2003 Advanced Study Institute

Models of Mental Health Services for Multicultural Societies 

June 2 - 3, 2003
Monday, June 2, 9:00 AM - 7:00 PM
Tuesday, June 3, 9:00 AM - 5:30 PM
Institute of Community & Family Psychiatry
Sir Mortimer B. Davis-Jewish General Hospital
4333 Cote Ste Catherine Road
Montreal, Quebec H3T 1E4



Recent changes in demography in countries of migration have increased awareness of the challenge of responding to cultural diversity in mental health care. This Advanced Institute brings together an international group of scholars and leaders in the field of multicultural mental health to compare the models of service in different culturally diverse societies. Panels and presentations will explore the historical background and current social contexts of mental health services delivery in Australia, Canada, Europe, India, the U.K. and U.S. Discussion will focus on the conceptual basis for integrating culture and ethnicity, the impact of racism, and emerging models of innovative practice. Topics will include: the place of culture in mental health services; the legacy of colonialism in French ethnopsychoanalysis; Canadian, British and U.S. approaches to racism in mental health care; public mental health in socio-cultural context; the U.S. Surgeon Generals Report on culture and mental health services; thinking about culture in the clinic; ethical issues in multicultural health care; European perspectives on good practices in mental health and social care for refugees; multicultural mental health care in Australia; transcultural child psychiatry; and community mental health in developing countries.


Monday, June 2, 2003

The Social and Historical Context of Multicultural Mental Health

9:009:15 From colonialism to multiculturalism: The place of culture in mental health services Laurence J. Kirmayer

9:159:45 The Legacy of lOedipe Africain Alice Bullard

9:4510:15 The Community Mental Health Movement in India Ravi L. Kapur

10:1510:45 Some Challenges to South Asian Psychiatry Sushrut Jadhav

10:4511:00 Break

11:00-11:30 The Great Divide: Canadian, British and American Differences in the Treatment of Psychosis in Persons of African Descent G. Eric Jarvis

11:30-12:00 Awakening Awareness of Racism in Canadian Society Myrna Lashley

12:00-12:30 Panel: Gilles Bibeau (Chair), Alice Bullard, Ellen Corin, Eric Jarvis, Sushrut Jadhav, Ravi Kapur, Myrna Lashley, Carlo Sterlin


Conceptualizing Multicultural Mental Health Care

2:00-2:30 A Canadian perspective on multicultural mental health Morton Beiser

2:30-3:00 The U.S. Surgeon Generals Report on culture and mental health services Steven R. Lopez

3:00-3:30 Cultures in the Making: Clinical Encounters in the Shadows of Psychosis Ellen Corin

3:30-3:45 Break

3:45-4:15 Thinking about culture as clinicians Jaswant Guzder

4:15-4:45 Ethical issues in multicultural health care Leigh Turner

4:455:45 Panel: Morton Beiser, Jaswant Guzder, Steve Lopez, Ccile Rousseau, Leigh Turner, Laurence Kirmayer (Chair)

6:00-7:00 Reception 

Tuesday, June 3, 2003

Emerging Models in Multicultural Mental Health Services

9:00-9:15 Introduction Laurence Kirmayer

9:15-9:45 Multicultural mental health services in Australia Harry Minas

9:45-10:15 The Center for Mental Health, Brussels: Culture-Responsive Therapy Revisited Antoine Gailly

10:15-10:30 Break

10:30-11:00 An Integrative Approach to Cultural Competency Training: Incorporating Consumer Voices and Recovery Principles Miriam Delphin & Gihan Omar

11:00-11:30 The Hong Fook Mental Health Association: Lessons Learned from Twenty Years of Service Hung-Tat Lo & Raymond Chung

11:30-12:00 Culturally-based care in Vancouver Soma Ganesan

12:00-12:30 Panel


Mental Health Care After War

2:00-2:30 Mental Health and Culture in (Post-)Conflict Settings Joop de Jong

2:30-3:00 Should there be Dedicated Refugee Mental Health Services in Resettlement Countries? Matthew Hodes

3:00-3:15 Break

3:15-3:45 In the Margin or Between the Lines? Articulation of Political and Clinical Dimensions in Mental Health Intervention for Migrant and Refugee Children Ccile Rousseau

3:45-4:15 Good Practice in the Mental Health Care of Refugees Charles Watters

4:15-5:00 Panel & Conclusion 


The Legacy of lOedipe Africain Alice Bullard (Georgia Institute of Technology)

LOedipe Africain is an eduring legacy of an early period of transcultural (or, ethno-) psychiatry. Psychiatrist Marie-Ccile Ortigues and her philosopher husband, Edmond Ortigues produced this study after four years of clinical work (from 1962 to 1966) at the Fann Hospital in Dakar, Senegal. These were years of intense creativity at Fann, as Dr. Henri Collomb set in motion a series of innovations that transformed a classical asylum into an open-door, culturally sensitive therapeutic center. LOedipe Africain confronts the transcultural project in the early post-colonial era with such candor and insight that it continues to speak to the profession today. This paper provides the intellectual and clinical context of the production of LOedipe Africain, then assesses its impact on transcultural psychiatry from publication to the present.

The Story of the Community Mental Health Movement in India Ravi L. Kapur (National Institute for Advanced Studies, Bangalore)  

The problem of mental illness in India is very large and the number of professionals to deal with it is too small. It would be decades before it is possible to create even the minimal facilities for mental health care if we depended only on the professionals. To deal with this dilemma a number of experiments have been tried out to provide mental health care using non professionals and practitioners of alternative medicine. In 1992, a National Mental Health programmed was devised which involved the sourcing out of mental health care through the primary health centers( PHCs) spread out in the rural areas. These health centers are manned by a basic doctor assisted by modestly trained primary health workers. The programmed was evaluated and was found to be unsatisfactory for reasons which had more to do with the structuring of PHCs and the administrative channels than with the training in mental health care given to the primary health workers. The involvement of the practitioners of alternative medicine has also been found disappointing. There is also the issue that with the socio-economic changes in the country, the family support for the chronically ill, which one took for granted, is less and less available in spite of best intentions. As a result there is increasing burden of the chronically ill on the public health facilities. The spectrum of the mental health problems is also changing especially in the cities where more and more people are asking for mental health counseling as well as facilities for the treatment and prevention of drug abuse. The talk will elaborate on these experiments so that other developing countries could learn from Indias successes as well as failures in this direction.

Decolonizing Psychiatry Sushrut Jadhav (University College, London) 

In contrast to the rigours of personal analysis, seminars and training over extended period that characterise western psychotherapeutic training, psychiatric training in India continues within the framework of a guru-chela apprenticeship but that has over the years added to it a watered down version of western psychotherapy. The process of deliberately filtering off cultural components of patients' narratives to yield symptoms and signs, including defence mechanisms that devalue projections onto mythical characters, is considered credible and meritorious. The paper argues this relates to an effort on the part of alienated health professionals attempting to approximate their patients' stories as stories to western therapeutic narratives to arrive at some sort of goodness of fit with the latter. This appears to be an easier way to resolve their dilemma: being accepted by their western counterparts, which in turn translates into merit amongst local colleagues. Once a cultural cleansing is achieved, therapy, or for that matter any other health intervention, can proceed as outlined in the eagerly awaited journals and books that arrive by post or through the philanthropic gesture of western colleagues. Through this process of collusion, local suffering is invalidated.

The Great Divide: Canadian, British and American Differences in the Psychiatric Assessment and Treatment of Psychosis in Persons of African Descent G. Eric Jarvis (McGill) 

Historically, psychiatrists in the United States and the United Kingdom have employed different criteria when establishing a diagnosis of schizophrenia. Although these differences have subsided, new disparities have emerged in recent years between the two countries concerning the assessment and treatment of psychotic disorder in minority populations, specifically in persons of African descent. Whereas the United States has large populations of native-born African Americans descended from slaves, the United Kingdom has experienced a relatively recent influx of Caribbean and African migrants from former colonies. American psychiatric research reports higher rates of psychotic disorder among African Americans, but tends to explain the finding as a problem of misdiagnosis in which black Americans are erroneously assigned diagnoses of psychosis instead of mood disorders. American researchers also suggest that the elevated rates of psychosis among African Americans are a result of low socioeconomic status, but rarely seek to understand the relationship among poverty, African origin and psychosis. When assessing racial differences in treatment of psychosis, American writers tend to discount positive findings and emphasize equality among the races without open reference to racism. British researchers, in contrast, tend to reject misdiagnosis as an explanation for high rates of psychotic disorder among black Britons. Racism is openly discussed in many papers, and is sought by researchers as a contributing cause to the excess of psychosis in this population. British writers tend to neglect socioeconomic factors as a principal cause of psychosis among black Britons. The silence of Canadian researchers on this subject is startling. These findings will be assessed in terms of the historical legacies of the three countries with respect to persons of African descent. 


Awakening Awareness of Racism in Canadian Society Myrna Lashley (John Abbot)  

Globalisation and the information age have made mass media more accessible and influential. As a result, we are constantly exposed to wars, terrorist acts, and new diseases. Such exposure often leads to racial profilingtowards those viewed as the perpetratorson the part of those who, for example, oversimplify the analysis of this information, or as an expression of their own fear. Similar effects are seen as responses to the effects and fears of globalisation on world-wide economies. The manner in which the information is often disseminated reflects, primarily, the Wester-European, Caucasian view of world events and the expected response is also often based on this model. However, the impact of this information, and profiling, often has a different and unrecognized deleterious effect upon those who are targeted by ethnicity, culture, race or gender as a result of these public statements. In order to address these realities, it is imperative that we create, or at the very least, modify our models of mental health services to incorporate the lived reality of those who are being racially profiled.  


The U.S. Surgeon Generals Report on Culture and Mental Health Services Steven R. Lopez (UCLA) 

An overview of the U.S. Surgeon General's Report (2001) will be presented, in particular the background to the report and its key themes. The implications of the report for mental health services will be critiqued. The strength of the report is that the stature and visibility of the Office of the Surgeon General in the United States provides credibility to efforts that address the mental health needs of ethnic and racial minorities. In addition, the report provides an excellent research-based resource to community organizations, service providers, policy makers, and researchers documenting the current status of mental health services for U.S. minority groups. The political implications of this report can not be overlooked. One implication is that the ethnic/racial groups represented in the report and their advocates in the mental health field, African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Hispanic Americans, have mobilized themselves further to improve the mental health services for their group. The limitations of the report concern the definition of culture as values, beliefs and practices and the focus on the four main ethnic/racial minority groups. In the report, culture is largely linked to race and ethnicity. As a result, the more dynamic view that culture consists of social processes tied to local worlds is overlooked and the relevance of culture in providing mental health services for all, regardless of race and ethnicity, is not addressed.  


Cultures in the Making: Clinical Encounters in the Shadows of Psychosis Ellen Corin (McGill) 

Culture is an elusive reality on the clinical scene: not because it does not exist; but because people navigate between different cultures, mobilize different elements or aspects of the cultural in which they participate and invest these with meanings that may vary according to the interlocutors or to social and cultural dynamics internal and external to the clinical setting. Reflections will be based on two main research projects involving psychotic people and their families. The first one, conducted in Chennai (India), reconstructs patients and families vision of the entrance into psychosis and their help-seeking process. The second, conducted in Montreal in several institutional settings, examines how patients, relatives and practitioners negotiate issues of meaning, behaviours and help and the impact for the clinical encounter. The role and significance of a resort to cultural signifiers by the various partners will be discussed.

Thinking About Culture as Clinicians Jaswant Guzder (McGill) 

A cultural consultation model was developed at the Jewish General Hospital Cultursl Consultation Service (CCS) which focussed on the therapist as well as the patient. The process of these interchanges involved a widening discussion on assessment and alliance. These clinical consultations included the threads of intergenerational family issues, institutional context, sociopolitical realities, mythic constructs, spiritual beliefs, and wider systemic issues At times otherness, diversity and assimilation present challenges to therapists on the front line of mental health access. Communication problems, framing of goals, negotiation of power, diagnosis, refugee processing, and youth protection or social service mandates often were informed by consideration of the therapist-client relationship and the cultural axis. The CCS created a space validating the use of these discourses, which are often absent both in the mandate of training and in clinical construction of meaning. 


Ethical issues in Multicultural Health Care Leigh Turner (McGill)

Contemporary healthcare in North America is commonly provided in multicultural,multilingual settings. Notwithstandingthe plurality of cultural models of health,illness, family life, andeveryday reasoning, contemporary scholarship in bioethics is dominated bythe imagery and rhetoric of individual agents making autonomouschoices and engaging in rational long-term planning that anticipates future health states.Furthermore, contemporary scholarship in bioethics is dominated by universalist accounts of moral reasoning that fail to attend to important variations in cultural and religious models of moral reflection. However, within health care settings, many ethical issues arise as patients, their loved ones, and health careproviders navigate such issues as the disclosure of diagnostic and prognostic information, the withholding or withdrawal of treatment,and differentials in power and social status. This presentation willconsider some of the many different ethical issues that arise in multicultural health care settings and consider whyscholarship in bioethics provides so little insight into the complexities and uncertaintiesof providing care in multicultural societies.


Multicultural Mental Health Services in Australia Harry Minas (Melbourne)  

In Australia, the political ideology of multiculturalism has created a space in which the development of services that are responsive to the diverse needs of indigenous and immigrant communities can occur. The differing claims of indigenous and immigrant communities, and the different government and societal responses to them, have resulted in quite separate development of research, policies and service models for these two groups of communities. For indigenous communities the central issue has been community control of the design and operation of health services. In relation to immigrant communities the development of services initially emphasized the importance of surmounting the communication barrier imposed by different languages. An extensive system of Commonwealth and state-funded interpreting services has been developed, with public health (including mental health) information available in many languages. The inadequacy of this partial response to the needs of immigrants is widely recognized. Governments at national and state levels have accepted the proposition that all mental health policies and service programs must respond to the fact of cultural pluralism. The national mental health standards, which form a centrally important part of the second national mental health plan agreed between the Commonwealth and the states, include a comprehensive set of standards for the provision of culturally appropriate services. Each of the six states has either a specialist transcultural psychiatry unit, funded by state health departments, [e.g. http://www.vtpu.org.au ] or a transcultural mental health network. The roles of these organisations are broadly similar: to assist state health departments (through research, professional and community education and service innovation) to improve the accessibility, quality and cultural appropriateness of state funded mental health services available to immigrants. The Commonwealth Department of health has funded the establishment of the Australian Transcultural Mental Health Network. This organization commissions research and other projects of national significance and provides a national information service that disseminates information on research, education and service innovation that will contribute to continuing improvement in mental health services for immigrants. [http://atmhn.unimelb.edu.au] 


The Center for Mental Health-Brussels: Culture Responsive Therapy Revisited Antoine Gailly (Brussels)

As a country of migration Belgium is confronted with the challenges and problems of responding to cultural diversity in mental health care. Since the seventies the Center for Mental Health - Brussels has provided culturally responsive therapy for children, adolescents, and adults with different ethnocultural background (immigrants, political refugees, asylum-seekers, and people without documents). The story of the center reveals some interesting perspectives for the future of culturally responsive therapy. A literature survey shows that the major model to improve culturally responsive therapy includes three basic competencies: (1) ethnographic knowledge of culturally and racial divers clients, (2) developing multicultural skills, and (3) awareness of the assumptions, attitudes, values and beliefs about ones own and others race and culture. From a cultural historical analysis of the praxis at the center it becomes clear that these competencies result from the way the problems in providing adequate care for culturally different people and the crisis of multicultural therapeutic competence are interpreted. This implies that the competencies are the result of a specific political, socio-cultural context and of the way culture has been historically defined (which implies signifying reality, and thus mental illness, at different levels of meaning). As such the above-mentioned competencies are based on the metaphor of Western know-how and consistent with the belief that knowledge brings control and effective work. Therefore, much of the literature on multicultural therapy is directive, offering reflections and suggestions regarding cultural therapeutic implications. This paper presents a metacultural therapy. Culturally responsive care cannot be based any longer on pure comparative ethnographic data and on the development of technical skills. This would lead to too many ethnic based theories and the salience of multiculturalism would become trivialized. The idea of a metacultural theory thus affects the potential for a crisis of relativism. In our metacultural theory culture is no longer considered as a static entity but as a process, as contextual creation as the social construction of meaning and thus as offering continuity. This implies an intersubjective perspective in which the therapists and the clients thoughts and feelings become a field of interaction that operates on multiple levels, within which the client and therapist work to construct meaning together. In this perspective the cultural countertransference of the therapist becomes very important. This will be demonstrated by presenting clinical vignettes.  


An Integrative Approach to Cultural Competency Training: Incorporating Consumer Voices and Recovery Principles Miriam Delphin & Gihan Omar (Yale) 

Numerous approaches to cultural competency training have emerged within the field as a means of increasing knowledge, skills, and awareness in working with multicultural populations. An integrative approach to cultural competency training for mental health and substance abuse service providers will be described in which consumer story-telling and perspectives were an integral part of the program development and training process. In addition, recovery-oriented values and principles emphasizing person-centered care, strengths and assets and spirituality as a cultural resource were incorporated throughout the training. These concepts build on and further enhance traditional cultural competency principles, and together served as the conceptual underpinnings of the training curriculum. The inclusion of consumer story-telling and recovery oriented approaches to care enhance traditional training and provide participants with a framework to understand the value and utility of culturally competent mental health treatment.

The Hong Fook Mental Health Association: Lessons Learned from Twenty Years of Service Hung-Tat Lo (University of Toronto) & Raymond Chung  

This paper will describe the evolution of the Hong Fook Mental Health Association in Toronto from 1982-2002. Toronto is the most culturally diverse cities in Canada, and arguably the world. The story of Hong Fook reflects the many sociopolitical currents impacting on a service created to serve some of the ethnocultural populations of the city. Starting with the Chinese and Vietnamese, as the Boat People arrived in Canada, its target populations have grown to include the Cambodians, Koreans, and Mainland Chinese. Its services have also evolved from a consultation model to case management and other diversified activities. Through case examples, its service models are illustrated. Along the way, vignettes are used to elicit lessons learned through the operation of the service. The relationships of Hong Fook with mainstream institutions demonstrate the many challenges inherent in such interactions. The strengths and limitations of the ethnospecific community services are discussed, and possible directions towards a culturally competent mental health system are presented. The paper concludes with the importance to share experience in this developing field. 


Culturally-based Mental Health Care in Vancouver Soma Ganesan (UBC)

The Cross Cultural Clinic at Vancouver General Hospital began operating in 1988 with limited resources but has now expanded to include seven psychiatrists with an annual patient load of approximately 5000. Staff psychiatrists speak a combined total of 22 languages and dialects. The clinic also benefits from having a Japanese psychiatric consultant providing regular services to the clinic. Patient referrals come from family physicians, social services, school boards, and immigrant settlement organizations from across the province. For languages not spoken by staff psychiatrists, the hospital provides trained interpreter services. This clinic also provides second opinions to other health and mental health service providers who have an interest in providing culturally responsible services to their patients/clients. Marital, mixed marriage, and intergenerational cultural conflict counselling are also part of our mandate. Our clinic, established in the early 1990s, works closely with multicultural liaison workers at Vancouver Community Mental Health Services. Service consists of liaison workers covering language- and culture-specific groups (Punjabi, Hindi, Chinese, Spanish, and Vietnamese). Its mandate is to provide direct services to clients/patients from the Vancouver Community Mental Health Services (with a current active client/patient roster of roughly 10,000); consultation services to general practitioners, primary health care workers, law enforcement officers, the school board, and the Ministry of Child and Family Services; and run public forums and family support groups. It has recently seen the addition of a Native Liaison Worker. The program is focussed on chronic persistent mental illness. The Cross Cultural Clinic and the Liaison Workers program fall under the Vancouver Coastal Health Authority and, therefore, one administration. The annual symposium has been a regular activity of the Cross Cultural Program for the past seven years. Most of the symposiums draw is from immigrant settlement counsellors, mental health services providers, and administrators. It also provides people a networking opportunity. 

Mental Health and Culture in (Post-)Conflict Settings Joop de Jong (Transcultural Psychosocial Organisation; Vrije Universiteit, Amsterdam) 

The bulk of the 35 million refugees and internally displaced worldwide reside in countries that on average have less than one psychiatrist or psychologist per 100,000 or even per one million people. Survivors often belong to a different ethnic or socio-economic group than those who may offer help. Survivors express their plight in a specific discourse and use different explanatory models. Service delivery systems, even if they are community oriented, tend to exclude specific groups. For example, because mental health professionals or paraprofessionals hardly know how to help people with certain problems (e.g. perpetrators of violence), because survivors are stigmatized (e.g. rape survivors), or because survivors do not trust or understand the rationale of modern psychosocial or mental health support. Empowerment of local resources is felt to increase sustainability, equity and the use of natural support systems such as healers and mourning, cleansing and reconciliation rituals. Collaboration between allopathic and traditional services is often advocated but is also a challenge. A further challenge to service providers is that most conflicts are the results of political, economic, and socio-cultural processes. Sequelae of such conflicts can likely only be resolved by multilevel, multisectoral public health approaches informed by social sciences (especially anthropology), behavioral sciences, and epidemiology. This lecture will try to show how culture moulds the relationship between traumatic and other events, moderators and outcomes. We know little about the cultural influence on the measurement of traumatic events or about the ways people perceive personal losses or property loss. Cultural factors mediate the persons ability to utilize resources when trying to cope with disasters, and culture may jeopardize refugees who cannot longer afford to perform rituals. Whereas there is a lot of criticism on the concept of PTSD, there also is the need for a wide inventory of idioms of distress and traumatic stress reactions. Epidemiology and anthropology have an equally important role in looking for the possible neurobiological universal substrate and the culture specific reactions to complex emergencies, wars and natural disasters. However, most of the anthropological work still needs to be done.  


Should there be Dedicated Refugee Mental Health Services in Resettlement Countries? Matthew Hodes (UK)  

In the UK and many other countries that receive immigrants, including asylum seekers, it is important to provide appropriate access and effective delivery of mental health services. Refugees are frequently concentrated in particular areas, frequently the inner cities. While this has advantages for social support, and provides potential for the development of specific welfare services, mental health services may feel overwhelmed by the high demand and needs of this group. It is proposed that tiered services are required. Refugees with psychopathology with less social impairment may be seen in dedicated services that operate in community settings such as schools for youngsters, and family centres. However refugees also may have high rates of more severe disorders associated with high levels of social impairment, as compared to non-refugee peers, and will need treatment by multidisciplinary teams, in out-patient clinics or inpatient (residential) settings. Data will be shown from ongoing work with young refugees in London to illustrate these points. There will be discussion of implications arising such as skills mix, involvement of therapists from the refugee communities or language group being served, and the feasibility of family oriented services.  


In the Margin or Between the Lines? Articulation of Political and Clinical Dimensions in Mental Health Intervention for Migrant and Refugee Children C. Rousseau, T. Measham, L. Nadeau (McGill)

In mainstream mental health services the political issues have been largely considered as irrelevant to the clinical work except if directly accessible in terms of external environmental issues like trauma or stressors. The implicit political dimension built in mental health services plays however a key role, which often may represent a repetition of unequal power relations between minority groups and the host society, but the process of negotiating and confronting this interaction may be a source of empowerment. This presentation will focus on some of the challenges associated with an intent to transform the services from within. Is it possible within a clear advocacy role to organise a safe space of expression while avoiding the creation of a symmetrical split. The latter would still reproduce the opposition between migrants and refugees and host country institutions? How can migrant and refugee community specificities be addressed without increasing the exclusion that may stem from a rigid representation of these specificities? To what degree can certainties stemming from the hegemony of medical knowledge be challenged before reaching a level of unbearable confusion? And finally, how much can power-relations be modified from within a system of inequality before provoking retaliation?  


Good Practice in the Mental Health Care of Refugees Charles Watters (Kent) 


This paper will include the presentation of the results of an international study into good practice in the mental health care of refugees sponsored by the European Commission. The study, conducted in 2002/03, includes an examination of mental health care for migrants and refugees in a range of European countries and assesses the potential for the international transfer of models of good practice. In recent years, countries have been faced with the challenge of providing appropriate (mental) health and social care for growing numbers of refugees and other migrants. This group is particularly at risk for mental health problems. Some are problems of the kind which arise in every population, some are connected with experiences of violence and upheaval in the country of origin, and some with the particular stresses experienced during and after the flight (problems of acculturation and integration and the effects of asylum policies). The effects of torture have been widely publicised and are rightly a focus of great concern, but even for those who have not suffered this experience they may suffer from significant mental health problems in the post-migration environment. However, existing services are frequently unable to provide appropriate help for refugees and other migrants. On the basis of a study of migration and mental health care in Europe the author has highlighted six areas of particular concern in service provision. The included problems relating to monitoring and research, the `embeddedness and structural position of mental health and social care services for migrants and refugees, the presence of racism in services, the absence of user involvement, the training of staff and the particular problems in the delivery of `talking treatments. To date, however, there has been little systematic exchange of experience and good practice between different countries. This paper examines the difficult question of how good practices can be identified and how they can be transferred between countries. The paper will focus in particular on developments in Europe and will place these in a broader international context. Specific reference will be made to work focussing on the Medical Foundation for the Care of Victims of Torture in the UK and the Pharos Programme in the Netherlands. The paper will extend this comparative examination and draw conclusions regarding the potential for the transfer of good practice internationally.  


Morton Beiser, M.D., is Director, Centre of Excellence for Research on Immigration and Settlement (CERIS). He has over 30 years experience in cultural psychiatric research including path-breaking research on Aboriginal youth and Southeast Asian refugees with whom he conducted a 10-year longitudinal study of adaptation of 1300 Boat people. He is principal investigator on the CIHR-funded New Canadian Children & Youth Study (NCCYS), the first large-scale longitudinal population survey of the mental health and adaptation of immigrant and refugee youth. He is also PI on a project funded by Citizenship & Immigration Canada to produce computer-assisted university courses on immigration and its impact on Canada. 


Gilles Bibeau, PhD., Professor, Department of Anthropology, Universit de Montral, is a medical anthropologist with extensive research experience in Africa, Latin America, North America and South Asia. His research includes social and cultural analysis of health services; religious systems and globalization; ethnocultural and national identities; and the social dynamics of street gangs and marginal milieus in Montreal. He chairs a Universit de Montral CIDA project with a consortium of five universities in Costa Rica, Peru and Brazil developing teaching programs and audiovisual materials on social determinants of health.

Alice Bullard, Ph.D. is Associate Professor, School of History and Sociology of Science and Technology at the Georgia Institute of Technology, in Atlanta. Her research is in the history of human sciences, especially psychiatry and anthropology in francophone colonial and post-colonial lands. She has been a Fulbright Scholar in Paris and a fellow at the Humanities Centre at the Australian National University. In 2000 she published, Exile to Paradise; Savagery and Civilization in Paris and the South Pacific (Stanford University Press). Currently she is engaged in two projects: work with Mauritanian political refugees and non-governmental organizations, and a history of psychiatry in francophone Africa (with special emphasis on the Fann Hospital in Dakar, Senegal).

Ellen Corin, Ph.D., is Associate Professor at the Departments of Anthropology and Psychiatry, McGill University, and researcher at the psychosocial Research Division at the Douglas Hospital. She has conducted extensive research, first in Africa and now in Quebec and in India in collaboration with Indian researchers and clinicians. In these various settings, she has been particularly interested by the interface between culture and psychic processes. Her current research concerns the role and significance of culture in psychosis, ascetic pathways to spirituality in India, and alternative practices in mental health. She is also a member of the Socit psychanalytique de Montral and of the Canadian Psychoanalytic Society.

Miriam Delphin, Ph.D. is currently an Instructor of Psychology in the Department of Psychiatry at Yale University. She also is Director of Cultural Competency Programming of Consultation with the Yale University Program for Recovery and Community Health. Her research interests include the role of ethnic identity development in access and adherence to treatment among urban adults of color with behavioral health needs, ethnic differences in coping and help seeking behavior, and assessing the impact of race and stereotyping biases on the diagnostic process. Dr. Delphin is additionally interested in conducting health disparities research with the aim of identifying disparity areas to be minimized through the development of culturally responsive treatment approaches and through mental health provider cultural competency training.

Antoine Gailly, Ph.D. studied psychology and anthropology at the University of Leuven, Belgium. He is director of the Center for Mental Health of the Region of Brussels Capital, Belgium where culturally responsive therapy is provided for children, adolescents, and adults with different ethnocultural background (immigrants, political refugees, asylum-seekers, and people without documents). The Center also organizes training and supervision in culture responsive therapy. He has done research in Turkey and North Africa in the fields of medical anthropology, ethnicity, multicultural(ism) (personality), the anthropology of migration, and transcultural psychotherapy. Currently he is also engaged in an international educational program for linkworkers and translators in mental health services. He is the president of the Dutch platform for Culture and Mental Health in Belgium and a member of advisory boards for the Belgian government, as well as several national and international networks and associations.

Soma Ganesan, M.D is Clinical Professor and Director of the Cross-Cultural Program, Department of Psychiatry, University of British Columbia and Medical Director of Psychiatry at Vancouver Hospital and Health Sciences Centre. He is a member of the Ministers Advisory Council on Mental Health. He participatig in setting up the Multicultural Liaison Worker program at Vancouver Community Mental Health Services and is a founding member of the Vancouver Association of Survivors of Torture. He maintains a high level of involvement in the development of clinical services, policy and research in refugee and cross-cultural mental health.

Jaswant Guzder, MD is Associate Professor in the Department of Psychiatry, McGill university, Director of the Child Day Treatment Centre at the Jewish General Hospital, and a founding co-director of the JGH Cultural Consultation Service. She is also an Adjunct Professor in the McGill Faculty of Education, and a supervisor in the Concordia University Creative Arts Therapy Program. She is an artist and a member of the Canadian Psychoanalytic Society.

Matthew Hodes, MBBS BSc MSc PhD FRCPsych, studied medicine at Guys Medical School, social anthropology at the London School of Economics, then trained in general psychiatry and child & adolescent psychiatry at the Maudsley Hospital. Carried out research into adolescent eating disorders at the Institute of Psychiatry & Maudsley Hospital. Currently, he is Senior Lecturer in Child and Adolescent Psychiatry at Imperial College London, and Consultant in Child and Adolescent Psychiatry at St Marys Department of Child and Adolescent Psychiatry, Paddington Green, CNWL Mental Health Trust. His research and clinical interests include: eating disorders, family function, and cultural psychiatry including refugee mental health. In recent years, he has been developing research and mental health services for young refugees in London.

Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, is Senior Lecturer in Cross-Cultural Psychiatry, University College London, Hon. Consultant Psychiatrist, Psychiatric Intensive Care Unit, St. Pancras Hospital, London, Founding Editor, Anthropology & Medicine journal and Programme Director, UCL MRCPsych courses. He has worked on projects concerned with homeless population and developing services, research and training in cultural consultations with the migrant and refugee communities in the UK, developing training and research projects in India, including amongst dalit populations. His current work includes sensitising British mental health professionals to psychiatric aspects of Islam and Muslim cultures; exploring why British Indians do not donate blood; and a study documenting the cultural landscape of hospital porters and domestic workers in inner London psychiatric hospitals.

G. Eric Jarvis, M.D., M.Sc., is director of the Cultural Consultation Service and research associate at the Jewish General Hospital. He is interested in the social construction of insight, and his research involves examining the role of religious practice in the mental health of immigrants, how ethno-racial status affects the urgent treatment of psychosis, and the process of cultural consultation.

Ravi L. Kapur is J.R.D. Tata Visiting Professor at the National Institute of Advanced Studies. He completed his M.B.B.S. from Amritsar Medical College and Diploma in Psychological Medicine from All India Institute of Mental Health and Neuro Sciences (currently, the National Institute of Mental Health and Neuro Sciences or NIMHANS),Bangalore. In 1965, he went to Edinburgh as a Commonwealth Medical Fellow where he completed both his Ph.D. in Psychiatry and the membership examination of Royal College of Psychiatrists. Later he became a Fellow of the Royal College of Psychiatrists. He is also a Fellow of the Indian Academy of Sciences and of the National Academy of Medical Sciences. After returning from Edinburgh he spent 4-years in rural Karnataka studying the patterns of mental disorder. This work was later published as The Great Universe of Kota (Hogarth). Subsequently he worked as Professor of Psychiatry at Kasturba Medical College (1972-1974) Manipal, and as Professor of Community Psychiatry and the Head of the Department of Psychiatry (1974-1983) at NIMHANS. While there he spearheaded the Community Mental Health Programme for the country and also took a major part in developing the National Mental Health Programme. In 1981-1982, he took a one year I.C.M.R. Sabbatical to study the effects of Yoga on mental states. In 1985-86, Prof. Kapur was a Fulbright Scholar-in-residence at the Harvard University, holding simultaneously Visiting Professorship at the Medical School and the Divinity School. He has been a Consultant to World Health Organisation on many assignments, including organising National Mental Health Programmes for Somalia, Oman and Indonesia. His research interests include `Cross-cultural Psychiatry, Psychological basis of Creativity and the Contributions of Indian Philosophical Traditions to the Study of Psychology. Currently, he is involved in a study of Sanyasis and Sadhus who live high up in Himalayas, trying to understand their motivation to leave the society and experiences during their SADHANA. In spite of these research activities, Prof. Kapur maintains his involvement in clinical work and is a practising psychotherapist.

Joop de Jong, MD, PhD is Professor of Mental Health and Culture at the Vrije Universiteit in Amsterdam. He is the director of TPO (Transcultural Psychosocial Organization)Peace of Mind, a WHO Collaborating Center for Refugees and Ethnic Minorities. TPO has developed or supported psycho-social and mental health programs in (post-)conflict situations in 16 countries in Africa, Asia Europe and Latin America (Algeria, Burundi, Cambodia, Congo, Eritrea, Ethiopia, Gaza, India (Tibetans), Kosovo, Mozambique, Namibia, Nepal, Sri Lanka, Sudan, Surinam, Uganda). In the Netherlands, TPO is carrying out several epidemiological studies on immigrants and refugees. Joop de Jong publishes in the field of cultural psychiatry and psychotherapy, public mental health and epidemiology. In addition, he works part-time as a psychiatrist/psychotherapist. In the past, he worked for seven years as a tropical doctor, public health officer, and psychiatrist/psychotherapist in Africa and Asia.

Myrna Lashley, Ph.D., was born in Barbados, educated in Barbados and Montreal had earlier experiences in Oceanography and as a singer. She holds a PhD in Counselling Psychology from McGill University and spent 9 years as a psychologist and later Director of the Employee Assistance Program at the Montreal Childrens Hospital. Following this, she was on the Faculty of John Abbott College for 8 years, initially in the department of Psychology, and subsequently as Chair of Correctional Technology. Currently, she is the Colleges Dean of Arts and Letters. Throughout this time she has maintained academic interests in the realm of cultural adaptation and racial integration. She is also a member of the Transcultural Psychiatry teams at the JGH and MCH. In addition, she maintains a strong community presence with her specialized services for the Court in evaluating culturally or ethnically diverse adolescents and adults. Throughout this time she has continued to serve on a number of local, provincial and federal boards, especially those where cultural or ethnic origin, and the relationship with Canadian society, are important. Her current research is focused upon the strategies used by Black, English speaking Caribbean youth to achieve academic success. 

Steven R. Lpez, Ph.D. is a professor of psychology and psychiatry at UCLA. His main area of research addresses how sociocultural factors relate to the psychopathology, assessment, and intervention of Latinos and other ethnic minority groups in the United States. He began with the study of culture and assessment and has extended his work to culture and intervention to develop a heuristic model of cultural competence for clinical practice. More recently he has been studying the relationship of family factors and the course of schizophrenia, particularly among Mexican American families. Specifically, his research team has found that ethnicity is related to family predictors of relapse such that family criticism predicts relapse for EuroAmericans and the lack of family warmth predicts relapse for Mexican Americans. In addition to his research, Dr. Lopez maintained a clinical practice for several years in both public and private mental health facilities. He also has consulted to numerous mental health and health organizations regarding their clinical staff's "cultural competence." From 1995-99 he directed a summer research training program for U.S. minority students and faculty in Mexico City in collaboration with the Instituto Mexicano de Psiquiatria and the Universidad Nacional Autonoma de Mexico. He was one of the five science editors for the U.S. Surgeon General's Report on Mental Health: Culture, Race, and Ethnicity (2001).

Laurence J. Kirmayer, M.D., is James McGill Professor & Director, Division of Social & Transcultural Psychiatry, McGill, and Editor of Transcultural Psychiatry. He directs the Culture & Mental Health Research Unit at the Sir Mortimer B. DavisJewish General Hospital and is Co-Director of the National Network for Aboriginal Mental Health Research. His research interests include the integration of culture in psychiatric theory and practice, the mental health of Canadian Aboriginal peoples. cognitive-social psychological models of somatization and dissociation, and the theory of metaphor.

Myrna Lashley. Ph.D. is Professor of Psychology and Vice-Dean, John Abbott College, Montreal. She has extensive experience in research on the impact of cultural diversity on doctor-patient communication and in training and consultation in policy milieus including municipal, provincial and federal government as well as corrections and law enforcement. Her current research concerns the mental health impact of family reunification for immigrant families from the Caribbean.

Hung Tat Lo, M.D., is a community psychiatrist in Toronto who founded the Hong Fook Mental Health Association, and served as the psychiatric consultant for the past 20 years. He also consulted to the Culture, Community and Health Studies program at the Centre for Addiction and Mental Health, Across Boundaries, and the Cultural Consultation Team of Mt. Sinai Hospital. He is also Assistant Professor of the University of Toronto, and chaired the System Responsiveness Sub-Committee of the Toronto Peel Mental Health Reform Implementation Task Force.

Harry Minas, MD is Director of the University of Melbourne Centre for International Mental Health and Director of the Victorian Transcultural Psychiatry Unit. With financial support from the Commonwealth Department of Health he established the Australian Transcultural Mental Health Network. With colleagues in the Victorian Transcultural Psychiatry Unit he developed the first diploma and masters courses in transcultural mental health, contributed to state and national policy development in transcultural mental health, and led the design of innovative programs in transcultural mental health service delivery. Professor Minas has continued to develop an interest, and programs, in international mental health development, such as the University of Melbourne-Harvard Medical School International Mental Health Leadership Program. He is actively involved in issues of equity and human rights in relation to mental health and migration. Professor Minas has consulted for the Commonwealth Department of Health, the Australian Agency for International Development (AusAID), the International Organization for Migration and the World Health Organization. The Centre for International Mental Health is a World Health Organization Collaborating Centre.

Gihan Omar, Psy.D. is a licensed clinical psychologist and faculty member in the Yale University School of Medicine and the Program for Recovery and Community Health (PRCH). She specializes in multicultural health and cultural competency. During her work at Yale, Dr. Omar has conducted several projects within this focus and has received a grant from the National Institute on Drug Abuse (NIDA) to examine process and outcome variables influencing treatment adherence including ethnicity and ethnic identity of client and clinician and level of cultural competency of the clinician. In addition, Dr. Omar also develops and conducts cultural competency training and consultation as part of the PRCH Cultural Competency Training team at the statewide and national levels.

Ccile Rousseau, M.D., M.Sc., is Associate Professor, Dept of Psychiatry, McGill Univrtsity & Director, Transcultural Psychiatry Service, Montreal Childrens Hospital, where she has built a team addressing refugee and immigrant childrens mental health, with particular interest in children of war. She has conducted epidemiological and ethnographic research on the personal, family and cultural determinants of refugee childrens mental health. She has developed innovative school prevention programs for refugee and immigrant children and adolescents using creative expression workshops. In partnership with researchers in international law and community organizations, she has analyzed the cultural and psychological construction of immigration policies and their consequences for the mental health of refugees.

Leigh Turner, Ph.D. is an Assistant Professor in the Biomedical Ethics Unit and Department of Social Studies of Medicine at McGill University.Professor Turner is the Director of the Masters Specialization in Bioethics at McGill University.In addition, he is a clinical ethicist at Montreal General Hospital.From 1998-2000, Turner was an Assistant Professor at the University of Toronto Joint Centre for Bioethics and a clinical ethicist at Baycrest Centre for Geriatric Care and Sunnybrook & Women's College Health Sciences Centre. In 1999, he spent three months as a National Endowment for the Humanities/Sealy & Smith Visiting Scholar at the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. From 1996-1997, he was a Research Associate at the Hastings Center in New York. He completed his PhD in 1996 within the School of Religion and Social Ethics at the University of Southern California with a dissertation entitled Bioethics in a Pluralistic World.His current research addresses cultural and ethical dimensions of end-of-life care, the ethnocentric presuppositions ofvarious models of practical moral reasoning, and the relationship between bioethics and the social sciences.

Charles Watters, Ph.D. is Director of the European Centre for the Study of Migration and Social Care, Co-ordinator of the European MA in Migration, Mental Health and Social Care and Senior Lecturer in Mental Health at the University of Kent. His current work includes an international study of good practice in the mental health of refugees. funded by the European Commission. which includes detailed comparative study of developments in the UK, Netherlands, Spain and Portugal. He has also undertaken qualitative research on the experiences of asylum seekers and refugees in the UK in collaboration with the Refugee Council and the Medical Foundation for the Care of Victims of Council in London. He leads a research group at the University of Kent with a focus on evolving research methodologies for the study of refugees experiences in `developed countries.

Contact Information

Dr. Juan Almendares B. Executive Director Centre for the Prevention, Treatment and Rehabilitation for Torture Victims and their Relative, CPTRT Apartado Postal 5347 Tegucigalpa, Honduras Tel: (504) 232-4204 Fax: (235-3367 Email: cptrt [at] sdnhon.org.hn

Professor Morton Beiser Centre for Addiction & Mental Health, University of Toronto 250 College St., Toronto, ON M5T 1R8 416-979-4988 Email: mortonbeiser [at] rogers.com

Professor Gilles Bibeau Department of Anthropology Universit de Montral CP 6128,Succ. A., Montreal, Quebec H3C 3J7 514-343-6593 Email: gilles.bibeau2 [at] sympatico.ca

Alice Bullard Associate Professor History Georgia Institute of Techonology School of history, Technology & Society 685 Cherry Street Atlanta, Georgian 30332-0345 Tel: (404) 894-3196 Fax: (404) 894-0535 Email: alice.bullard [at] hts.gatech.edu

Raymond C.Y. Chung, MSW,RSW Executive Director Hong Fook Mental Health Association 1065 McNicoll Avenue Scarborough, ON M1W 3W6 Tel: 416-493-4242 x 222 Fax 416-493-2214 Email: rchung [at] hongfook.ca

Dr. Ellen Corin Douglas Hospital Research Centre Psychosocial Division, Lehman Pavillon 6875 Lasalle Blvd., Montreal H4H 1R3 5143-761-6131 x4339 Email: ellen.corin [at] douglas.mcgill.ca

Dr. Miriam Delphin Yale University Program on Recovery and Community Health 205 Whitney Avenue, Suite 306 New Haven, CT 06511 203-772-2086

Dr. Antoine Gailly Center for Mental Health-Brussels

E. Delvastraat 35, B-1020 Brussels, Belgium Tel (work): ++32 (0)2 428.99.00; Email (work): antoine.gailly [at] mail.be Tel (pr): ++32 (0)2 461.23.65; Email (pr): antoinegailly [at] yahoo.co.uk

Dr. Soma Ganesan Department of Psychiatry University of British Columbia 2250 Wesbrook Mall Vancouver, BC V6T 1W6 604-875-4115 Email: sganesan [at] vanhosp.bc.ca

Dr. Jaswant Guzder Institute of Community & Family Psychiatry Sir Mortimer B. DavisJewish General Hospital 4333 Cte Ste. Catherine Rd. Montreal, Quebec H3T 1E4 340-8222 x5965 Email: jaswant [at] videotron.ca

Dr. Matthew Hodes Senior Lecturer in Child and Adolescent Psychiatry Academic Unit of Child and Adolescent Psychiatry Imperial College of Science, Technology and Medicine St Mary's Campus, Norfolk Place London W2 1PG Tel: +44 (0)20 78861145 Fax: +44 (0)20 7886 6299 Email: m.hodes [at] imperial.ac.uk

Dr. Sushrut Jadhav Department of Psychiatry University College London Medical School 48 Riding House St., London, W1N 8AA, UK 44 207 679 9292 Email: s.jadhav [at] ucl.ac.uk

Dr. G. Eric Jarvis Institute of Community & Family Psychiatry Sir Mortimer B. DavisJewish General Hospital 4333 Cte Ste. Catherine Rd. Montreal, Quebec H3T 1E4 340-8222 x5178

Professor Joop de Jong Transcultural Psychosocial Organization (TPO) Keizersgracht 329, 1016 EE Amsterdam, Netherlands tel 31-20-6200005 fax 31-20-4223534 Email: jdejong.tpo [at] pom.nl

Professor Ravi L. Kapur National Institute of Advanced Studies Indian Institute of Science Campus Bangalore 560012, India Email: rlkapur [at] bgl.vsnl.net.in Email: kapur_ravinder_l [at] hotmail.com

Dr. Laurence J. Kirmayer Institute of Community & Family Psychiatry Sir Mortimer B. DavisJewish General Hospital 4333 Cte Ste. Catherine Rd. Montreal, Quebec H3T 1E4 514-340-7549 Email: laurence.kirmayer [at] mcgill.ca

Professor Myrna Lashley John Abbott College PO Box 2000 21275 Lakeshore Road Ste. Anne de Bellevue, Quebec H9X 3L9 514-457-6610 x5513

Dr. Hung Tat (Ted) Lo 409 -4040 Finch Avenue East Scarborough, Ontario M1S 4V5. Tel: 416-297-4807 Email: hilo [at] sympatico.ca

Professor Steve Lopez Department of Psychology University of California, Los Angeles 405 Hilgard Los Angeles, CA 90024-1563 310-206-8752 Email: lopez [at] psych.ucla.edu

Dr. Harry Minas Director, Victorian Transcultural Psychiatry Unit Level 2, Bolte Wing St. Vincent's Hospital 14 Nicholson Street Fitzroy, Victoria 3065 Australia Tel: +61 3 94110308 Fax: +61 3 94160265 Email: h.minas [at] unimelb.edu.au http://www.cimh.unimelb.edu.au

Dr. Gihan Omar Yale University Program on Recovery and Community Health 205 Whitney Avenue, Suite 306 New Haven, CT 06511 Cell phone: 203-675-9074

Dr. Carlo Sterlin Clinique Externe de psychiatrie, Hpital Jean-Talon 7345 rue Garnier Montreal, Quebec H2E 2A1 514-729-9036

Dr. Leigh Turner Biomedical Ethics Unit McGill University 3690 Peel Montreal, Quebec H3A 1W9 398-4239; 4239 Email: turner [at] falaw.lan.mcgill.ca

Dr. Charles Watters European Centre for the Study of Migration and Social Care Univ. of Kent, Canterbury, Kent CT2 7LZ, UK 0 1 227 823088 Email: C.Watters [at] ukc.ac.uk

Back to top