Cultural psychiatry is in a good position to promote this interdisciplinarity, as it has been conceived this way for decades. The role of psychology is uncertain, however. While psychologists and other disciplines are involved, sometimes deeply, cultural psychiatry is predominantly a collaboration between psychiatrists and anthropologists. One problem is that the psychological approach, both theoretically and methodologically, can be an uncomfortable fit with cultural psychiatry. There are many reasons for this, but central among them is the relative inattention to culture and local context in mainstream psychology, paralleling some of the problems in mainstream psychiatry.

We believe that a revisioned psychiatry demands a revisioned psychology – a contextual psychology that responds to key anthropological critiques and yet remains psychology. We have recently proposed ‘cultural-clinical psychology’ as one such revisioned psychology (Ryder, Ban, & Chentsova-Dutton, 2011). Conceived as a blend of cultural and clinical psychologies, cultural-clinical psychology follows cultural psychology in positing that mind and culture ‘make each other up’ (Shweder, 1990). In keeping with emerging trends in clinical psychology, cultural-clinical psychology further posits that a similar statement can be made about mind and brain. Each level is understood broadly and can be extended, for example: brain to the nervous and endocrine systems; mind to commonly used external tools and close others; culture to artifacts and social institutions. Concepts such as ‘symptom’, ‘syndrome’, ‘trait, and ‘resilience’ are here understood as system properties, rather than residing at a particular level (Chentsova-Dutton & Ryder, in press; Ryder, Dere, Sun, & Chentsova-Dutton, in press). The result is a revisioned psychology, dedicated both to research and to clinical practice, that conceptualizes culture-mind-brain as a single system with multiple, mutually constitutive, levels.

Achieving this ambitious goal will obviate the need for the specifier ‘cultural’. Cultural-clinical psychology would become clinical psychology, as cultural psychiatry would become psychiatry (and cultural psychology would become psychology). Given broader trends strongly favouring biological approaches, however, cultural aspects are emphasized in contrast. For now, the potential contributions of cultural-clinical psychology to a revisioned psychiatry will be evaluated through generativity – does this perspective add new ideas, pointing to new research, leading in turn to new clinical interventions? A full consideration of this question is well beyond our scope here, so we will content ourselves with a single example. We believe the best psychology researchers concern themselves with explanation through underlying processes. This concern could be brought to bear on many of the generative but vaguely specified ideas used in cultural psychiatry. Take for example the ‘symptom pool’, proposed by medical historian Edward Shorter (CITE). The idea that different historical eras and – by extension – cultural contexts have specific symptom pools upon which people draw to convey distress has wide applicability and explanatory power. Psychologists want to know: how does this actually work?

What follows is a psychologically plausible model of the symptom pool. Each claim is supportable through psychological research, although very little research to our knowledge has specifically been designed for this purpose. We begin with the idea that the universe accessible to our perceptions is so complex that we can only attend to that which is meaningful (Peterson). This complexity includes many symptom constituents – experiences that could potentially become symptoms. Indeed, the background noise of such experiences is much greater than we generally realize, including physical sensations, stray thoughts, emotional fluctuations, and interpersonal disturbances, transient dissociations, and even brief quasi-psychotic experiences. Cultural scripts can then help us understand how we navigate this complexity in meaningful ways, some of which pertain to how potentially symptomizable experiences are to be understood. The symptoms themselves emerge in part due to feedback loops: attention to particular experiences increases the frequency and severity of these experiences. Out of the background noise of daily life, or the background chaos of an incipient crisis, emerge full-blown symptoms: pathological system properties of culture-mind-brain (Ryder & Chentsova-Dutton, 2012).

This approach points to research designed to establish the various phases of this psychological model in specific cultural contexts, with specific symptoms and syndromes. Can it also impact directly on clinical practice? To begin with, psychological assessment techniques need to tap into locally relevant symptom pools. If successful, psychology will contribute psychometric rigour, as well as a growing arsenal of methods that range far beyond traditional self-report questionnaires (Ryder et al., 2011). Beyond symptoms, a psychological process model of the symptom pool can guide us to assess the relevant cultural schemas operating in a particular sufferer’s local world. This could lead to techniques designed to assess both the meanings and practices endorsed by a particular person, and also their assumptions about the meanings and practices considered normative in their local worlds. We should also consider how we might assess the loops that generate and maintain symptoms. One possible approach to this might be the ‘chain analysis’ technique used in cognitive-behavioural therapy (CBT), in which a clinician works collaboratively with a client to unpack the event sequences that promote and maintain pathology. Here, successful assessment points the way towards potentially successful treatment.

We believe that knowledge of local symptom pools and the ways in which they operate can direct us to specific clinical interventions. First, by opening up possibilities for discussion, there is the potential to build rapport. Second, and more importantly for our purposes here, a study of the loops operating in the client’s culture-mind-brain provides entry points for intervention. Importantly, these entry points do not have to take place at the same level at which we conceptualize a given problem. Just as a pill can change social behaviours, so too can a psychological intervention change the brain (Ryder et al., 2011). In this case, interventions targeting specific loops have the potential to interrupt a pathological pattern in the culture-mind-brain. Much of this work is already being done in contemporary CBT, as well as in family systems therapy, but attention to the symptom pool broadens our understanding of the different ways this can happen. As befits a discipline committed to research and clinical work, these clinical possibilities require careful evaluation. Generativity in theory and research, with practical benefits for assessment and treatment, are central to the making the case for a cultural-clinical psychology that will make lasting contributions to an emerging revisioned psychiatry.

Invisible Children

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For many illegal immigrants who have children, one of their main concerns is access to schooling. Without valid documentation, the parents are often forced to pay school fees for their children, which is not always possible. Some parents decide not to send their children to school, out of fear of being identified. In the cases where the school admits a child without papers, they do not receive a student number (“permanent code” in Quebec), which affects their access to a diploma at the end of their studies. Doubly vulnerable due to their their illegal status and their age, these children are effectively invisible within the education system.
A group formed of organizations such as the Centre des travailleurs immigrants, La Mission communiautaire de Montréal and La Commission des droits de la personne, along with other researchers and smaller community organizations combined their efforts with the goal of obtaining access to education for all children in Quebec, regardless of status.
Before the new school year began in Fall 2013, the group was met with their first achievement: the Ministry of Education put forward certain measures to allow more children without status into Quebec schools and to be given a permanent code. This access is limited to only certain categories of youth, but the group is buoyed by their progress and by the opening of dialogue with the government.
A feature in French about Francesca Meloni, one of the members of the group working for access to education for children without status, can be found on the Sherpa Recherche site here. You can also read Meloni’s PhD thesis in English, Living with Uncertainty: An Ethongraphic Study on the Agency and Belonging of Undocumented Youth in Canada here.

Podcast: Post-partum depression and immigrant women

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Paola Ardiles, founder and network lead at BridgeforHealth.org speaks about postpartum depression (PPD) within the immigrant population in Canada. What are some of the specific challenges immigrant women with PPD face? What services are out there to help and what do caregivers need to know about working with immigrant women with PPD?

To read more on this subject, please consult the April 2013 article “Cultural background and socioeconomic influence of immigrant and refugee women coping with postpartum depression” published in The Journal of Immigrant and Minority Health.