About – Migration and Mental Health

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.

Source: About – Migration and Mental Health

The European Psychiatric Association Guidelines on Cultural Competency – Summary

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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

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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.

 

Racism and Discrimination

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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