Cultural competence in mental health care: a review of model evaluations

BACKGROUND: Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups. METHODS: A systematic review that included evaluated models of professional education or service delivery. RESULTS: Of 109 potential papers, only 9 included an evaluation of the model to improve the cultural competency practice and service delivery. All 9 studies were located in North America. Cultural competency included modification of clinical practice and organizational performance. Few studies published their teaching and learning methods. Only three studies used quantitative outcomes. One of these showed a change in attitudes and skills of staff following training. The cultural consultation model showed evidence of significant satisfaction by clinicians using the service. No studies investigated service user experiences and outcomes. CONCLUSION: There is limited evidence on the effectiveness of cultural competency training and service delivery. Further work is required to evaluate improvement in service users' experiences and outcomes

Careif Position Statement on Migration and Mental Health

People have moved from one place to another within the same country or across national borders for millennia. The reasons for such movements have varied, as does the duration for which people migrate. With globalisation and global connections across countries, migration has increased. The process of migration and its impact on the mental health of individuals has been and will remain heterogeneous. The responses of migrants to the process vary, depending upon a number of factors. Individuals may migrate individually, with their families or in groups. They may move to avoid political or religious persecution and seek political asylum in another country (forced migration) or migrate for personal, employment, economic or educational reasons (voluntary migration). Although these two categorisations are often a little more complex than this. Not all migrants will feel negatively affected by migration. People may migrate on a seasonal, recurrent, permanent or temporary basis. It may be within or across generations. Many migrants will never access mental health services, whilst others may use these in varying ways and with diverse requirements or presentations. The experiences and requirements of voluntary and involuntary migrants may differ. Mental health Services may need to ensure that they are accessible and appropriate to all members of society including those who have migrated. This paper makes some suggestions in relation to this

Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review

<p>Abstract</p> <p>Background</p> <p>Studies suggest that the rates of self harm vary by ethnic group, but the evidence for variation in risk factors has not been synthesised to inform preventive initiatives.</p> <p>Methods</p> <p>We undertook a systematic literature review of research about self harm that compared at least two ethnic groups in the United Kingdom.</p> <p>Results</p> <p>25 publications from 1765 titles and abstracts met our inclusion criteria. There was higher rate of self harm among South Asian women, compared with South Asian men and White women. In a pooled estimate from two studies, compared to their white counterparts, Asian women were more likely to self harm (Relative Risk 1.4, 95%CI: 1.1 to 1.8, p = 0.005), and Asian men were less likely to self harm (RR 0.5, 95% CI: 0.4 to 0.7, p < 0.001). Some studies concluded that South Asian adults self-harm impulsively in response to life events rather than in association with a psychiatric illness. Studies of adolescents showed similar methods of self harm and interpersonal disputes with parents and friends across ethnic groups. There were few studies of people of Caribbean, African and other minority ethnic groups, few studies took a population based and prospective design and few investigated self harm among prisoners, asylum seekers and refugees.</p> <p>Conclusion</p> <p>This review finds some ethnic differences in the nature and presentation of self harm. This argues for ethnic specific preventive actions. However, the literature does not comprehensively cover the UK's diverse ethnic groups.</p

A follow-up on psychiatric symptoms and post-traumatic stress disorders in Tuareg refugees in Burkina Faso

Introduction: The aim of this study was to carry out a 2-year follow-up of refugees in a camp in Burkina Faso who had been interviewed previously. We also aimed to verify whether the general conditions in which they lived (e.g., protection by international organizations and the conclusion of negotiations and new hope of returning to Mali and reunification with surviving family members) would affect their mental health state. Methods: This is a cross-sectional study repeated over time on a cohort of refugees. People living in the Subgandé camp who had participated in the first survey in 2012 were identified using informational chains and approached for follow-up. Those who agreed were interviewed using the Short Screening Scale for post-traumatic stress disorder (PTSD) and the K6 scale, French versions, to measure general psychopathology and the level of impairment. Results: The second survey shows a dramatic decrease in psychopathological symptoms (positivity at K6 scale). Improvement was also conspicuous in the frequency of people with stress symptoms (positivity at Short Screening Scale for PTSD and simultaneous positivity to K6 scale). The frequency of people screened positive at the Short Screening Scale for PTSD had also decreased, but the level of improvement was not pronounced. Conclusion: Our findings confirm that when physical conditions improve, psychological symptoms can also improve. Although in the studied sample psychological factors, such as the hope of returning to their own land and thus the possibility of maintaining ethnic cohesion, may have played a role, future research carried out with a proper methodology and sufficient resources to identify protective factors is needed

Prevalence and predictors of video game addiction: a study based on a national representative sample of gamers

Video gaming has become a popular leisure activity in many parts of the world, and an increasing number of empirical studies examine the small minority that appears to develop problems as a result of excessive gaming. This study investigated prevalence rates and predictors of video game addiction in a sample of gamers, randomly selected from the National Population Registry of Norway (N =3389). Results showed there were 1.4 % addicted gamers, 7.3 % problem gamers, 3.9 % engaged gamers, and 87.4 % normal gamers. Gender (being male) and age group (being young) were positively associated with addicted-, problem-, and engaged gamers. Place of birth (Africa, Asia, South- and Middle America) were positively associated with addicted- and problem gamers. Video game addiction was negatively associated with conscientiousness and positively associated with neuroticism. Poor psychosomatic health was positively associated with problem- and engaged gaming. These factors provide insight into the field of video game addiction, and may help to provide guidance as to how individuals that are at risk of becoming addicted gamers can be identified

Effectiveness of guided self-help in decreasing expressed emotion in family caregivers of people diagnosed with depression in Thailand: a randomised controlled trial

Background: High expressed emotion (EE) can extend the duration of illness and precipitate relapse; however, little evidence-based information is available to assist family caregivers of individuals with depression. In the present exploratory study, we examined the effectiveness of a cognitive behaviour therapy (CBT) based guided self-help (GSH) manual in decreasing EE in caregivers of people with depression, in Thailand. Method: A parallel group randomised controlled trial was conducted, following CONSORT guidelines, with 54 caregivers who were allocated equally to GSH or control group (standard outpatient department support). In addition, both groups were contacted weekly by telephone. EE was assessed, using the Family Questionnaire (FQ), at baseline, post-test (Week 8) and follow-up (Week 12). Results: FQ scores at baseline indicated that both groups had similar, though moderately high level of EE. However, between baseline and post-test EE scores decreased markedly in the intervention group, but in contrast, they increased slightly in the control group. Between post-test and follow-up, little change took place in the EE scores of either group. Overall, the intervention group recipients of GSH showed a significant decrease in EE whereas the control group recipients of standard outpatient department support reported a slight increase in EE. Conclusion: These findings provide preliminary evidence that GSH is beneficial in reducing EE in caregivers, which is advantageous to family members with depression and caregivers. The approach may be used as an adjunct to the limited outpatient department support given to caregivers by mental health professionals and, perhaps, to caregivers who do not attend these departments

WPA guidance on mental health and mental health care in migrants

The WPA is committed to promote equity in the access to mental health services for persons of different age, gender, race/ethnicity, religion and socioeconomic status. As part of this commitment, the Association decided to devote one of the guidances to be developed within its Action Plan 2008-2011 (1,2) to mental health and mental health care in migrants. A Task Force was appointed for this purpose, which produced the present document. Mental health practitioners work in an increasingly multicultural world, shaped by the migrations of people of many different cultural, racial and ethnic backgrounds. People migrate for many reasons: political, socioeconomic and educational. The diversity of cultures, ethnicity, races and reasons for migration can make understanding experiences of illness challenging in migrants whose background differs significantly from the clinician. Culture has an important role in the presentation of distress and illness, and cultural differences impact upon the diagnosis and treatment of migrant populations in part due to linguistic, religious and social variation from the clinician providing care. Additionally, it appears that the incidence and prevalence of mental disorders varies among people of different cultural backgrounds, due to an interplay of biological, psychological and social factors. The provision of health care is necessarily influenced by the demands of people of many different cultures, and it is important that cultural differences be appreciated and understood to arrive at a correct diagnostic impression and treatment plan

Moving Beyond Christianity: Islam, Judaism, Hinduism and Mental Health

To date the literature on religion and mental health has focused upon Christianity. We cannot assume that these findings can be transposed onto other faith groups. In this paper I focus upon Islam, Judaism and Hinduism and discuss understandings of mental illness and the relationships between central beliefs and mental health. I discuss implications for clinical work and psychotherapy