STIHR Culture & Mental Health Research 2003-2009

Introduction

The Culture and Mental Health Services program funded by the Canadian Institutes of Health Research trains researchers to study the impact of cultural variations on the cause and course of psychiatric disorders and to evaluate the effectiveness of interventions and models of mental health services for multicultural populations.

Download the CIHR brochure [.pdf] here.

Our faculty includes leading researchers in psychiatry, psychology, anthropology, epidemiology, sociology and bioethics. The program trains researchers in these disciplines to combine epidemiological, ethnographic and clinical research methods to produce more accurate and valid information on the mental health status and service needs of immigrants, refugees, and ethnocultural communities. The program also trains researchers to conduct international research in mental health services to address the relevance of models of mental health care for Canadian society as well as for service needs in developing countries.

The training program is based at the Division of Social and Transcultural Psychiatry of McGill but involves senior researchers from the University of Montreal, Toronto and UBC as well as University College London, Harvard, UCLA and the Universities of Melbourne, Kent, Copenhagen and Paris. Research mentors and collaborating faculty include scholars in the fields of psychiatry, psychology, anthropology, sociology, bioethics, law, public health, social work and health economics who have worked together over the last 15 years to develop a transdisciplinary approach to research on culture and mental health that emphasizes:

• an ethnographic approach to the study of diagnostic categories, theories and styles of reasoning in mental health theory and practice;
• culturally-grounded studies of local ways of expressing, interpreting and managing suffering, pain and illness (i.e. popular idioms of distress, explanatory models, and systems of meaning);
• a focus on models of mental health services and intervention that can respond to the cultural diversity of immigrants, refugees and ethnocultural communities.

The program includes graduate and postgraduate training for researchers from diverse health and social science backgrounds who wish to develop expertise in conceptualizing and measuring cultural dimensions of health care. The emphasis is on conducting research in collaboration with faculty and their collaborators across Canada and internationally and participation in ongoing training seminars developed in close articulation with the research.

The coupling of research in clinical and community settings provides a unique setting for training well-rounded health services researchers ready to tackle the challenges likely to emerge with the increasing diversity of Canadian society in the years to come.

Rationale

Although problems of under-utilization of services and under-detection and inappropriate treatment of common mental disorders affect many groups in society, there is evidence that they are particularly severe for immigrants, refugees and ethnic minorities as well as for Aboriginal peoples in urban and rural settings. There continues to be a dearth of research on immigrant, refugee and Aboriginal mental health services. This training program will prepare researchers to address basic conceptual and methodological issues in designing, delivering and evaluating mental health services for Canada's culturally diverse population. It will also train Canadian researchers in skills needed to contribute to conducting mental health services research in developing countries.

The need for the program follows from several compelling facts:

1. The increasing cultural diversity of Canada's population makes issues of culture crucial to the development and evaluation of effective health services. Fully 1 in 6 of all people in Canada are foreign born and most of the more than 200,000 people who come to Canada each year are from Asia, Africa, the Middle East and Latin America-societies with great internal diversity and significant differences from the European cultures prevalent in earlier waves of migration.
   
2. There is good evidence that cultural differences contribute to health disparities and unequal access to care. A growing body of literature demonstrates how cultural factors affect every aspect of psychopathology and treatment; however, this knowledge is not well integrated into existing models of service and clinical practice in Canada.
   
3. Notions of culture, ethnicity and "race" tend to be poorly addressed in much current health services research. This is largely due to a lack of integration of contemporary social science theory and methods of qualitative research. The transdisciplinarity of the area of culture and mental health demands that trainees have adequate exposure to methods and models from psychiatry, psychology, anthropology, epidemiology, sociology, and bioethics, as well as other clinical and social science disciplines.
   
4. Cultural diversity is conceptualized in markedly different ways in different countries depending on local histories of migration, ideologies of citizenship and patterns of ethnic identity so that research done in other countries cannot always be applied to the Canadian situation. At the same time, the comparative study of models of health services in different countries can shed light on the particularities of the Canadian situation and point the way to innovation.
   
5. The fact that most people with mental illness if they consult, seek help in primary care settings means that there is a need for researchers to learn how to work with primary care practitioners to conduct research responsive to their needs and the needs of the populations they serve.
   
6. Researchers must learn how to work collaboratively with ethnocultural communities to conduct research that is responsive to community needs and respects ethical and cultural concerns. There is also a need for researchers to learn how to effectively disseminate research results to health planners, providers and consumers so that knowledge informs policy, stimulates improved practice, and contributes to the welfare of involved communities.
   

Objectives

We provide graduate and postgraduate research training in culture and mental health services:

1. to train researchers to integrate epidemiological and ethnographic (quantitative and qualitative) research methods to produce more accurate and valid information on the mental health status and service needs of immigrants, refugees, Aboriginal peoples and ethnocultural communities;
   
2. to train researchers to identify the influence of cultural and social factors on the pathways and barriers to care, mental health service design and delivery, and the response to treatment of individuals with the range of mental health problems including psychiatric disorders;
   
3. to train researchers to critically evaluate and study ethical issues in cross-cultural mental health research and clinical practice;
   
4. to train researchers in the development of community partnerships for participatory research and in the effective dissemination of research findings to policy makers, cultural communities, primary care institutions and practitioners, and other stakeholders;
   
5. to develop and disseminate curricula, methods and materials for training researchers from psychiatry, psychology, primary care, social work, nursing and social sciences to integrate cultural frameworks into studies on psychiatric disorders, health services, and health promotion.
   
6. to evaluate innovative training methods addressing the social context of mental health services, in particular the fragmentation of service, the need for support of service providers and the transfer of skills in transcultural intervention.
   

Research training curriculum materials and mentorship for projects will be made available more widely through an Internet web-site and the Annual McGill Summer Program in Social and Cultural Psychiatry.