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.

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.

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/

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.

Strengthening research in Aboriginal mental health

The work done by the Network for Aboriginal Mental Health Research was featured in the Fall edition of JGH News, a publication of the Jewish General Hospital in Montreal. Laurence Kirmayer founded the Network 15 years ago. Since then it has grown from a provincial to a national organization with ties to researchers around the world. An important function of the Network is training new researchers in sound and culturally responsive mental health and addiction-focused methodologies. In the article Dr. Kirmayer is quoted explaining the importance of culture in approaches to mental health: “Culture has to be part of the cure, but it can’t be done in a generic way. It has to be tailored to a community’s needs in reinforcing a person’s positive identity and sense of belonging.”

One researcher that has benefited from her collaboration with the Network is Morgan Kahentonni Philips, a Kahnawake resident of Mohawk descent. She has a B.A. and M.A. in anthropology from Concordia, but recently began a Ph.D. program in education at McGill University in part due to her work with the Network. As quoted in the JGH News article, she explains her motivation: “I realized how little is understood by mainstream people about indigenous societies… Now at McGill I’m helping to develop a curriculum for doctors who may have native patients, but may not truly understand them. It’s important for doctors to know, for instance, about their history of assimilation, the loss of language and the residential schools where their heritage was denied to them. Most of all, we want to remove the stereotypes.” If you would like to know more about or join the Network please visit the website.

Video: Dr. Laurence Kirmayer introducing the MMHRC

Canada is a highly diverse society, close to 1 out of 5 people were born outside of the country. Every year about 250,000 immigrants are accepted into the country, about 25,000 refugees. The Multicultural Mental Health Resource Centre (MMHRC) is a clearing house for information on cultural diversity relative to providing mental health services to Canada’s population. A doctor, for example, can go to the website and print out available materials on specific mental health issues in the language best understood by their patient.

The website is targeted to four principle groups of people: 1) Health care and social service providers, 2) people with mental health problems, as well as their family and friends, 3) the personnel of ethnocultural and community organizations who want to help their clients better navigate the health care system, and 4) people involved in health planning and policy making. The MMHRC is actively engaged in making the latest and best research on culture and mental health available to people on the front lines, in a form that is most useful for them. By articulating both national and local networks of mental health service providers that tailor to the needs of ethnocultural communities, the MMHRC aims to strengthen the human and informational resources available for improving mental health services for all of Canada’s diverse population.