Improving Access to Clinical and Community Resources for Multicultural Mental Health Care
This knowledge-to-action research project will address the challenge of responding to cultural diversity in mental health care. Newcomers (including immigrants and refugees) and members of some established ethnocultural groups tend to under-utilize mental health services and may receive inappropriate or ineffective care. Culturally based ways of understanding and dealing with mental health problems play a central role in determining the use of mental health resources as well as clinicians’ ability to provide effective treatment. Given the high levels of diversity in Canadian communities, it is not always possible to have sufficient local expertise in the form of bilingual, bicultural practitioners or culture brokers. This project will develop and evaluate a set of internet-based tools and networking strategies to facilitate multicultural mental health services. The objective is to make sound and relevant cultural information readily available to consumers, planners, and providers across Canada, including those in rural or remote settings, and to evaluate the use of these resources by end-users.
The project will draw from recent work by the Canadian Collaboration for Immigrant and Refugee Health that is developing evidence-based guidelines for the primary care treatment of common mental disorders in primary care including depression, PTSD and trauma-related disorders, anxiety and adjustment disorders, domestic violence and child maltreatment. The reviews have identified ‘best practices’, and potential tools that can facilitate the work of health planners, community organizations, and health professionals, as well as directly assisting consumers. There are three basic issues that need to be addressed to make this knowledge more useful: (i) how to organize and present the information to address the needs of specific categories of users; (ii) how to insure the information is continuously updated to reflect advances in knowledge and changes in the characteristics and needs of local communities; and (iii) how to make the information accessible at the sites where it is needed.
To address these issues, we propose to develop internet-based knowledge resources on cultural issues in mental health care. The use of the web will allow us to: create different portals that organize information in ways relevant to specific users (health planners, community organizers, clinicians, consumers) and make the resources immediately accessible through users’ desktop computers. A moderated wikipedia-like mechanism will allow the network of stakeholders to collaborate in ensuring that information is continually updated.
The resources will address the impact of cultural diversity in three areas: recognition and diagnosis of mental health problems; collaboration with community groups, organizations and institutions in treatment and recovery; and cultural adaptation and delivery of preventive and treatment services in primary care and other health care settings. The specific topics and format for these resources will be determined through consultation and collaboration with stakeholders but will likely include: information on common mental disorders in multiple languages; information on how to access and work with interpreters, culture brokers, and community resources; information on migration-related issues for immigrants, refugees and asylum seekers; information on cultural meanings of mental health and illness and cultural variations in symptoms pertinent to clinical diagnosis and interventions; culturally adapted guidelines for prevention and treatment of common mental health problems, linked to specific tools needed to follow the guidelines.
These resources will be developed through a process of participatory action research: creation of stakeholder advisory groups including community organizations, government agencies, primary care providers, and other mental health professionals; identification of information and tools needed by each group to improve the delivery of cultural diversity on mental health care, promotion and stigma reduction; preparation of specific materials in needed formats; and delivery and assessment of the impact of the materials on a range of end-users, including consumers, family care providers, professionals, and policy makers. Assessment procedures will be built into the website to collect ongoing data on utilization and impact of the materials as well as direct interviewing of end-users. The partners brought together for this project will provide a basis for developing a sustainable national network to advance multicultural mental health care.
PI: L.J. Kirmayer, F.L. Lemire, K. McKenzie, C.D. McKnight, N. Caidi, A. Cortinois, M. Desmeules, R. Grad, I. Hemlin, A.R. Jaddad, U. Kiziltan, Y. Leanza, G. Mazowita, L.A.O’Grady, P. Pluye, E. Raikhel, A. Ungareanu
Canadian Institutes of Health Research, Knowledge to Action Grant, 2008-2010.
Testing the Clinical Efficacy of Cultural Formulations in a Psychiatric Intensive Care Unit
Principal Investigator: Sushrut Jadhav, University College London
Start date: March 2006
Duration: 18 months
Funded by the Department of Health. Study site: Mornington Psychiatric Intensive Care Unit, St Pancras Hospital
London NW1 0PE
UK Department of Health publications, numerous independent enquiries, and research in the field of British Forensic Mental Health have consistently recommended equality of access, experience and outcome for Black and Ethnic Minority mental health service users. Black and Ethnic Minority communities perceive forensic services as culturally insensitive, discriminatory and disempowering. It is also evident that culture is consistently viewed by health professionals as synonymous with ethnic minority, excluding themselves and indigenous white Britons. Bold innovative interventions that are culturally appropriate, evidence based, effective, and value for money are needed. Such an approach also requires the notion of culture to be expanded to include the culture of mental health professionals, management, and hospitals; rather than a singular focus on ethnicity of patients.
The lead applicant has developed a unique method, based on existing theory in medical anthropology, and grounding the DSM-IV Cultural Formulation approach within an inner London setting. This approach provides users with an opportunity to systematically narrate their suffering in terms of their own cultural vocabulary. Each narrative is transcribed, structured and circulated to all members of the multi-disciplinary mental health team, and to the user. A brief questionnaire to the clinical team collates responses on how this additional narrative might change their understanding of the user’s suffering. Responses to this are then deployed to effect concrete changes in treatment plans. Pilot interviews conducted in a locked adult psychiatric intensive care unit, with 20 patients from different ethnic backgrounds, have consistently revealed clinically significant new information about patient’s lives, improved rapport, and allowed crucial changes in treatment plans and diagnosis. This pilot study also revealed functional and structural barriers to delivering culturally sensitive care, and identified stereotypes about culture, held by both staff and management.
The proposed dual ethnographic and quantitative research aims at a systematic and rigorous evaluation of the clinical efficacy of the Cultural Formulation approach, in a secure adult male psychiatric intensive care unit. Two social scientists (Dr Samrat Sengupta & Ms Jenny Bloomfield) with mental health background will conduct a randomised clinical intervention trial. This trail will test the efficacy of the CF interventions with 35 male patients, regardless of ethnicity, admitted to this acute adult psychiatric unit, and compare with 35 controls. Demonstrating the efficacy of this unique intervention will include robust outcome variables encompassing both patient experience and professional concerns. Simultaneously, a year long clinical ethnography of the unit will both complement and systematically document concrete institutional and functional processes that impede or enhance delivery of culturally sensitive care, including ideas of how culture is constructed in acute psychiatry. If successful, this approach offers potential for mainstreaming within routine clinical care in both forensic and acute mental health settings.
Dr Sushrut Jadhav MBBS, MD, MRCPsych., PhD Senior Lecturer in Cross-cultural Psychiatry, University College London. Hon. Consultant Psychiatrist, Psychiatric Intensive Care Unit, St. Pancras Hospital, London NW1. Co-Director, MSc in Culture and Health. Editor, Anthropology & Medicine journal.
Correspondence:
Centre for Behavioural & Social Sciences in Medicine
Division of Medicine, University College London Medical School
Charles Bell House, 67 -73, Riding House Street
London W1W 7EJ, United Kingdom
Tel.: +44 (0)20 7679 9478/9292 (Academic) or
Tel.: +44 (0)20 7530 3734 (Clinical)
Fax: +44 (0)20 7679 9028
Academic: UCL Division of Medicine
Journal: Anthropology & Medicine