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Hoshmand S, Knegtering H, Spoelstra SK. Cultural competence of mental health practitioners in the Netherlands. Int J Soc Psychiatry 2024; 70:282-288. [PMID: 37874035 DOI: 10.1177/00207640231206062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence. AIMS This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training. METHODS A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire. RESULTS Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence. CONCLUSION The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.
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Affiliation(s)
- S Hoshmand
- Lentis Psychiatric institute, Groningen, The Netherlands
| | - H Knegtering
- Lentis Psychiatric institute, Groningen, The Netherlands
- University Medical Center Groningen, University of Groningen, Rob Giel Research Center, Groningen, The Netherlands
| | - S K Spoelstra
- Addiction care North Netherlands, Groningen, The Netherlands
- NHL Stenden Hogeschool, Leeuwarden, The Netherlands
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Bhugra D, Smith A, Liebrenz M, Ventriglio A, Gnanapragasam SN, Buadze A, Pemberton M, Poulter D. "Otherness", otherism, discrimination, and health inequalities: entrenched challenges for modern psychiatric disciplines. Int Rev Psychiatry 2023; 35:234-241. [PMID: 37267034 DOI: 10.1080/09540261.2023.2192275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 06/03/2023]
Abstract
Identity is a complex concept that can be informed by various factors, involving biological, psychological, experiential, and social influences. Specifically, one's social identity refers to the ways in which individuals can adopt attributes from established collective categories, like cultural identities, ethnic identities, gender identities, and class identities, amongst others. Social identity can encompass unique and diverse interactions at an individual level, known as micro-identities, that may be selectively expressed, hidden, or downplayed, contingent on distinct sociocultural settings. However, the formation of social identity is recurrently defined in opposition to perceptions of the Other, which can entail adverse paradigms of marginalisation, stigma, and discrimination. Although this theory of Otherness has been developed across different fields, particularly sociology, it may be important in psychiatric contexts as it can engender inherent risk factors and mental health inequalities. Consequently, this paper seeks to bring attention towards these issues, exploring the construction of Otherness and its detrimental outcomes for psychiatry, such as systemic discrimination and disparities in therapeutic support, alongside recommended initiatives to mitigate against the effects of Otherness. This may require multifactorial approaches that include cultural competency training, interventions informed by micro-identities and intersectionality, patient advocacy, and structural changes to mental health policy.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London, UK
| | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Ana Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, Specialized Outpatient Clinic for ADHD, University of Zurich, Zurich, Switzerland
| | - Max Pemberton
- Specialist Registrar, Camden and Islington NHS Foundation Trust, London
| | - Daniel Poulter
- South London and Maudsley Foundation NHS Trust, London, UK
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Understanding Distribution of Gender and Race across Consultation Liaison Psychiatry in USA. Psychiatr Q 2022; 93:587-597. [PMID: 35195848 DOI: 10.1007/s11126-022-09975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
The United States of America (USA) has a culturally and ethnically diverse population. Various gender and racial minorities in the healthcare system are not represented adequately when compared to their ratios in the general population. This study reviewed the gender and racial distribution and its temporal trends among fellows in Consultation-Liaison Psychiatry (CLP) within the USA. A retrospective analysis was performed to evaluate the gender and race of fellows in CLP fellowship programs in the USA from 2007 to 2019. Data was retrieved from publicly available Accreditation Council for Graduate Medical Education (ACGME) Resource Books. According to ACGME data, races were categorized as White (non-Hispanic), Asian/Pacific Islander, Hispanic, Black (non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was self-reported as male, female, and not reported. Among fellows in CLP, the White (Non-Hispanic) race remained the most represented and increased by 7.3% from 2011 to 2019, with an 18.6% increase in relative change. In contrast, the Asian/Pacific Islander, African American/Black (Non-Hispanic), and others decreased by 6.2%, 4.0%, and 4.6%, respectively. Gender distribution trends showed an increase in male representation with a relative increase of 14.7% and an absolute increase of 5.5%. Similar trends were seen in female representation with a relative and absolute increase of 5.2% and 2.8%, respectively. However, women remained the most represented throughout the period. Considering the ongoing globalization & rapidly evolving US demographics, it is crucial to analyze the gender and racial disparities within psychiatry. Racial concordance and a diversified culturally competent physician workforce is imperative for the effective delivery of mental health services.
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Venkataramu VN, Vajawat B, Raghuraman BS, Chaturvedi SK. Cultural competency training for psychiatry residents and mental health professionals: A systematic review. Int J Soc Psychiatry 2021; 67:833-839. [PMID: 33325310 DOI: 10.1177/0020764020981610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cultural competence is a prerequisite skill for a psychiatrist. There is a dearth of information on the methods used for training of cultural competence and their outcomes. This study aims to explore and determine the existing methods used for cultural competency training (CCT) for psychiatry residents and how useful these training methods are. METHOD A systematic review methodology based on PRISMA guidelines was adopted for this study. The literature search reviewed databases of PubMed and MesH, using keywords 'psychiatry resident', 'psychiatry', 'psychiatrist', 'mental health', and 'mental health professional'. In the end,14 articles qualified for the detailed review. The level of evidence and quality of the studies were evaluated and recorded. RESULTS The methods of cultural competence training identified were grouped as, active/passive/mixed; group training/individual training. These included documentaries or non-feature films based teaching, secondary consultation and cross consultation models, case vignette discussions, Objective Structured Clinical Examination (OSCE), behavioral simulation, video demonstration, cultural discussion in rounds, and traditional clinical teaching. The studies covered participants from different cultural backgrounds, mainly urban and predominantly university/institution based. CONCLUSION There is limited literature in the area to conclude one method to be better than the other with respect to CCT in psychiatry residents. However, this review identified a variety of training methods, which can be used and pave way for research on their effectiveness. Training and evaluation of psychiatry residents in the area of cultural competence should be done routinely during their training to enable them to practice in the multi ethic societies.
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Affiliation(s)
| | - Bhavika Vajawat
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - S K Chaturvedi
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Characterizing individuals accessing mental health services in the UAE: a focus on youth living in Dubai. Int J Ment Health Syst 2021; 15:29. [PMID: 33789685 PMCID: PMC8011192 DOI: 10.1186/s13033-021-00452-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai. Methods Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models. Results The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders. Conclusions The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.
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Kirmayer LJ, Fung K, Rousseau C, Lo HT, Menzies P, Guzder J, Ganesan S, Andermann L, McKenzie K. Guidelines for Training in Cultural Psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:195-246. [PMID: 32345034 PMCID: PMC7918872 DOI: 10.1177/0706743720907505] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.
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Affiliation(s)
- Laurence J Kirmayer
- James McGill Professor and Director, Division of Social and Transcultural Psychiatry, 5620McGill University, Montreal, Quebec; Director, Culture and Mental Health Research Unit, Jewish General Hospital, Montreal, Quebec
| | - Kenneth Fung
- Clinical Director, Asian Initiative in Mental Health, University Health Network, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; President, Society for the Study of Psychiatry and Culture, Toronto, Ontario
| | - Cécile Rousseau
- Professor, Division of Social and Cultural Psychiatry, 5620McGill University, Montreal, Quebec
| | - Hung Tat Lo
- Director, Asian Clinic, Hong Fook Mental Health Association, Toronto, Ontario
| | - Peter Menzies
- Psychiatrist, Four Directions Therapeutic and Consulting Services, working with First Nations communities in northern Ontario
| | - Jaswant Guzder
- Professor, Department of Psychiatry, 5620McGill University, Montreal, Quebec; Senior Clinician, Cultural Consultation Service, Institute of Community and Family Psychiatry, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec; Senior Clinician, Child Psychiatry, Jewish General Hospital, Montreal, Quebec
| | - Soma Ganesan
- Clinical Professor of Psychiatry, University of British Columbia, Vancouver, British Columbia; Director, Cross Cultural Psychiatry Program, University of British Columbia, Vancouver, British Columbia
| | - Lisa Andermann
- Psychiatrist, Mount Sinai Hospital, Toronto, Ontario; Associate Professor, Equity, Gender and Populations Division, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Kwame McKenzie
- CEO, Wellesley Institute, Toronto, Ontario; Professor of Psychiatry, University of Toronto, Toronto, Ontario; Director, Department of Health Equity, Centre for Addiction and Mental Health, Toronto, Ontario
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Xavier SM, Jarvis GE, Ouellet-Plamondon C, Gagné G, Abdel-Baki A, Iyer SN. Comment les services d’intervention précoce pour la psychose peuvent-ils mieux servir les migrants, les minorités ethniques et les populations autochtones ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088188ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yrttiaho S, Bruwer B, Zar HJ, Donald KA, Malcolm-Smith S, Ginton L, Hoffman N, Vuong E, Niehaus D, Leppänen JM, Stein DJ. Pupillary and Attentional Responses to Infant Facial Expressions in Mothers Across Socioeconomic Variations. Child Dev 2020; 92:e236-e251. [PMID: 33369736 DOI: 10.1111/cdev.13503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Maternal responses to infant facial expressions were examined in two socioeconomically diverse samples of South African mothers (Study I, N = 111; and Study II, N = 214; age: 17-44 years) using pupil and gaze tracking. Study I showed increased pupil response to infant distress expressions in groups recruited from private as compared to public maternity clinics, possibly reflecting underlying differences in socioeconomic status (SES) across the groups. Study II, sampling uniformly low-SES neighborhoods, found increased pupil dilation and faster orientation to expressions of infant distress, but only in the highest income group. These results are consistent with maternal physiological and attentional sensitivity to infant distress cues but challenge the universality of this sensitivity across socioeconomic diversity.
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EPA guidance on cultural competence training. Eur Psychiatry 2020; 30:431-40. [DOI: 10.1016/j.eurpsy.2015.01.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/22/2022] Open
Abstract
AbstractThe stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value.
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Cruz I, Serna C, Rué M, Real J, Galván L, Pifarré J. Comparative exposure to antipsychotic medications in immigrant and native-born populations of a Spanish health region. Eur Psychiatry 2020; 27:477-82. [DOI: 10.1016/j.eurpsy.2011.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/01/2011] [Accepted: 02/05/2011] [Indexed: 10/18/2022] Open
Abstract
AbstractBackgroundRaised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences.ObjectiveTo compare exposure to antipsychotic medications in immigrant and native-born populations in Spain.MethodDescriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008.Results1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant.ConclusionsAll immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.
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Trinh NH, Tuchman S, Chen J, Chang T, Yeung A. Cultural Humility and the Practice of Consultation-Liaison Psychiatry. PSYCHOSOMATICS 2020; 61:313-320. [PMID: 32299622 DOI: 10.1016/j.psym.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cultural competency has long been the gold standard for clinicians who treat patients of different races and/or cultural backgrounds than their own. However, in recent years, there has been increasing criticism of the cultural competency framework because of its reliance on stereotypes and an overemphasis on knowledge acquisition. OBJECTIVE We review this transition, including the critiques of cultural competency. We highlight trends in psychiatrist diversity, education, and training on cultural humility, including how consultation-liaison psychiatrists can incorporate advances in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, regarding the role of culture in clinical diagnosis, treatment, and management. METHODS We review the transition from cultural competency to cultural humility, including the critiques of cultural competency. We highlight trends in psychiatrist diversity, education, and training on cultural humility. RESULTS We illustrate how consultation-liaison psychiatrists can incorporate advances in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, regarding the role of culture in clinical diagnosis, treatment, and management. CONCLUSIONS Cultural humility, which minimizes the power imbalance between clinicians and patients and emphasizes patient-focused interviewing and care, is a useful approach for consultation-liaison psychiatrists working with diverse patients and with diverse multidisciplinary teams in the general hospital.
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Affiliation(s)
- Nhi-Ha Trinh
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Psychiatry, Harvard Medical School, Boston, MA.
| | - Sylvie Tuchman
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA
| | - Justin Chen
- Psychiatry, Harvard Medical School, Boston, MA; Ambulatory Psychiatry Services, Massachusetts General Hospital, Boston, MA
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA
| | - Albert Yeung
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Psychiatry, Harvard Medical School, Boston, MA
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Cultural Humility for Consultation-Liaison Psychiatrists. PSYCHOSOMATICS 2018; 59:554-560. [PMID: 30274799 DOI: 10.1016/j.psym.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Case presentation and analysis is a useful way to revisit key clinical themes, broad concepts, and teach others, especially when it comes to cross-cultural clinical issues. Patients from different cultural backgrounds tend to have different explanatory models of illnesses and related help seeking behaviors. Ineffective communication between clinicians and patients from nonmajority cultural groups may lead to less satisfaction with care and disparities in access to health care and in treatment outcomes. CONCLUSIONS To address health disparities, psychiatrists need to be able to understand the illness beliefs of all patients, particularly those from diverse cultural backgrounds. Using cultural humility to work with patients from all cultures by understanding the patients' values and preferences is a key attitude for successful cross-cultural clinical encounters.
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Affiliation(s)
- Winny Ang
- University of Antwerp, Faculty of Medicine and Health Sciences Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk (Antwerp), Belgium
- Child and Adolescent Psychiatry Consultation Service 't_verhaal, Cuylitsstraat 99, 2018, Antwerp, Belgium
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Dauvrin M, Lorant V. Leadership and cultural competence of healthcare professionals: a social network analysis. Nurs Res 2015; 64:200-10. [PMID: 25871625 PMCID: PMC4418777 DOI: 10.1097/nnr.0000000000000092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND International migration is a global phenomenon challenging healthcare professionals to provide culturally competent care. OBJECTIVES The purpose of this study was to investigate the influence of leaders on the cultural competence of healthcare professionals. METHODS A cross-sectional survey was conducted from 2010 to 2012 to obtain data for a social network analysis in 19 inpatient services and five primary care services in Belgium. The Competences in Ethnicity and Health questionnaire was used. A total of 507 healthcare professionals, including 302 nurses, identified their social relationships with other healthcare professionals working in their service. Highest in-degree centrality was used to identify the leaders within each health service. Multiple regressions with the Huber sandwich estimator were used to link cultural competence of leaders with the cultural competence of the rest of the healthcare staff. RESULTS Cultural competence of the healthcare staff was associated with the cultural competence of the leaders. This association remained significant for two specific domains of cultural competence-mediation and paradigm-after controlling for contextual and sociodemographic variables. Interaction analysis suggested that the leadership effect varied with the degree of cultural competence of the leaders. DISCUSSION Cultural competence among healthcare professionals is acquired partly through leadership. Social relationships and leadership effects within health services should be considered when developing and implementing culturally competent strategies. This requires a cautious approach as the most central individuals are not always the same persons as the formal leaders.
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Affiliation(s)
- Marie Dauvrin
- Marie Dauvrin, RN, MPH, PhD, is Postdoctoral Researcher, Fonds de la Recherche Scientifique-FNRS, Prospective Research for Brussels (INNOVIRIS) and Institute of Health and Society IRSS, Université catholique de Louvain, Belgium. Vincent Lorant, PhD, is Professor, Institute of Health Society IRSS, Université catholique de Louvain, Belgium
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Bhugra D, Gupta S, Schouler-Ocak M, Graeff-Calliess I, Deakin N, Qureshi A, Dales J, Moussaoui D, Kastrup M, Tarricone I, Till A, Bassi M, Carta M. EPA Guidance Mental Health Care of Migrants. Eur Psychiatry 2014; 29:107-15. [DOI: 10.1016/j.eurpsy.2014.01.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractMigration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.
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Bennett J. Training mental health professionals in cultural capability: sustainability of knowledge and skills. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/17542863.2011.636946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bäärnhielm S, Mösko M. Cross-cultural training in mental health care--challenges and experiences from Sweden and Germany. Eur Psychiatry 2013; 27 Suppl 2:S70-5. [PMID: 22863254 DOI: 10.1016/s0924-9338(12)75711-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Globalization and cultural diversity challenge mental health care in Europe. Sensitivity to culture in mental health care benefits effective delivery of care to the individual patient and can be a contribution to the larger project of building a tolerant multicultural society. Pivotal for improving cultural sensitivity in mental health care is knowledge in cross-cultural psychiatry, psychology, nursing and related fields among professionals and accordingly training of students and mental health professionals. This paper will give an overview, and a critical examination, of current conceptualisation of cross-cultural mental health training. From German and Swedish experiences the need for crosscultural training and clinical research on evaluation will be presented.
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Affiliation(s)
- S Bäärnhielm
- Transcultural Centre, Stockholm County Council & Karolinska Institutet.
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Dinh NM, Groleau D, Kirmayer LJ, Rodriguez C, Bibeau G. Influence of the DSM‐IV Outline for Cultural Formulation on multidisciplinary case conferences in mental health. Anthropol Med 2012; 19:261-76. [DOI: 10.1080/13648470.2011.646944] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nathalie M.H. Dinh
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Danielle Groleau
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Laurence J. Kirmayer
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Charo Rodriguez
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
| | - Gilles Bibeau
- a St-Mary's Hospital Center , McGill University-affiliated Hospital, 3830, Lacombe Avenue , Montreal, Quebec , Canada H3T 1M5
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Mösko MO, Baschin K, Längst G, von Lersner U. Interkulturelle Trainings für die psychosoziale Versorgung. PSYCHOTHERAPEUT 2012. [DOI: 10.1007/s00278-011-0878-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Limited English proficient Asian Americans: Threshold language policy and access to mental health treatment. Soc Sci Med 2010; 72:230-7. [PMID: 21144636 DOI: 10.1016/j.socscimed.2010.10.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/02/2010] [Accepted: 10/18/2010] [Indexed: 11/21/2022]
Abstract
The importance of providing timely, effective mental health services is increasingly recognized worldwide, and language barriers are a formidable obstacle to achieving this objective. Threshold language policy is one response implemented by California and other states within the U.S., in accordance with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, and national origin in programs receiving federal funding. This policy mandates language assistance services for Medicaid enrollees whose primary language is other than English once their population size reaches a designated level. Medicaid is the federal-state-funded health insurance program for specific classifications of low-income Americans. This study evaluated the impact of threshold language policy on Vietnamese, Cantonese, Hmong, and Cambodian limited English proficiency persons' use of public mental health services in California. Using random-effects regression on 247 observations, we regressed aggregate Vietnamese, Cantonese, Hmong, and Cambodian Medicaid mental health service penetration rates on an indicator of the threshold language policy's implementation, while controlling for a linear time trend and the effects of non-threshold language assistance programming. Immediately after implementation, threshold language policy requirements were associated with a penetration rate increase among this population. The penetration rate increase became greater after accounting for the impact of concurrent language assistance. However, this increase diminished over time. The findings indicate that, at least in the short run, language assistance measures requiring reasonable accommodations once populations of LEP persons reach a specified size have detectable effects on their mental health service use. These requirements increase the number of mental health consumers, but appear to provide declining benefit over time. California's threshold language policy provides one example of how public or national health systems worldwide may attempt to address the issue of equity of mental health service access for burgeoning immigrant/migrant populations with language assistance needs.
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Berg JE. The level of non-Western immigrants' use of acute psychiatric care compared with ethnic Norwegians over an 8-year period. Nord J Psychiatry 2009; 63:217-22. [PMID: 19034713 DOI: 10.1080/08039480802571010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Immigrants are assumed by many to have more mental health problems than the population in the countries they have emigrated to, and clinicians have the impression that an increasing number of non-Western immigrants are referred to acute psychiatric care. Patients referred over an 8-year period to an acute care facility, responsible for a catchment area of close to 100,000 inhabitants in Oslo, Norway, were scrutinized to study the latter assumption. In total 792 men and 701 women (47.0%) were referred. There were 168 men and 59 women among the non-Western immigrants, i.e. 26.0% of the non-Western immigrants were women, whereas 50.2% or 611 out of 1217 ethnic Norwegians were women. Non-Western immigrants were referred twice as often in 2007, n=40, as in 2000, n=19. Non-Western immigrants as a percentage of the other referred patients increased from 15.2% to 16.0% in 2006, which was lower than the representation in the general population. Mean age was lower for non-Western immigrants, 34.6 (standard deviation, s=14.7) than for ethnic Norwegians 39.5 (s=11.6). Mean length of stay was lower for ethnic Norwegians. If the prevalence of mental disorders is the same or higher in immigrants than in the original population, this study indicates that they are under-represented among referred patients from the catchment area population. This seems to be the case especially for women.
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Affiliation(s)
- John E Berg
- Department of Acute Psychiatry, Lovisenberg Diakonal Hospital, Oslo, Norway.
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