The Migration and Mental Health Database

Compiled by a scientific committee of international academics in collaboration with the Documentation Center of the Swiss Forum for Migration and Population Studies / National Center of Competence in Research –The Migration-Mobility Nexus (NCCR) at the University of Neuchâtel (Switzerland), the ‘Migration and Mental Health’ database is a comprehensive collection of academic resources which focuses specifically on the topic of migration and mental health.

To understand mental health, we draw on the definition provided by the World Health Organization whereby: ‘Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’ As such, it incorporates a significant consideration of the social, cultural, political and economic environment. We are specifically interested in focusing on the mental health issues related to vulnerable populations and forced migration – the coerced movement of a person or persons away from their home or home region – including undocumented migrants, asylum seekers and refugee populations.

The database uses bibliographic research technologies to identify new publications with the selection of keyword attributions ensured by an international scientific committee of expert academics in the field. The project consists of a fully searchable online version of the bibliography of scientific publications from the year 2000 to the present, with systematic and continual updates from September 2016. It thus aims to provide a free major hub for those concerned about issues of mental health among migrant populations. As such, it is open to those in an academic field (researchers, teachers, students, lecturers), practitioners working clinically with this populations who would like to update their academic knowledge as well as interested citizens. All are warmly invited to add to this collaborative project by submitting articles to the scientific committee.

Source: About – Migration and Mental Health

The European Psychiatric Association Guidelines on Cultural Competency – Summary

The European Psychiatric Association Guidelines on Cultural Competency

EPA guidance on cultural competence training. Schouler-Ocak, M., Graef-Calliess, I. T., Tarricone, I., Qureshi, A., Kastrup, M. C., & Bhugra, D. (2015). European Psychiatry, 30(3), 431-440. doi:10.1016/j.eurpsy.2015.01.012

 

What is Cultural Competency?

  • Cultural Competency as a skillset “that a clinician can employ to understand the cultural values, attitudes and behaviors of patients, especially those whose cultural background differs from that of the mental health professional”
  • Cultural Competence includes an awareness of the impact of the psychiatrists’ own ethno-cultural identity on their patients
  • Cultural Competence is a concept that captures the capacity to provide appropriate care for diverse patients, overcoming socio-cultural differences and other systemic challenges to reduce disparities with regard to mental health care provision
  • Cultural Competency is about respecting differences and making sure that these are bridgeable in order that they do not negatively impact upon the diagnostic and therapeutic process

 

Why is Cultural Competency needed?

  • Cultural Competence is necessary in clinical practice whereby the psychiatrist sees each patient in the context of the patient’s culture as well as their own cultural values and prejudices
  • mental health specialists regularly come into contact with patients from different cultural backgrounds
  • immigrants’ health, including mental health, is seriously affected by their trajectory and/or the social conditions in which they live in the receiving country
  • the ability to understand and be aware of cultural factors in the therapeutic interaction between the therapist and the patient
  • culture plays an important role in the symptom presentation of distress and illness
  • idiom of distress in which patients communicate with psychiatrists can vary considerably from culture to culture and many languages do not have equivalent words to describe various mental disorders
  • minority patients are not the only ones who have differing cultures. All patients and staff are shaped by their own cultures with respect to ethnicity, religion, professional world etc., which can be very different from those of the patients.
  • patients are not the only ones with culture. institutions have their own cultures as well which can produce barriers of various kinds, and minority groups may well face strong barriers to health care access
  • patients who are illegal or undocumented immigrants, asylum seekers, or refugees have a “fragile existence” which raises additional issues about clinical management best addressed by culturally competent therapists.

 

How does Cultural Competence play out in clinical management?

These are some of the culturally adapted interventions suggested:

  • the cultural values of the immigrant patient should be incorporated into therapy
  • if possible immigrant patients can be paired with therapists of the same cultural or ethnic group
  • mental health interventions should be easily accessible and targeted to immigrant patients’ circumstances
  • support resources available within an immigrant patient’s community, extended family members, and tradition should all be incorporated into therapy interventions
  • Interventions conducted in patients’ native or primary language
  • the incorporation of psychologically trained interpreters or culture broker into the treatment process
  • review the cultural formulation interview in DSM-5 in which a major effort was made to recognize the influence of cultural factors on psychiatric symptoms and disease entities

 

What are the benefits of Cultural Competency?

  • culturally knowledgeable therapists influence changes in attitudes and behaviors in patients
  • therapists who show multicultural competence receive higher ratings than therapists who do not show multicultural competence
  • Cultural Competence training presented to psychiatrists in the context of clinical practice and with organizational support can lead to progress made in decreasing ethnic disparities in care

 

What are some suggested methods of developing Cultural Competency?

  • using cases and case note reviews
  • participant observation
  • cultural consultation where members of staff present cases and experts can advise them on specific cultural issues
  • Interactive lectures and role play along with small group work can help staff understand the most effective ways of doing things and engaging patients
  • listening carefully to the patient
  • eliciting the psychopathology in a culturally appropriate manner
  • assessing needs and suggesting changes in management while looking at the outcome
  • therapist acknowledging their own personal prejudices and try and deal with them
  • avoiding assumptions and stereotyping to develop higher levels of empathy will produce better therapeutic engagement
  • cultural empathy can transcend language barriers as most of the communication occurs at a nonverbal level
  • Outcome indicators may be one way forward for measuring cultural sensitivity and Cultural Competency in an organization

 

In conclusion:

“Competent treatment of minority patients requires that mental health professionals are open to understanding the similarities and differences between more traditional and modern Western approaches. It is important to understand and emphasize that Cultural Competence is not a static phenomenon but a developmental process, which represents a continuum. It must be remembered that Cultural Competency should be tempered with what has been termed ‘‘cultural humility. Attaining a level of cultural proficiency indicates a level of Cultural Competence but this is not absolute and will need ongoing development.” And “individual learning is not enough to guarantee a sensitive approach to diversity at the organizational level”, “institutional Cultural Competence requires not only the recognition of the barriers that exist to quality care at a systemic, organizational, and institutional level but also the elimination of these”.

 

Improving Cultural Competence to Reduce Health Disparities

Systematic Review of Cultural Competence Research Now Available

This report by the U.S. Agency for Healthcare Research and Quality (AHRQ) reviews studies of interventions to improve culturally appropriate health care for people with disabilities; lesbian, bisexual, gay and transgender populations; and racial/ethnic minority populations found that none examined cultural competence’s impact on disparities. Although many of the interventions studies were innovative, poor study quality prevented conclusions on whether they worked.

To download click here:  Comparative Effectiveness Review: Improving Cultural Competence to Reduce Disparities

You may also be interested in “Taking Steps Toward Cultural Competence,” a fact sheet from The SHARE Approach, a shared decision making toolkit.

 

Improving Cultural Competence – NCBI Bookshelf

Improving Cultural Competence – NCBI Bookshelf

Excerpt

The development of culturally-responsive clinical skills is vital to the effectiveness of behavioral health services. According to the U. S. Department of Health and Human Services (HHS), cultural competence “refers to the ability to honor and respect the beliefs, languages, interpersonal styles, and behaviors of individuals and families receiving services, as well as staff members who are providing such services. Cultural competence is a dynamic, ongoing developmental process that requires a long-term commitment and is achieved over time” (HHS 2003a, p. 12). It has also been called “a set of behaviors, attitudes, and policies that … enable a system, agency, or group of professionals to work effectively in cross-cultural situations” (Cross et al. 1989, p. 13).

This Treatment Improvement Protocol (TIP) uses Sue’s (2001) multidimensional model for developing cultural competence. Adapted to address cultural competence across behavioral health settings, this model serves as a framework for targeting three organizational levels of treatment: individual counselor and staff, clinical and programmatic, and organizational and administrative. The chapters target specific racial, ethnic, and cultural considerations along with the core elements of cultural competence highlighted in the model. These core elements include cultural awareness, general cultural knowledge, cultural knowledge of behavioral health, and cultural skill development. The primary objective of this TIP is to assist readers in understanding the role of culture in the delivery of behavioral health services (both generally and with reference to specific cultural groups). This TIP is organized into six chapters and begins with an introduction to cultural competence. The following subheadings provide a summary of each chapter and an overview of this publication.

Sections

Internalization of race and difference: Implications for psychotherapy in a diverse society

McGill Advanced Study Institute in Cultural Psychiatry, June 2014

Jaswant Guzder, MD

Racialized embodiment of ethnic difference has identity implications for visible minorities and may constitute a development line that runs parallel to that of gender identity with similar progression over the life cycle. Internalization of racialized identity and racism is a complex process that involves external agendas as well as intrapsychic realities. Yet the supervision of psychotherapists and family therapist rarely addresses countertransference or transference issues related to these realities. The social and political context of collectives and groups organizes resistance and openness to a discourse that allows these dimensions of identity to be discussed. This paper will elaborate through clinical examples of how these issues may present in therapy.

 Click Here to Watch the Lecture

Racism and Discrimination

Thinking about racism and discrimination should begin with the recognition that ‘race’ is a social construction with no solid foundation in biology. Hence, the term ‘race’ itself is deeply problematic and we should avoid reproducing the categories it is part of. In Canada, the term ‘racialized groups’ has gained favour because it draws attention to this social process of constructing race. Despite the negative effects of racism, individuals and communities may accept and elaborate racialized identities as part of a process of collective affirmation.

Knowing more about the Canadian history of discrimination is a crucial step (e.g. European colonization and the Indian Residential School system, the Komagatu Maru, the internment of Japanese in WWII, Africaville, etc.). Ultimately, learning to empathize with and, to some degree, understand the predicament of others is essential. This can be achieved in part through dialogue, role-playing and imagination but it is helpful to experience the predicament of being seen as a ‘visible minority’ — for example by living in a community where one’s appearance marks one off as “other’. Pedagogically, achieving this kind of (self)awareness requires a diverse community that works to maintain a safe space for mutual learning and encounter and the humility to recognize the limits of empathy and understanding. Friendships between people with different identities and experiences are essential for this journey.

White privilege is woven deeply into the fabric of Canadian society but racial thinking is part of other forces of marginalization and discrimination: of indigenous peoples, of non-European immigrant groups, of the religious or linguistic ‘Other’, and, increasingly, of refugees seeking safe haven.

Some references that may be useful:

Aspinall, P. (2005). Language matters: the vocabulary of racism in health care. J Health Serv Res Policy, 10(1), 57-59.

Brascoupé, S., & Waters, C. (2009). Cultural safety: Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. Journal of Aboriginal Health, 7(1), 6-40.

Corneau, S., & Stergiopoulos, V. (2012). More than being against it: anti-racism and anti-oppression in mental health services. Transcult Psychiatry, 49(2), 261-282. doi: 10.1177/1363461512441594

Gravlee, C. C. (2009). How race becomes biology: embodiment of social inequality. Am J Phys Anthropol, 139(1), 47-57. doi: 10.1002/ajpa.20983

Crampton, P., Dowell, A., Parkin, C., & Thompson, C. (2003). Combating effects of racism through a cultural immersion medical education program. Acad Med, 78(6), 595-598.

Fredrickson, G. M. (2002). Racism: a short history. Princeton, N.J.: Princeton University Press.

Gunew, S. M. (2003). Haunted nations: the colonial dimensions of multiculturalisms. New York: Routledge.

Guzder, J., & Rousseau, C. (2013). A Diversity of Voices: The McGill ‘Working with Culture’ Seminars. Cult Med Psychiatry, 37(2), 347-364. doi: 10.1007/s11013-013-9316-0

Kirmayer, J.J. (2014). Critical psychiatry in Canada. In: R. Moodley & M. Ocampo (Eds.) Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando (pp. 170-181). New York: Routledge.

Neville, H., Spanierman, L., & Doan, B. T. (2006). Exploring the association between color-blind racial ideology and multicultural counseling competencies. Cultur Divers Ethnic Minor Psychol, 12(2), 275-290. doi: 2006-05763-007 [pii] 10.1037/1099-9809.12.2.275

Noh, S., Kaspar, V., & Wickrama, K. A. (2007). Overt and subtle racial discrimination and mental health: preliminary findings for Korean immigrants. Am J Public Health, 97(7), 1269-1274. doi: AJPH.2005.085316 [pii] 10.2105/AJPH.2005.085316

 Noh, S., & Kaspar, V. (2003). Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health, 93(2), 232-238.

 Ridley, C. R. (1995). Overcoming Unintentional Racism in Counseling and Therapy: A Practitioner’s Guide to Intentional Intervention. (Vol. 5). Thousand Oaks, California: SAGE Publications.

 Satzewich, V. (2011). Racism in Canada. Don Mills: Oxford University Press.

 Saul, J. R. (2008). A Fair Country: Telling Truths About Canada. Toronto: Viking Canada.

 Smedley, A., & Smedley, B. D. (2005). Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race. Am Psychol, 60(1), 16-26. doi: 10.1037/0003-066X.60.1.16

 Todd, N. R., Spanierman, L. B., & Aber, M. S. (2010). White Students Reflecting on Whiteness: Understanding Emotional Responses. J Divers High Educ, 3(2), 97-110. doi: 10.1037/a0019299

 As well, see some of the videos of talks from our Advanced Study Institute this year at:

http://www.mcgill.ca/tcpsych/videos/asi-videos/2014

Working Together: Aboriginal and Torres Strait Islander Mental and Health and Wellbeing

Telethon Kids Institute – Working Together 2nd Edition.

We are pleased to announce that the 2nd Edition of Working Together: Aboriginal and Torres Strait Islander Mental and Health and Wellbeing Principles and Practice 2014 is now available online. The editors are Pat Dudgeon, Helen Milroy and Roz Walker.

The book is intended for staff and students and all health practitioners working in areas that support Indigenous mental health and wellbeing. Working Together offers a high quality, comprehensive examination of issues and strategies influencing Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing.

The new book includes several new chapters. It examines issues across the life course, with a greater focus on children and young people; the significant impacts of mental health in the justice system; the cultural determinants of social and emotional wellbeing and intellectual and development disabilities.  It includes holisitic models of care, as well as interdisciplinary and inter-professional approaches and working with carers to deliver an even more robust text and resource.

Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice 2014 was funded by the Australian  Government Department of the Prime Minister and Cabinet, Telethon Kids Institute/Kulunga Aboriginal Research Development Unit in collaboration with the University of Western Australia.

The book is available in hard copy as well as on line. You can download book chapters directly from the website.

Lost in Translation: Mental Health of Newcomers

Lost in Translation: Mental Health of Newcomers – New Canadian Media

An interview with Dr. Jaswant Guzder on issues of access to mental health care for immigrants and refugees and the importance of interpreters. Includes discussion of suicide, psychosis, depression, and cultural consultation.

Equal Benefit for Minorities From Psychotherapy, Study Finds

Members of racial or ethnic minority groups benefit just as much from psychotherapy as do members of the white majority in Western countries, according to a report in Psychiatric Services in Advance.

Researchers from Vrije Universiteit (VU), University Amsterdam, and the EMGO Institute for Health and Care Research looked at 56 randomized, controlled trials among adults that compared psychotherapies with usual care or a waiting list. The most common treatments were cognitive-behavioral therapy (in 32 trials) or interpersonal psychotherapy (11 trials).

“Our overall results suggest there is little reason to assume that psychotherapy is less effective for racial-ethnic minority populations compared with nonminority populations,” concluded the authors. “Because our meta-analysis did not give strong indications that psychological treatments work differently between specific racial-ethnic minority groups, more attention should be paid to the gap between effective mental health care and the delivery of these services.”

Psychiatric Services 2014; doi: 10.1176/appi.ps.201300165

The authors are with the Department of Clinical Psychology, VU University, Amsterdam, the Netherlands, and the EMGO Institute for Health and Care Research (e-mail: b.unlu@vu.nl).