Catalyst – October 2016 – Case for Diversity Paints Opportunity for Service Improvement | Mental Health Commission of Canada

Source: Catalyst – October 2016 – Case for Diversity Paints Opportunity for Service Improvement | Mental Health Commission of Canada

MHCC Backs Research in Case for Diversity with an Investment in Refugee Mental Health

They say timing is everything. This is certainly true in the case of prescient policy work undertaken by the Mental Health Commission of Canada to improve mental health services and supports by and for immigrants, refugees, ethno-cultural and racialized (IRER) populations.

“We began our work to understand the disparity in service usage before the Syrian refugee crisis, and before recent revisions to Canada’s immigration policy,” says Ed Mantler, MHCC Vice-President of Programs and Priorities. “We have long understood this population to be underserved, and now we really have the momentum to push forward with the case for service improvement.”

Mantler is referring to the MHCC’s Case for Diversity Project, which began in 2014, building on a significant prior research paper.

Led by Drs. Kwame McKenzie and Branka Agic, this seminal work paints an up-to-date portrait of the demography of diversity in Canada, promising practices, and an economic analysis.

“To ensure fair access to mental health services for IRER populations, equity must become part of health system planning, including setting targets and identifying those responsible for leading change,” says Dr. Kwame McKenzie, co-principal investigator on the project and Director of Health Equity at CAMH. “As a country with a diverse population and an increasingly knowledge-based economy, the mental health of all of Canada’s residents is an important investment and we cannot afford to leave anyone behind.”

MHCC President and CEO Louise Bradley echoes Dr. McKenzie’s perspective. “We can now point to specific numbers that tell us we aren’t investing enough in the mental wellness of a vulnerable population,” says Bradley. “By replicating promising practices, we can make smart, targeted investments that are likely to have the greatest impact. And we are prepared to back this research with an investment of our own.”

At the launch event of the Case for Diversity, Bradley announced that the MHCC will provide funding to the Refugee Mental Health Project, an evidence-informed online course – available in English and French – to help settlement, social and health service providers build knowledge and skills around the needs of refugees.

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”.


Here’s Why Black People in Canada Are Healthier Than Those in the U.S. | TakePart

Researchers say it doesn’t have to do with socioeconomic status or Canada’s health care system.

Researchers are finding that racism and a legacy of American slavery may play an even bigger role in health disparities, a revelation that is being unearthed by diving deep into numbers that compare the health of America’s black population with that of blacks in a country where the African slave trade wasn’t significant: Canada.

Chantel Ramraj, a researcher at the University of Toronto’s Dalla Lana School of Public Health, set out to compare the differences between the health of blacks and whites in Canada and the U.S. The study, published in the journal Social Science and Medicine, found that black Canadians fare better than black Americans, even after controlling for socioeconomic factors and bad health behaviors. Researchers believe that means there must be other reasons why disparities exist between the two countries, such as the biological legacy of slavery and ongoing systemic racism in America.


Source: Here’s Why Black People in Canada Are Healthier Than Those in the U.S. | TakePart

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.


CBC Ideas on Cultural Psychiatry

Early in the twentieth century German psychiatrist Emil Kraepelin travelled to Indonesia to see how mental illnesses there compared to what he knew back home. Transcultural psychiatry was born. Today McGill University is a world leader in the research and practice of a branch of psychiatry with links to anthropology, cultural studies and family therapy. David Gutnick steps into a world where treatment relies less on medication and more on talk and understanding.

Source: Like I Was Talking to Myself in the Mirror – Home | Ideas with Paul Kennedy | CBC Radio

Hope Within Horror: Marina Nemat – Home | Ideas with Paul Kennedy | CBC Radio

When Marina Nemat was 16 and living in Tehran, she was arrested at gunpoint and sentenced to life in Iran’s most notorious prison, where she was repeatedly tortured and assaulted. She now lives just north of Toronto, and argues that the best way to combat evil in the world is through small acts of kindness. She delivered the 2016 International Issues Discussion series lecture at Ryerson University in Toronto.

Source: Hope Within Horror: Marina Nemat – Home | Ideas with Paul Kennedy | CBC Radio

Caring for a newly arrived Syrian refugee family

This practice article discusses preventive primary care for a newly arrived Syrian refugee family. The recommendations for preventive interventions have been adapted for newly arriving asymptomatic Syrian refugees from the Canadian Collaboration for Immigrant and Refugee Health (CCIRH) guidelines2 and other guidelines.  They take into account the findings of European surveillance reports, as Europe has received nearly 600 000 Syrian refugees in the past year alone. See:


Guide for Intercultural Relations in Mental Health | CMHA Montréal

The Guide for Intercultural Relations in Mental Health is a reference for health and social service workers, whether specialized in mental health or not, providing support and prevention services for immigrants. The Guide provides reflections in issues of intervention in intercultural contexts as well as pointers for understanding difficulties related to migration and distinguishing adaptation problems from psychological distress seen with more severe mental health problems.  It presents concrete ways to improve your practice  to help the people you see everyday. As well, the Guide provides a directory of useful resources.

>>> Read the Table of contents

>>> Read an excerpt

Source: Guide des Relations interculturelles en santé mentale | ACSM Montréal

Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians

A Review for Mental Health and Psychosocial Support Staff Working with Syrians Affected by Armed Conflict

This report, prepared for UNHCR in 2015, provides information on the sociocultural background of the Syrian population as well as cultural aspects of mental health and psychosocial wellbeing relevant to care and support. it is based on an extensive review of the available literature on mental health and psychosocial support, within the context of the current armed conflict in Syria.


Resources on Refugee Law and Human Rights

In response to the refugee crisis in Europe, OUP has made more than 30 book chapters, journal articles (including some from the Journal of Refugee Studies), and pieces of content from online resources freely accessible to assist those working with refugees on the ground, as well as anyone who would like to know more about the framework of rights and obligations concerning refugees.

The collection will be freely accessible at least until the end of 2015, and you can access it here: