Comprehensive Textbook of Psychiatry.

The upshot of these needs for change is both dismaying and exciting, both disturbing in the destruction of long-familiar patterns of dealing with human suffering, and paradoxically hopeful in raising the possibility that significant failures in our health care systems of the past — limited access to medical care and grossly inadequate public sector “non-systems”, for example — may now be addressed more successfully.

Administration and policy in mental health

In recent years, cultural competence has become a popular term for a variety ofstrategies to address the challenge of cultural diversity in mental health services.This issue of Transcultural Psychiatry presents papers from the McGill AdvancedStudy Institute in Cultural Psychiatry on ‘‘Rethinking Cultural Competencefrom International Perspectives,’’ which was held in Montreal, April 27and 28, 2010. Selected papers from the meeting have been supplemented withother contributions to the journal that ﬁt the theme. Taken together, thesepapers show how conceptual analysis and critique of cultural competence canpoint toward ways to improve the cultural responsiveness, appropriateness andeﬀectiveness of clinical services, and in doing so contribute to reducinghealth disparities.Cultural diversity poses challenges to mental health services for many reasons.Culture inﬂuences the experience, expression, course and outcome of mentalhealth problems, help-seeking and the response to health promotion, preventionor treatment interventions. The clinical encounter is shaped by diﬀerencesbetween patient and clinician in social position and power, which are associatedwith diﬀerences in cultural knowledge and identity, language, religion and otheraspects of cultural identity. Speciﬁc ethnocultural or racialized groups may suﬀerhealth disparities and social disadvantage as a result of the meanings and mater-ial consequences of their socially constructed identities. In some instances, cul-tural processes may create or constitute unique social and psychological problemsor predicaments that deserve clinical attention. In culturally diverse societies,the dominant culture, which is expressed through social institutions, includingthe health care system, regulates what sorts of problems are recognized and whatkinds of social or cultural diﬀerences are viewed as worthy of attention.A large literature shows the importance of social determinants of healthincluding social status, employment, education, wealth and social support

https://journals.sagepub.com/doi/pdf/10.1177/1363461512444673

Rethinking cultural competence

Background: In developing countries, most people with mental, neurological and substance-abuse (MNS) disorders do not receive adequate care mainly because of a lack of mental health professionals. Non-specialist health workers, but also other professionals with health roles, such as teachers, may therefore have an important role to play in delivering MNS health care. Researchers in The Cochrane Collaboration carried out a review of the effects of using non-specialist health workers or other professionals with health roles to help people with MNS disorders in developing countries. After searching for all relevant studies in scientific databases, they found 38 studies published before October 2012. Their findings are summarised below. What is a non-specialist health worker? Any type of health worker (like a doctor, nurse or lay health worker) who is not a specialist in mental health or neurology but who may have had some training in these fields. We also looked at teachers, as they can be particularly important in the care of children and youths. What the research says: The studies in this review were from 22 developing countries. In most studies, lay health workers delivered the mental health care, and addressed depression or anxiety (or both), or post-traumatic stress disorder. The review shows that the use of non-specialist health workers, compared with usual healthcare services: Â· may increase the number of adults who recover from depression or anxiety (or both) two to six months after treatment; Â· may slightly reduce symptoms formothers with depression; Â· may slightly reduce the symptoms of adults with post-traumatic stress disorder (non-specialists and teachers were used in one study); Â· probably slightly improves the symptoms of people with dementia; Â· probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia; Â· may decrease the quantity of alcohol consumed by problem drinkers. It is uncertain whether lay health workers or teachers reducepost-traumatic stress disorder symptoms among children. There were too few studies to draw any conclusions about the cost-effectiveness of using non-specialist health workers or teachers, or about their impact on people with other MNS conditions such as epilepsy, schizophrenia, and alcohol and drug abuse problems. In addition, very few studies measured unintended consequences of non-specialist health worker-led care - such effects could impact on the appropriateness and quality of care. Quality of the evidence: Overall, non-specialist health workers and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, post-traumatic stress disorder and alcohol-use disorders, and patient and carer outcomes for dementia. However, this evidence is of low or very low quality in some areas, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific interventions using non-specialist health workers to help people with MNS disorders are more effective.

/pdf/non-specialist-health-worker-interventions-for-the-care-of-4p2djvvv9r.pdf

Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries.

Social Determinants of Health: Canadian Perspectives

This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.

/pdf/guidelines-for-training-in-cultural-psychiatry-1p3ranrbio.pdf

Guidelines for Training in Cultural Psychiatry

Summary: Purpose: David Taylor and Murray Falconer suggested that some patients may develop a psychotic illness after resection of a ganglioglioma that led to intractable seizures. They implied that the mechanism of this association remained unclear. This concept is currently not universally accepted (M. Trimble, personal communication).



Methods: We studied six children or young adults from four centers who developed psychosis after resection of a ganglioglioma or dysembryoplastic neuroepithelioma (DNET).



Results: All patients were operated on because of intractable epilepsy. The lesions involved mainly the temporal lobe. Patients had good outcomes for seizure control. In none of the six was potentially psychogenic medication used nor were the psychotic symptoms postictal in nature. The psychosis was schizophreniform with paranoid features and prominent depressive symptoms. Although some behavioral abnormalities were described preoperatively, none had been psychotic before operation. This type of psychotic reaction was not encountered in the four centers in a comparable period after resection of other types of lesions. This complication is rare; it occurred in only one of 39 patients who had such a lesion resected.



Conclusions: Psychotic illness may rarely occur after resection of a ganglioglioma or DNET for treatment of intractable epilepsy. This does not seem to occur after removal of other types of lesions. Because the patients had good outcomes for seizures, the mechanism may be related to “forced normalization.” The original observations of Taylor and Falconer are confirmed by this study; the reasons for the selective occurrence, however, remain speculative.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1528-1157.1999.tb01992.x

Psychosis after resection of ganglioglioma or DNET : Evidence for an association

Cultural competence is increasingly recognized as an essential component of effective mental health care delivery to address diversity and equity issues. Drawing from the literature and our experience in providing cultural competence consultation and training, the paper will discuss our perspective on the foundational concepts of cultural competence and how it applies to a health care organization, including its programs and services. Based on a recent consultation project, we present a methodology for assessing cultural competence in health care organizations, involving mixed quantitative and qualitative methods. Key findings and recommendations from the resulting cultural competence plan are discussed, including core principles, change strategies, and an Organizational Cultural Competence Framework, which may be applicable to other health care institutions seeking such changes. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental health care service to the diverse patients, families, and communities.

https://journals.sagepub.com/doi/pdf/10.1177/1363461512439740

Organizational cultural competence consultation to a mental health institution

The social construction of gender is an important concept for better understanding the determinants of mental health in women and men. Going beyond physical and physiological differences and the traditional biomedical approach, interdisciplinary study of the complex factors related to culture and society, power and politics is necessary to be able to find solutions to situations of disparity in mental health, related to both prevalence of disorders, availability and response to treatment. Gender inequality continues to be a source of suffering for many women around the world, and this can lead to adverse mental health outcomes. This review focuses on developments in the literature on culture, gender and mental health over the past decade, focusing on themes around the social construction of gender, mental health and the media, a look at cultural competence through a gender lens, gender and the body, providing some examples of the intersection between mental health and gender in low-income countries as well as the more developed world, and the impact of migration and resettlement on mental health. At the clinical level, using a bio-psycho-social-spiritual model that can integrate and negotiate between both traditional and biomedical perspectives is necessary, combined with use of a cultural formulation that takes gender identity into account. Research involving both qualitative and quantitative perspectives, and in many cases an ethnographic framework, is essential in tackling these global issues.

Culture and the social construction of gender: mapping the intersection with mental health.

Objective
As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country.

Lisa Andermann

Papers

Guidelines for Training in Cultural Psychiatry

Psychosis after resection of ganglioglioma or DNET : Evidence for an association

Organizational cultural competence consultation to a mental health institution

Culture and the social construction of gender: mapping the intersection with mental health.

An Integrative Approach to Cultural Competence in the Psychiatric Curriculum.