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.
To address these issues, we are developing a set of internet-based tools and networking strategies to facilitate multicultural mental health services, with a focus on primary care providers. 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 use of the web will allow us to: create different portals that organize information in ways relevant to specific users and make the resources immediately accessible through users’ desktop computers, as well as, potentially, other platforms, such as PDAs or touch-screen kiosks.
We have chosen to initially focus on family physicians, in part because most mental health care takes place in primary care settings. The recognition of such patterns of service utilization has led to shared and collaborative care projects, such as the Canadian Collaborative Mental Health Initiative (CCMHI), which have begun to develop models for collaboration between primary health care providers and mental health specialists.
The specific topics and format for the web-based resources will be determined through consultation and collaboration with stakeholders but will likely include:
- Information on how to access and work with interpreters, culture brokers and community resources
- Culturally-adapted guidelines for prevention and treatment of common mental health problems, linked to the specific tools needed to follow the guidelines
- Training and self-assessment materials for Continuing Medical Education (CME) in cultural competence
- Multilingual mental health information resources for patients, families and professionals
- Specific material on key issues including ethnocultural variations in diagnostic and neuropsychological assessment, and response to psychiatric medication
- Guidelines for the design and implementation of cultural consultation, community-based collaborative care, and ethnospecific mental health services and, eventually
- Information on helping patients to access community groups and resources.
These resources will be developed through a process of participatory action research. We will conduct an assessment of family physicians’ information needs in regard to culture and mental health. Representatives of the College of Family Physicians of Canada, patient advocacy groups and government organizations will be involved in all stages of the project, including needs assessment, a comprehensive scan of available resources, and development and evaluation of a web-based resource. Assessment procedures will also be built into the resource to collect ongoing data on the utilization and impact of the materials.
This project is funded by the Canadian Institutes for Health Research.