Cultural Consultation: A Model of Mental Health Service for Multicultural Societies

Division of Social and Transcultural Psychiatry, McGill University, Culture and Mental Health Research Unit, Sir Mortimer B Davis-Jewish General Hospital, Montreal, Quebec.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 05/2003; 48(3):145-53. DOI: 10.1176/foc.4.1.125
Source: PubMed


This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers.
We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance.
Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up.
The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.

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Available from: Jaswant Guzder, May 04, 2014
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    • "). An evaluation of this McGill model found evidence of improved diagnostic accuracy, culturally relevant care planning and workforce satisfaction, and highlighted the need for healthcare professionals to receive further training in working with interpreters (Kirmayer et al. 2003). "
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    ABSTRACT: Cultural competence is defined as a set of skills, attitudes and practices that enable the healthcare professionals to deliver high-quality interventions to patients from diverse cultural backgrounds. Improving on the cultural competence skills of the workforce has been promoted as a way of reducing ethnic and racial inequalities in service outcomes. Currently, diverse models for training in cultural competence exist, mostly with no evidence of effect. We established an innovative narrative-based cultural consultation service in an inner-city area to work with community mental health services to improve on patients' outcomes and clinicians' cultural competence skills. We targeted 94 clinicians in four mental health service teams in the community. After initial training sessions, we used a cultural consultation model to facilitate 'in vivo' learning. During cultural consultation, we used an ethnographic interview method to assess patients in the presence of referring clinicians. Clinicians' self-reported measure of cultural competence using the Tool for Assessing Cultural Competence Training (n=28, at follow-up) and evaluation forms (n=16) filled at the end of each cultural consultation showed improvement in cultural competence skills. We conclude that cultural consultation model is an innovative way of training clinicians in cultural competence skills through a dynamic interactive process of learning within real clinical encounters.
    Journal of Psychiatric and Mental Health Nursing 11/2013; 21(9). DOI:10.1111/jpm.12124 · 0.84 Impact Factor
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    • "Patient dissatisfaction arises more frequently from poor communication than from medical errors [62], and language barriers degrade the quality of care, resulting in poorer health outcomes [63,64]. Culture frames the experience and expression of emotional distress and social problems [65]. Language barriers and the cultural complexity of assessing symptoms have been shown to prevent adequate diagnosis and treatment [65]. "
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    ABSTRACT: Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service -- Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Twenty-five studies met the inclusion criteria for this review of which15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.
    International Journal for Equity in Health 11/2013; 12(1):88. DOI:10.1186/1475-9276-12-88 · 1.71 Impact Factor
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    • "Therefore, the causes of dissatisfaction with care, failure to engage with services or accept treatment, and fears about safety may be explained by inherent communication problems that reflect different underlying assumptions and expectations about the causes and treatments of mental and emotional distress [6]. Ineffective communication and failed negotiation because of these differences may then lead to a feeling of not being understood, omissions of important information from the clinical assessment, conflict with staff, disengagement and/or a failure to take up interventions [6,7]. This may lead to more severe and more frequent episodes of illness and in turn the use of coercion, which is also associated with a higher rate of adverse incidents. "
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    ABSTRACT: Background Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes. Methods The THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature. Discussion A particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661).
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