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
“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”.