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.
Ontario steps in to fund health care for refugees.
OTTAWA — A year and a half after the federal government cut health funding for many refugees, Ontario has begun to pick up the slack, something that comes as a relief to members of Ottawa’s refugee community.
Working with Vietnamese Americans: A Clinical Training Manual for Mental Health Professionals
Thomas T. Nguyen
University of St. Thomas, Minnesota
Vietnamese Americans are among the most recent immigrants to the United States (Min, 2006). There is a higher need of mental health services for those who have witnessed traumatic events (i.e., war trauma and forced migration) and those struggling with acculturative stress. Unfortunately, there is a significant deficit of culturally appropriate mental health service providers in working with this specific population (U.S. Department of Health and Human Services, 2010). Despite efforts within the field in recent years to identify barriers to mental health services among Vietnamese Americans, mental health service utilization remains low and rates of early termination remains high. For many Vietnamese, low services utilization does not equate to a lesser need, but it reveals the many barriers (e.g., misunderstanding the Western concept of mental health, language communication, and cultural beliefs and practices) that prevent them from seeking mental health services. Further, a higher early termination rate is likely the result of the clinicians’ lack of cultural awareness and training. Thus, there is a need for a clinical training curriculum for mental health professionals working with this target group. The curriculum will address culturally appropriate interventions (i.e., multicultural awareness, understanding the Vietnamese cultural perception of mental illness, working with language interpreters, and intervention skills) to ensure that clinicians are better equipped with the knowledge and the skills to assist Vietnamese Americans, and also the ever-increasing diverse community.
Dr. Laurence Kirmayer was interviewed by Dr. Sofie Bäärnhielm, Director, Transkulturellt Centrum, Stockholms läns landsting, Stockholm February 2012.
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/appi.ps.201100280
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.
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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.
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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.
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The CBC speaks with Dr. Cécile Rousseau about psychiatry’s move toward integrating culture in training and psychiatric practices. Listen here for a fascinating dialogue about how this important aspect of identity is impacting the Canadian mental health context. Dr. Rousseau is a professor in the Division of Social and Transcultural Psychiatry at McGill University in Montreal where she directs the Transcultural Child Psychiatry Clinic. She is also a member of the MMHRC steering committee.