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Smith SM, Kheri A, Ariyo K, Gilbert S, Salla A, Lingiah T, Taylor C, Edge D. The Patient and Carer Race Equality Framework: a model to reduce mental health inequity in England and Wales. Front Psychiatry 2023; 14:1053502. [PMID: 37215650 PMCID: PMC10196047 DOI: 10.3389/fpsyt.2023.1053502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
The Patient and Carer Race Equality Framework (PCREF) is an Organisational Competence Framework (OCF), recommended by the Independent Review of the Mental Health Act as a means to improve mental health access, experience and outcomes for people from ethnic minority backgrounds, particularly Black people. This is a practical framework that should be co-produced with and tailored to the needs of service users, based on quality improvement and place-based approaches. We aim to use the PCREF to address the longstanding epistemic justices experienced by people with mental health problems, particularly those from minoritised ethnic groups. We will outline the work that led to the proposal, the research on racial inequalities in mental health in the UK, and how the PCREF will build on previous interventions to address these. By taking these into account, the PCREF should support a high minimum standard of mental health care for all.
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Affiliation(s)
- Shubulade Mary Smith
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Amna Kheri
- UCL Medical School, University College London, London, United Kingdom
| | - Kevin Ariyo
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Steve Gilbert
- Steve Gilbert Consulting, Birmingham, United Kingdom
| | - Anthony Salla
- Oxytocin Learning Community Interest Company, Oxfordshire, United Kingdom
| | - Tony Lingiah
- Kingston Hospital, Kingston upon Thames, United Kingdom
| | - Clare Taylor
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
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Musbahi A, Khan Z, Welsh P, Ghouri N, Durrani A. Understanding the stigma: a novel quantitative study comparing mental health attitudes and perceptions between young British Muslims and their non-Muslims peers. J Ment Health 2021; 31:92-98. [PMID: 34304663 DOI: 10.1080/09638237.2021.1952951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A significant proportion of young British Muslims identify themselves by religious identity rather than ethnicity however very few mental health studies have focused on this cohort. AIMS To explore whether young British Muslims' knowledge, awareness and perceptions of mental illness differ to their non-Muslim peers. METHOD Population based survey of second generation Muslims (n = 83) and non-Muslims (n = 76) aged 18-35. Anonymised 38-item questionnaire on mental health attitudes, perceptions and help seeking behaviours. RESULTS Muslims were less likely to correctly identify symptoms of mental illness compared to their non-Muslim peers. Stigma and awareness remains a major issue. A third of Muslims would consider stopping medication on advice of a religious leader. Nearly half of Muslims were more likely to attend a dedicated ethnic/religious mental health service. CONCLUSIONS British Muslim views and attitudes of mental health differ from their non-Muslim counterparts. Services should ensure they are religiously sensitive.
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Affiliation(s)
- Aya Musbahi
- South Tees NHS Trust, James Cook Hospital, Middlesbrough, UK
| | - Zainib Khan
- Greater Manchester Mental Health Foundation Trust, Manchester, UK
| | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nazim Ghouri
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Prajapati R, Liebling H. Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK. J Racial Ethn Health Disparities 2021; 9:598-619. [PMID: 33686621 PMCID: PMC8897382 DOI: 10.1007/s40615-021-00993-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/13/2022]
Abstract
Background Despite calls to address ethnic inequalities to accessing mental health services in the UK, governmental initiatives have had limited impact. Studies indicate that South Asian communities underutilise mental health services. Previous reviews have identified cultural and institutional factors that may influence service use, but these are mostly narrative and limited in their scope. Method A systematic literature search resulted in fifteen studies exploring the experiences of seeking help and barriers to accessing and using services from the perspective of British South Asian service users. Findings Qualitative data was synthesised through meta-ethnography, and three themes emerged: Distanced from Services, Dilemma of Trust and Threat to Cultural Identity. South Asian service users were positioned at a distance from being able to access services and stuck in a dilemma of mistrusting White and Asian professionals. They constructed their cultural identity through a set of important values which were neglected by mental health services. Service users, therefore, appeared to engage in an ongoing evaluation of the potential benefits of accessing services against the risks of threat to their personal and cultural identities. The findings are discussed in relation to Eurocentric models of care and community engagement approaches. Conclusion The review argues that institutional racism and cultural dissonance marginalise South Asian service users from access to quality and effective mental healthcare. It is recommended that services acknowledge the impact of alienation and powerlessness and advance their practices to establish trust and cultural safety for South Asian service users in the UK.
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Affiliation(s)
- Riddhi Prajapati
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB UK
| | - Helen Liebling
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB UK
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Grau L, Carretier E, Moro MR, Revah-Levy A, Sibeoni J, Lachal J. A qualitative exploration of what works for migrant adolescents in transcultural psychotherapy: perceptions of adolescents, their parents, and their therapists. BMC Psychiatry 2020; 20:564. [PMID: 33243219 PMCID: PMC7690022 DOI: 10.1186/s12888-020-02970-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Migrant adolescents are at a higher risk than their native-born counterparts of psychiatric disorders, and their care is a public health issue. In France, transcultural psychotherapy is a treatment provided by a group of therapists designed to meet the specific needs of these patients when usual care appears ineffective. The objective of this study was to explore the therapeutic elements at work in transcultural psychotherapy. METHODS We conducted a qualitative study crossing the perspectives of adolescents receiving transcultural psychotherapy, their parents, their first-line therapist (FLT), and the transcultural therapists. The families were chosen by purposive sampling. Data were collected during semi-structured individual (for FLTs) and group (families and transcultural therapists) interviews that explored the therapeutic elements involved and effective in transcultural psychotherapy. We used interpretative phenomenological analysis (IPA) to examine the data. In all, 44 participants were questioned: three adolescents (2 girls and 1 boy, all aged 18 to 21 years) and their parents (3 mothers and 1 father), three FLTs (2 child psychiatrists and 1 psychologist), and the 34 therapists participating in the three transcultural psychotherapy groups. RESULTS The analysis uncovered three themes: (1) the perceived effectiveness of the group's functioning; (2) the recounting of the individual, family, and cultural history to allow for complexity and nuance; and (3) the personal investment by therapists, made possible by the group. CONCLUSIONS Our results show some therapeutic elements at work in transcultural psychotherapy that enable it to meet the particular needs of some migrant adolescents that are unmet in standard therapy. Continuing to study transcultural psychotherapy and assess its effectiveness is essential for promoting and optimizing psychiatric care for migrant adolescents.
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Affiliation(s)
- Léa Grau
- UFR des Lettres, des Sciences de l'Homme et des Sociétés Unité Transversale de Recherche Psychogenèse et Psychopathologie, UTRPP EA4403, Univ. Paris 13, F-93430, Villetaneuse, France
| | - Emilie Carretier
- UFR des Lettres, des Sciences de l'Homme et des Sociétés Unité Transversale de Recherche Psychogenèse et Psychopathologie, UTRPP EA4403, Univ. Paris 13, F-93430, Villetaneuse, France
- AP-HP, Hôpital Cochin, Maison de Solenn, 97 Boulevard de Port Royal, 75014, Paris, France
| | - Marie-Rose Moro
- AP-HP, Hôpital Cochin, Maison de Solenn, 97 Boulevard de Port Royal, 75014, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, F-94807, Villejuif, France
- Université de Paris, PCPP, F-92100, Boulogne-Billancourt, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, F95100, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, F95100, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Jonathan Lachal
- AP-HP, Hôpital Cochin, Maison de Solenn, 97 Boulevard de Port Royal, 75014, Paris, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, F-94807, Villejuif, France.
- Université de Paris, PCPP, F-92100, Boulogne-Billancourt, France.
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Carballeira Carrera L, Lévesque-Daniel S, Radjack R, Moro MR, Lachal J. Clinical Approaches to Cultural Diversity in Mental Health Care and Specificities of French Transcultural Consultations: A Scoping Review. Front Psychiatry 2020; 11:579147. [PMID: 33192718 PMCID: PMC7652727 DOI: 10.3389/fpsyt.2020.579147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cultural context substantially affects the experience and clinical expression of psychiatric diseases, while cultural factors limit both access to and effectiveness of care, especially for migrant families requiring specific types of services. We conducted a scoping review on psychiatric services adapted to cultural diversity, to compare these models of care to the French Transcultural Psychotherapy model. Methods: Systematic electronic search of databases (PubMed and PsycINFO), manual search of archives of journals dealing with transcultural psychiatry, and consultations with international experts, to identify all papers describing clinical models devoted to psychiatric care for migrants, published between January 1990 and October 2018. Narrative synthesis of the included articles. Results: The study included 29 papers. The specificities of psychiatric services for migrant families are linked to the host country's migration patterns and citizenship model. In English-speaking countries, specialized services for ethnic minorities offer ethnic matching of the therapist and patient. In Canada, indirect transcultural consultation services have existed since the late 1990s. Australia emphasizes the networking of consultation services and professional training in cultural competence, while the Nordic countries (Sweden, Finland, Norway, and Denmark) focus management on trauma. In France, psychotherapy services, with flexible numbers of therapists involved according to the situation, have existed since 1990. Discussion: Most initiatives place emphasis on training and supervision, in an indirect approach not specifically focused on the patient, or offer cultural matching of patient and therapist. The French transcultural approach, on the contrary, makes the family's culture and its cultural diversity an integral part of the therapy process.
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Affiliation(s)
- Laura Carballeira Carrera
- Alicia Koplowitz Short-Term Fellowship, Madrid, Spain
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
| | - Sarah Lévesque-Daniel
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Centre integré universitaire de santé et de services sociaux de l'Est-de-l'île-de-Montréal (CIUSSS) du Nord-de-l'Île-de-Montréal, Université de Montréal, Montréal, QC, Canada
| | - Rahmeth Radjack
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Jonathan Lachal
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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Carretier E, Grau L, Mansouri M, Moro MR, Lachal J. Qualitative assessment of transcultural psychotherapy by adolescents and their migrant families: Subjective experience and perceived effectiveness. PLoS One 2020; 15:e0237113. [PMID: 32760157 PMCID: PMC7410290 DOI: 10.1371/journal.pone.0237113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/20/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Adolescent migrants present psychological disorders more frequently than the corresponding host population but their access to care and to follow-up are less effective. The French method of transcultural psychotherapy (TPT) was conceived to respond to these problems. Our objective is to assess how these adolescents and their families perceive the experience and effectiveness of TPT. METHOD We conducted semistructured interviews with the families of adolescents seen for TPT. The data were analyzed by a qualitative thematic methodology. RESULTS We spoke to 21 participants in 8 families. The families came to TPT with a sense that the teen's current treatment was at an impasse. During the follow-up, they noted that family communication and relationships had improved, as had their connection to their culture of origin. Besides commenting on what they perceived as limitations, families identified specific elements of TPT as therapeutic. CONCLUSION The pronounced diversity of the group and the use of both multiperspective narration and an interpreter were specific elements driving the construction of a good therapeutic alliance, despite the initial barriers. Pursuit of the evaluation of TPT is essential to advance the psychiatric care of adolescent migrants.
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Affiliation(s)
- Emilie Carretier
- Maison de Solenn, Cochin Hospital, Paris, France
- Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Team DevPsy, Paris-Saclay University, Villejuif, France
| | - Léa Grau
- Unité Transversale de Recherche Psychogenèse et Psychopathologie, Paris 13 University, Villetaneuse, France
| | | | - Marie Rose Moro
- Maison de Solenn, Cochin Hospital, Paris, France
- Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Team DevPsy, Paris-Saclay University, Villejuif, France
| | - Jonathan Lachal
- Maison de Solenn, Cochin Hospital, Paris, France
- Inserm, Centre de Recherche en Epidémiologie et Santé des Populations, Team DevPsy, Paris-Saclay University, Villejuif, France
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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Ocloo J, Matthews R. From tokenism to empowerment: progressing patient and public involvement in healthcare improvement. BMJ Qual Saf 2016; 25:626-32. [PMID: 26993640 PMCID: PMC4975844 DOI: 10.1136/bmjqs-2015-004839] [Citation(s) in RCA: 492] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/29/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND There have been repeated calls to better involve patients and the public and to place them at the centre of healthcare. Serious clinical and service failings in the UK and internationally increase the urgency and importance of addressing this problem. Despite this supportive policy context, progress to achieve greater involvement is patchy and slow and often concentrated at the lowest levels of involvement. METHODS A selective narrative literature search was guided by the authors' broad expertise, covering a range of disciplines across health and social care, policy and research. Published systematic literature reviews were used to identify relevant authors and publications. Google and hand searches of journal articles and reference lists and reports augmented identification of recent evidence. RESULTS Patients and the wider public can be involved at most stages of healthcare, and this can have a number of benefits. Uncertainty persists about why and how to do involvement well and evaluate its impact, how to involve and support a diversity of individuals, and in ways that allow them to work in partnership to genuinely influence decision-making. This exposes patient and public involvement (PPI) to criticisms of exclusivity and tokenism. CONCLUSIONS Current models of PPI are too narrow, and few organisations mention empowerment or address equality and diversity in their involvement strategies. These aspects of involvement should receive greater attention, as well as the adoption of models and frameworks that enable power and decision-making to be shared more equitably with patients and the public in designing, planning and co-producing healthcare.
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Affiliation(s)
- Josephine Ocloo
- Department of Surgery and Cancer, Faculty of Medicine, Centre for Patient Safety and Service Quality, Imperial College London, London, UK
| | - Rachel Matthews
- National Institute for Health Research (NIHR) Collaboration for Leadership and Applied Health Research and Care (CLAHRC) for Northwest London, Imperial College London, London, UK
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Abstract
AIMS This review will focus on the rates, clinical characteristics, risk factors and methods of self-harm and suicide in different ethnic groups in the United Kingdom, providing an update synthesis of recent literature. METHODS Studies that met the inclusion criteria between 2003 and 2013 were reviewed using the following databases: MEDLINE, PsycINFO, EMBASE and CINAHL. The methodological quality of each study was then assessed using a structured scoring system. RESULTS A total of 2,362 articles were retrieved, 10 of which matched the inclusion criteria were reviewed. Significant differences were found in the rates of self-harm between ethnic groups with Asian males being least likely to self-harm and Black females being most likely to self-harm. Also, Black and South Asian people were less likely to repeat self-harm. Factors that may help protect or predispose individuals to self-harm or attempt suicide (such as religion, mental health and coping styles) also differ between ethnic groups. CONCLUSIONS There are clear ethnic differences in self-harm and suicide, which may be affected by factors such as cultural pressures and prevalence of mental illness. An awareness of these differences is vital to help prevent further attempts of self-harm and suicide. Further research into differences between ethnic and cultural groups and self-harm continues to be important.
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Affiliation(s)
- Ali Al-Sharifi
- Department of Psychiatry, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Carl R Krynicki
- Department of Psychiatry, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Department of Psychiatry, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
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Kirmayer LJ, Rousseau C, Guzder J. Introduction: The Place of Culture in Mental Health Services. CULTURAL CONSULTATION 2014. [DOI: 10.1007/978-1-4614-7615-3_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Abstract
Cultural psychiatry research in the UK comprises a broad range of diverse methodologies, academic disciplines, and subject areas. Methodologies range from epidemiological to anthropological/ethnographic to health services research; mixed methods research is becoming increasingly popular, as are public health and health promotional topics. After briefly outlining the history of cultural psychiatry in the UK we will discuss contemporary research. Prominent themes include: the epidemiology of schizophrenia among Africans/Afro-Caribbeans, migration and mental health, racism and mental health, cultural identity, pathways to care, explanatory models of mental illness, cultural competence, and the subjective experiences of healthcare provision among specific ethnic groups such as Bangladeshis and Pakistanis. Another strand of research that is attracting increasing academic attention focuses upon the relationship between religion, spirituality, and mental health, in particular, the phenomenology of religious experience and its mental health ramifications, as well as recent work examining the complex links between theology and psychiatry. The paper ends by appraising the contributions of British cultural psychiatrists to the discipline of cultural psychiatry and suggesting promising areas for future research.
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Affiliation(s)
- Simon Dein
- University College London and University of Durham
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Corneau S, Stergiopoulos V. More than being against it: anti-racism and anti-oppression in mental health services. Transcult Psychiatry 2012; 49:261-82. [PMID: 22508637 DOI: 10.1177/1363461512441594] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anti-racism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services, and to help reduce their impact on mental health and clinical outcomes. This literature review summarizes how these two philosophies of practice are conceptualized and the strategies used within these frameworks as they are applied to service provision toward racialized groups. The strategies identified can be grouped in seven main categories: empowerment, education, alliance building, language, alternative healing strategies, advocacy, social justice/activism, and fostering reflexivity. Although anti-racism and anti-oppression frameworks have limitations, they may offer useful approaches to service delivery and would benefit from further study.
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Loewenthal D, Mohamed A, Mukhopadhyay S, Ganesh K, Thomas R. Reducing the barriers to accessing psychological therapies for Bengali, Urdu, Tamil and Somali communities in the UK: some implications for training, policy and practice. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2012. [DOI: 10.1080/03069885.2011.621519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Johansson Blight K, Ekblad S, Lindencrona F, Shahnavaz S. Promoting Mental Health and Preventing Mental Disorder among Refugees in Western Countries. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2009.9721780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kirmayer LJ, Bennegadi R. Les politiques de l'altérité dans la rencontre clinique. ACTA ACUST UNITED AC 2011. [DOI: 10.3917/lautr.034.0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Shahnavaz S, Ekblad S. Understanding the Culturally Diverse in Psychiatry Rather than Being Culturally Competent – a Preliminary Report of Swedish Psychiatric Teams' Views on Transcultural Competence. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2007. [DOI: 10.1108/17479894200700024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Dinesh Bhugra
- Section of Cultural Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF, UK.
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Bhui K, Warfa N, Edonya P, McKenzie K, Bhugra D. Cultural competence in mental health care: a review of model evaluations. BMC Health Serv Res 2007; 7:15. [PMID: 17266765 PMCID: PMC1800843 DOI: 10.1186/1472-6963-7-15] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 01/31/2007] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups. METHODS A systematic review that included evaluated models of professional education or service delivery. RESULTS Of 109 potential papers, only 9 included an evaluation of the model to improve the cultural competency practice and service delivery. All 9 studies were located in North America. Cultural competency included modification of clinical practice and organizational performance. Few studies published their teaching and learning methods. Only three studies used quantitative outcomes. One of these showed a change in attitudes and skills of staff following training. The cultural consultation model showed evidence of significant satisfaction by clinicians using the service. No studies investigated service user experiences and outcomes. CONCLUSION There is limited evidence on the effectiveness of cultural competency training and service delivery. Further work is required to evaluate improvement in service users' experiences and outcomes.
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Affiliation(s)
- Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London, Queen Mary's School of Medicine and Dentistry, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Nasir Warfa
- Centre for Psychiatry, Barts and The London, Queen Mary's School of Medicine and Dentistry, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Patricia Edonya
- Centre for Psychiatry, Barts and The London, Queen Mary's School of Medicine and Dentistry, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Kwame McKenzie
- Department of Mental Health Sciences, Royal Free & University College School of Medicine, University of London, UK
| | - Dinesh Bhugra
- Department of Cultural Psychiatry, Institute of Psychiatry, King's College, University of London, UK
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Bowl R. The need for change in UK mental health services: South Asian service users' views. ETHNICITY & HEALTH 2007; 12:1-19. [PMID: 17132582 DOI: 10.1080/13557850601002239] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES UK literature on mental health services for ethnic minority service users relies heavily on perceptions of professionals, carers and community representatives. This research investigates the views of South Asian service users themselves about experiences of mental health services and how they might be improved. DESIGN Thematic analysis of material from focus groups and individual interviews with Asian mental health service users within one local area. RESULTS South Asian service users clearly identify the impact of socio-economic exclusion upon their mental health. Cultural and institutional exclusion compound this, leading to continuing insensitivity towards their particular needs within hospital and community-based services. Asian service users feel unsafe to share their particular concerns within many service settings. They see advocacy that recognises their experience of exclusion as a significant resource for mental health improvement. They want sounder financing of culturally appropriate services for recovery; further development of the cultural competence of staff within mainstream services; and educational programmes about mental health directed at minority communities. CONCLUSION UK mental health services remain unresponsive to the consistently expressed views of South Asian service users. A major cultural change is required if the UK Government initiative Delivering Race Equality is to impact successfully at the local level. It will have a greater chance of success if the rhetoric of user involvement is matched by systematic consultation with South Asian service users.
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Affiliation(s)
- Ric Bowl
- Community Mental Health Programmes, Institute of Applied Social Studies, University of Birmingham, Edgbaston B15 2TT, UK.
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Ingleby D. Getting Multicultural Health Care off the Ground: Britain and The Netherlands Compared. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2006. [DOI: 10.1108/17479894200600023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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