1
|
Gwata D, Ventriglio A, Hughes P, Deahl M. Structural inequalities, knife crime: A qualitative study. Int J Soc Psychiatry 2024; 70:667-678. [PMID: 38557268 DOI: 10.1177/00207640231221092] [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: 04/04/2024]
Abstract
The importance and impact of youth violence is increasingly being recognised and is a cause of international concern. In the UK, youth violence, specifically knife crime, is on the increase and has resulted in the deaths of many young people. In order to explore the impact of knife crimes on mental health and wellbeing of individuals, a number of focus groups were conducted with 24 professionals from multiple agencies. Qualitative analysis showed various emerging themes, which included ineffective mental health systems, structural violence and inequalities, policing, safety and community engagement, vulnerability and resilience in minority communities. Equity in mental health services, further development and roll-out of public mental health approaches and training accompanied by sufficient resources is needed.
Collapse
Affiliation(s)
| | | | | | - Martin Deahl
- Institute of Psychiatry, Kings College, London, UK
| |
Collapse
|
2
|
Ruiz-Cosignani D, Chen Y, Cheung G, Lawrence M, Lyndon MP, Ma’u E, Ramalho R. Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review. J Telemed Telecare 2024; 30:466-474. [PMID: 34989643 PMCID: PMC10928963 DOI: 10.1177/1357633x211069664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/08/2021] [Indexed: 01/18/2023]
Abstract
Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users' socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.
Collapse
Affiliation(s)
- Daniela Ruiz-Cosignani
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark Lawrence
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mataroria P Lyndon
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Etuini Ma’u
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Rodrigo Ramalho
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Perry A, Gardener C, Shieh J, Hồ QT, Doan A, Bhui K. Investigating the acceptability of a culturally adapted acceptance and commitment therapy group for UK Vietnamese communities: A practice-based feasibility study. Transcult Psychiatry 2024:13634615241228071. [PMID: 38529626 DOI: 10.1177/13634615241228071] [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] [Indexed: 03/27/2024]
Abstract
Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy that offers promise for the mental health of minoritised ethnic populations. Given the diversity of those presenting to inner-city services and barriers to accessing appropriate mental healthcare, we sought to develop a culturally syntonic ACT intervention for UK Vietnamese refugee communities in a practice-based partnership project between a National Health Service and local third-sector service in East London. The aim was to explore the feasibility, acceptability and impact of the adapted intervention to inform culturally inclusive clinical practice and future research. We outline key aspects of Vietnamese belief systems and culture, and consider how these might influence the optimisation of group-based ACT. We then present a mixed-method evaluation of the seven-session adapted ACT group for 11 participants (9 male and 5 female, aged between 44 and 73 years). Individual-level change analyses indicated clinically significant improvements in psychological flexibility for the minority of participants and a mixed pattern for impact on well-being. A thematic analysis and descriptive approach examined acceptability, feasibility and narratives of impact. Participants reported positive feedback on group experience, relevance and usefulness, and emergent themes indicate that the group facilitated key acceptance, commitment and behaviour-change processes, promoted social connections and increased engagement in meaningful life activities in relation to new perspectives and values-based action. Limitations are outlined, but overall, findings suggest preliminary support for the potential beneficial effect of the adapted ACT group as a feasible, culturally acceptable therapeutic approach for UK Vietnamese communities that is worthy of further investigation.
Collapse
Affiliation(s)
| | | | | | | | | | - Kamaldeep Bhui
- East London NHS Foundation Trust
- University of Oxford
- World Psychiatric Association Collaborating Centre (Research, Training, Policy) Oxford
| |
Collapse
|
4
|
Jarvis GE, Kirmayer LJ. Global migration: Moral, political and mental health challenges. Transcult Psychiatry 2023; 60:5-12. [PMID: 36919356 DOI: 10.1177/13634615231162282] [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] [Indexed: 03/16/2023]
Abstract
Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples' lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The papers collected in this thematic issue of Transcultural Psychiatry explore the experience of migration and highlight some of the challenges that governments and healthcare services need to address to facilitate the social integration and mental health of migrants. Clinicians need training and resources to work effectively with migrants, focusing on their resilience and on long-term adaptive processes. Efforts to counter the systemic discrimination and structural violence that migrants often face need to be broad-based, unified, and persistent to make meaningful change. When migrants are free to realize their talents and aspirations, they can help build local communities and societies that value diversity.
Collapse
Affiliation(s)
- G Eric Jarvis
- Division of Social & Transcultural Psychiatry, McGill University.,Culture and Mental Health Research Unit, Institute for Community & Family Psychiatry. Jewish General Hospital, Montreal
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University.,Culture and Mental Health Research Unit, Institute for Community & Family Psychiatry. Jewish General Hospital, Montreal
| |
Collapse
|
5
|
Can Translational Social Neuroscience Research Offer Insights to Mitigate Structural Racism in the United States? BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1258-1267. [PMID: 35609781 DOI: 10.1016/j.bpsc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/15/2022] [Accepted: 05/05/2022] [Indexed: 12/16/2022]
Abstract
Social isolation and conflict due to structural racism may result in human suffering and loneliness across the life span. Given the rising prevalence of these problems in the United States, combined with disruptions experienced during the COVID-19 pandemic, the neurobiology of affiliative behaviors may offer practical solutions to the pressing challenges associated with structural racism. Controlled experiments across species demonstrate that social connections are critical to survival, although strengthening individual resilience is insufficient to address the magnitude and impact of structural racism. In contrast, the multilevel construct of social resilience, defined by the power of groups to cultivate, engage in, and sustain positive relationships that endure and recuperate from social adversities, offers unique insights that may have greater impact, reach, and durability than individual-level interventions. Here, we review putative social resilience-enhancing interventions and, when available, their biological mediators, with the hope to stimulate discovery of novel approaches to mitigate structural racism. We first explore the social neuroscience principles underlying psychotherapy and other psychiatric interventions. Then, we explore translational efforts across species to tailor treatments that increase social resilience, with context and cultural sensitivity in mind. Finally, we conclude with some practical future directions for understudied areas that may be essential for progress in biological psychiatry, including ethical ways to increase representation in research and developing social paradigms that inform dynamics toward or away from socially resilient outcomes.
Collapse
|
6
|
Fortuna LR. Editorial: Disparities in Access to Child Psychiatric Services: Can We Shift the Landscape? J Am Acad Child Adolesc Psychiatry 2022; 61:862-863. [PMID: 35065189 DOI: 10.1016/j.jaac.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
A National Academy of Medicine report published in 1993 defined disparities in health care as "a difference in access or treatment provided to members of different racial or ethnic groups that is not justified by the underlying health conditions or treatment preferences of the groups."1 Disparities in access to and quality of mental health services have persisted for racially minoritized children and for many rural communities in the United States. The global pandemic has taken an enormous toll on the mental health and well-being of youth and their families and has exacerbated preexisting needs.2 The rapid expansion of telehealth capacity, providing services via text, telephone, or video, has provided access to a spectrum of services for individuals and expert consultation for partners in low-resource communities. Telehealth has demonstrated effectiveness for lowering the barriers to seeking treatment in rural communities for youth with suicidality, depression, and anxiety.3 However, disenfranchised, low-income populations lacking sufficient in-person care or internet broadband to support telepsychiatry services or who encounter other barriers, such as underinsurance or no insurance and limited cultural and linguistic matched services, continue to have poor access to care and are at risk for disparate outcomes.4 In the midst of a pandemic and an accelerated child and adolescent mental health emergency in the United States, disparities in access to services presents a crisis within a crisis. Is the services landscape shifting to address the need?
Collapse
|
7
|
Shepherd SM. Can a Connection to Culture Reduce Mental Illness Symptoms and Risk for Future Violence? AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stephane M. Shepherd
- Centre for Forensic Behavioural Science, Victorian Institute of Forensic Mental Health, Swinburne University of Technology, and
- National Centre for Cultural Competence, University of Sydney
| |
Collapse
|
8
|
Hussen SA, Kuppalli K, Castillo-Mancilla J, Bedimo R, Fadul N, Ofotokun I. Cultural Competence and Humility in Infectious Diseases Clinical Practice and Research. J Infect Dis 2020; 222:S535-S542. [PMID: 32926742 PMCID: PMC7489471 DOI: 10.1093/infdis/jiaa227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Infectious diseases as a specialty is tilted toward social justice, and practitioners are frequently on the front lines of the battle against health inequity in practices that are diverse and sometimes cross international borders. Whether caring for patients living with the human immunodeficiency virus, tuberculosis, or Ebola, infectious diseases practitioners often interact with those at the margins of societies (eg, racial/ethnic/sexual/gender minorities), who disproportionately bear the brunt of these conditions. Therefore, cultural barriers between providers and patients are often salient in the infectious diseases context. In this article, we discuss cultural competence broadly, to include not only the knowledge and the skills needed at both the organizational and the individual levels to provide culturally appropriate care, but also to include "cultural humility"-a lifelong process of learning, self-reflection, and self-critique. To enhance the quality and the impact of our practices, we must prioritize cultural competence and humility and be mindful of the role of culture in the patient-provider-system interactions, in our larger healthcare systems, and in our research agendas and workforce development.
Collapse
Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Healthcare System, Atlanta, Georgia, USA
| | - Krutika Kuppalli
- Division of Infectious Diseases and Geographic Medicine, Center for Innovation in Global Health, Stanford University School of Medicine, Stanford, California, USA
| | - José Castillo-Mancilla
- Division of Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Roger Bedimo
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center and Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Nada Fadul
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska School of Medicine, Omaha, Nebraska, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Healthcare System, Atlanta, Georgia, USA
| |
Collapse
|
9
|
Robertson J, Raghavan R, Emerson E, Baines S, Hatton C. What do we know about the health and health care of people with intellectual disabilities from minority ethnic groups in the United Kingdom? A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1310-1334. [DOI: 10.1111/jar.12630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
| | - Raghu Raghavan
- Faculty of Health and Life Sciences, Mary Seacole Research Centre De Montfort University Leicester UK
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
- Centre for Disability Research and Policy University of Sydney Sydney New South Wales Australia
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
| |
Collapse
|
10
|
Abstract
The concept of insight is used to indicate the propensity of patients with schizophrenia and other severe mental disorders to recognize their illness and engage in treatment. Thus, insight may have notable consequences for the ill individual: Those who lack insight are at higher risk of nonadherence to treatments, negative clinical outcomes, and worse community functioning. Although insight is an intuitive concept, its essence remains difficult to capture. However, many rating scales are available to aid assessment, both for clinical and research purposes. Insight cannot be reduced to a symptom, a psychological mechanism, or a neuropsychological function. It is likely to have dynamic relationships with all these dimensions and with responses to personal events and contextual factors. In particular, social consequences of mental illness and explanatory models that are alternative to the medical model may fundamentally shape insight and treatment choice. Moreover, the cultural or individual stigmatization of mental illness may turn the acquisition of insight into a painful event and increase the risk of depression. Clinicians need to carefully evaluate and promote insight through a personalized approach to aid patient process of care and personal growth.
Collapse
Affiliation(s)
- Martino Belvederi Murri
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mario Amore
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
11
|
Exploring the cultural flexibility of the ACT model as an effective therapeutic group intervention for Turkish speaking communities in East London. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x18000041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractThis study describes a successful community-based partnership project between statutory and third-sector services in East London; The City and Hackney Black and Minority Ethnic (BME) Access Service [East London NHS Foundation Trust (ELFT)] collaborated with Derman, a local community organization supporting the well-being of Turkish-speaking communities, to explore the cultural adaptability of an empirically supported, third-wave cognitive behavioural intervention, Acceptance and Commitment Therapy (ACT). The aim was to develop a culturally acceptable group that was responsive to the therapeutic needs of participants from Turkish-speaking communities. The study implemented a mixed-method analysis with a one group pre/post-test design to examine the effectiveness of a 7-session culturally adapted ACT group intervention and a descriptive approach was implemented to assess usefulness, relevance and acceptability. Results demonstrated an overall positive effect of the culturally adapted ACT intervention in terms of both symptoms and patient-reported outcomes. Participants showed significant improvements on measures of depression (p = 0.014), anxiety (p = 0.041) and psychological distress (p = 0.003). The magnitude of these changes was categorized as large, with effect sizes from 0.90 to 2.03. Qualitative responses indicated that the group was experienced as enjoyable and useful and was considered to be an accessible and acceptable therapeutic format. Although a pilot within clinical practice, the findings provide preliminary support for the clinical utility of ACT as an effective, culturally acceptable therapeutic approach for Turkish-speaking communities living in an urban UK setting. The study highlights the importance of culturally appropriate service development and a need for further research within this area.
Collapse
|
12
|
Perry A, Gardener C, Dove J, Eiger Y, Loewenthal K. Improving mental health knowledge of the Charedi Orthodox Jewish Community in North London: A partnership project. Int J Soc Psychiatry 2018; 64:235-247. [PMID: 29460690 DOI: 10.1177/0020764018756935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This article describes a successful community-based partnership project between statutory and third-sector services targeting the strictly Orthodox Jewish community (OJC). METHODS The City and Hackney Black and Minority Ethnic (BME) Access Service (East London NHS Foundation Trust (ELFT)) collaborated with Bikur Cholim, a local third-sector organisation based in the heart of a north London Charedi OJC, to develop a brief culturally tailored psychoeducational group intervention focusing on mental health promotion and prevention. In total, 34 carers in the Charedi OJC were provided with general information on mental health, the availability of support services and self-care. RESULTS Overall improvements in well-being, increased intentions to access services, particularly talking therapies, and qualitative feedback indicated that the group was very well received. CONCLUSION The project endorses the value of culturally relevant psychoeducation, enabling suggestions for culturally appropriate service development.
Collapse
Affiliation(s)
| | | | - Jonathan Dove
- 1 East London NHS Foundation Trust, London, UK.,3 Bikur Cholim, London, UK
| | | | | |
Collapse
|
13
|
Fu LY, Zimet GD, Latkin CA, Joseph JG. Associations of trust and healthcare provider advice with HPV vaccine acceptance among African American parents. Vaccine 2017; 35:802-807. [PMID: 28063706 DOI: 10.1016/j.vaccine.2016.12.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Healthcare providers (HCPs) are advised to give all parents a strong recommendation for HPV vaccination. However, it is possible that strong recommendations could be less effective at promoting vaccination among African Americans who on average have greater mistrust in the healthcare system. This study examines the associations of parental trust in HCPs and strength of HCP vaccination recommendation on HPV vaccine acceptance among African American parents. METHODS Participants were recruited from an urban, academic medical center between July 2012 and July 2014. We surveyed 400 African American parents of children ages 10-12years who were offered HPV vaccine by their HCPs to assess sociodemographic factors, vaccine beliefs, trust in HCPs, and the HPV vaccine recommendation received. Medical records were reviewed to determine vaccination receipt. RESULTS In multivariable analysis, children whose parents were "very strongly" recommended the HPV vaccine had over four times higher odds of vaccine receipt compared with those whose parents were "not very strongly" recommended the vaccine. Having a parent with "a lot of" versus "none" or only "some" trust in HCPs was associated with over twice the odds of receiving HPV vaccine. Very strong HCP recommendations were associated with higher odds of vaccination among all subgroups, including those with more negative baseline attitudes toward HPV vaccine and those with lower levels of trust. Adding the variables strength of HCP recommendation and parental trust in HCPs to a multivariable model already adjusted for sociodemographic factors and parental vaccine beliefs improved the pseudo R2 from 0.52 to 0.55. CONCLUSIONS Among participants, receiving a strong vaccine recommendation and having a higher level of trust in HCPs were associated with higher odds of HPV vaccination, but did not add much to the predictive value of a model that already adjusted for baseline personal beliefs and sociodemographic factors.
Collapse
Affiliation(s)
- Linda Y Fu
- General and Community Pediatrics, Children's National Health System, 111 Michigan Ave, NW, Washington, DC 20010, United States.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University, 410 W. 10th Street, HS 1001, Indianapolis, IN 46202, United States.
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, 7th Floor, Baltimore, MD 21205, United States.
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, CA, 4610 "X" Street, Sacramento, CA 95817, United States.
| |
Collapse
|