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:

Improving Cultural Competence – NCBI Bookshelf

Improving Cultural Competence – NCBI Bookshelf


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.


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:

Culturally and Linguistically Appropriate Services — Advancing Health with CLAS — NEJM

Culturally and Linguistically Appropriate Services — Advancing Health with CLAS — NEJM.

The CLAS standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations:
Principal Standard
1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce
2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.
Communication and Language Assistance
5. Offer language assistance to individuals who have limited English proficiency or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, orally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.
Engagement, Continuous Improvement, and Accountability
9. Establish culturally and linguistically appropriate goals, policies, and management accountability and infuse them throughout the organization’s planning and operations.
10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality-improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
14. Create processes for conflict and grievance resolution that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

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/

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: