Globalization, culture and mental health [Editorial]

The idea for this special edition of the International Review of Psychiatry edited by Rachel Tribe and Steve Melhuish arose out of a conference with a similar title, ‘Globalisation, culture and psychology’, held at the University of Leicester in 2012, where a number of the journal contributors presented their ideas. Globalization, culture and mental health is a complex, multidimensional theme, potentially covering large and diverse areas of literature and practice as well as a range of contemporary debates and politically charged narratives. It is not possible to do justice to all of the potential avenues that could be explored; as such, this special edition is inevitably partial and selective in what it covers. It comprises articles written by authors from a number of countries: Cuba, Ethiopia, India, Sri Lanka and the UK. Many of the contributors are applied psychologists and as such there is a strong focus on the intersection between psychology and the broader themes of globalization and culture. However, there are also articles about the global mental health movement and cultural formulation written by psychiatrists and a service user/expert by experience

Cuban internationalism – An alternative form of globalization

This paper looks at how the principles of internationalism have been integral to the Cuban healthcare system and to Cuba's cooperation and medical support in other countries around the world. The paper details the range and scope of Cuban health internationalism and the principles that underpin the Cuban approach of long-term collaboration, humane care, contextualization, trans-disciplinarity, respect for collective/historical memory and an ethical stance. The paper details the role of Cuban psychologists who have contributed to disaster relief work and gives an example of the Cuban approach in relation to Haiti following the earthquake in 2010

An investigation of cultural competency in the experiences of therapists newly trained to deliver cognitive-behavioural therapy

Background: Policies and guidance on the provision of mental health services to the diverse UK population acknowledge the need for therapists to be able to deliver psychological interventions in a culturally sensitive way to meet the needs of Black and Minority Ethnic groups. The requirements are highly relevant to Cognitive-Behavioural Therapists employed under the national Improving Access to Psychological Therapies programme which was introduced to address common mental health problems. Research rationale: Literature contains a wealth of material relevant to the cultural competency required of psychological practitioners, however writers have tended to focus on different facets of competency. A framework based on the guidance dispersed throughout the literature would serve as useful tool to investigate whether therapists emerging from IAPT training work in a way that is consistent with cultural competency practice guidance. A study could also explore how cultural competency, if evident, is acquired and how training contributes. Method: A narrative review of the literature was conducted to generate a thematic template that could be contrasted with the views and practices of therapists who had recently undergone IAPT training. Focus group interviews were conducted with participants at three IAPT services and the captured data was thematically analysed using Template Analysis whereby the themes from the review could be incorporated into the template used for the analysis. Findings: Participants demonstrated a range of perspectives and practices that were consistent with cultural competency guidance in the literature. Abilities were attributed to personal and professional experience, and to personal motivation to develop the capacity to work sensitively. Training was not considered to have significantly contributed to cultural competency and suggestions for how it may be improved were presented. It was concluded that it was possible for therapists to work in a culturally sensitive way without a comprehensive training based on cultural competency guidance, but that improvements for training could be drawn from the study.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Seeking asylum : postmigratory stressors and asylum seeker distress

1.1 Background: Despite growing recognition of the negative impact of ever stringent asylum employed by western governments, psychological conceptualisations of distress in these populations remains dominated by traumamodels. 1.2 Literature Review: A systematic literature review was conducted to collate and critique findings from studies relating postmigratory stress to asylum seeker distress. The 44 reviewed studies suggested asylum seekers endure a range of postmigratory stressors relating to acculturative challenges, social isolation, material deprivation and restrictive asylum legislation. Difficulties associated with conducting research with these populations are acknowledged. It is concluded that restrictive asylum policies greatly inhibit asylum seekers’ abilities to negotiate challenges resulting from displacement. Smail’s (2005) social materialist perspective is suggested as a framework for findings. 1.3 Research Report: No known British empirical research has focused on exploring relationships between postmigratory-stress and asylum seeker mental health. Based on established methodologies (e.g. Silove et al.,1997) a cross-sectional study was undertaken to explore the relative relationship with distress of postmigratory-stressors and premigratory-trauma exposure. An opportunity sample of 98 asylum seekers completed measures of postmigratory-stress (the PLDC: Silove et al., 1997); premigratory-trauma exposure (HTQ-TE; Mollica et al.,1992) and distress (HTQ-PTSD: Mollica et al.,1992; HSCL-25: Hesbacher et al.,1980; Winokur et al.,1984). High levels of exposure to premigratory-traumatic events, postmigratory stress, and distress were reported. Regression analyses revealed ‘Feeling a burden to others’ and being denied asylum to be the strongest predictors of distress. It is concluded that a range of postmigratory stressors impact negatively on asylum seeker wellbeing. Those denied asylum experience more restrictions and poorer mental health. Limitations are acknowledged. 1.4 Implications: The literature review and research report conclude that present asylum determination processes are damaging to those seeking refuge. Psychotherapeutic interventions directed at the intra-psychic level may be of limited effectiveness given the more primary social and material needs of these clients. 1.5 Critical Appraisal: Reflections on the research process are presented alongside key learning points.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Seeking asylum : postmigratory stressors and asylum seeker distress

1.1 Background: Despite growing recognition of the negative impact of ever stringent asylum employed by western governments, psychological conceptualisations of distress in these populations remains dominated by traumamodels. 1.2 Literature Review: A systematic literature review was conducted to collate and critique findings from studies relating postmigratory stress to asylum seeker distress. The 44 reviewed studies suggested asylum seekers endure a range of postmigratory stressors relating to acculturative challenges, social isolation, material deprivation and restrictive asylum legislation. Difficulties associated with conducting research with these populations are acknowledged. It is concluded that restrictive asylum policies greatly inhibit asylum seekers’ abilities to negotiate challenges resulting from displacement. Smail’s (2005) social materialist perspective is suggested as a framework for findings. 1.3 Research Report: No known British empirical research has focused on exploring relationships between postmigratory-stress and asylum seeker mental health. Based on established methodologies (e.g. Silove et al.,1997) a cross-sectional study was undertaken to explore the relative relationship with distress of postmigratory-stressors and premigratory-trauma exposure. An opportunity sample of 98 asylum seekers completed measures of postmigratory-stress (the PLDC: Silove et al., 1997); premigratory-trauma exposure (HTQ-TE; Mollica et al.,1992) and distress (HTQ-PTSD: Mollica et al.,1992; HSCL-25: Hesbacher et al.,1980; Winokur et al.,1984). High levels of exposure to premigratory-traumatic events, postmigratory stress, and distress were reported. Regression analyses revealed ‘Feeling a burden to others’ and being denied asylum to be the strongest predictors of distress. It is concluded that a range of postmigratory stressors impact negatively on asylum seeker wellbeing. Those denied asylum experience more restrictions and poorer mental health. Limitations are acknowledged. 1.4 Implications: The literature review and research report conclude that present asylum determination processes are damaging to those seeking refuge. Psychotherapeutic interventions directed at the intra-psychic level may be of limited effectiveness given the more primary social and material needs of these clients. 1.5 Critical Appraisal: Reflections on the research process are presented alongside key learning points.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Identity and psychological well-being : experiences of Zimbabwean males seeking asylum in the UK

In many western nations, immigration policies place significant restrictions upon individuals seeking asylum, such as denying them access to employment. The literature review set out to explore whether factors related to the post-migratory environment have implications for forced migrants’ identity and psychological well-being, via the loss of social roles. Systematic literature searches were conducted, resulting in a total of 27 relevant papers to be reviewed. It was tentatively concluded that both unemployment and social isolation contribute to the high levels of psychological distress observed amongst forced migrant populations, and that this relationship is mediated by social role loss. However, the synthesis of findings across studies was limited by methodological weaknesses and the range of nationalities studied. It was suggested that further research is required. The research study employed a qualitative, semi-structured interview design to explore identity issues and psychological well-being in a sample of seven Zimbabwean males seeking asylum in the UK. The data was analysed using Interpretative Phenomenological Analysis. Participants described negative consequences for their identities as a result of the economic and political downturn in Zimbabwe and revealed that their identities were further threatened upon arrival in the UK due to the many losses they had incurred by migrating. The legislative restrictions imposed upon them and the negative social representations they were exposed to as asylum seekers also served to threaten their identities and to undermine attempts to rebuild a positive sense of themselves. However, all participants described having regained some positive aspects of their identities and many talked about personal growth as a result of the adversity they had experienced. The findings were interpreted with reference to previous research and relevant psychological theory. Implications for clinical practice and suggestions for future research were discussed. The critical appraisal provides the researchers’ personal reflections on the research process.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Seeking asylum: Exploring the relationship between postmigratory stressors and mental health for asylum seekers and refused asylum seekers in the UK

Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems amongst these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated participants (N = 97) had endured a range of pre- and postmigratory stressors and scored highly on measures of anxiety, depression and PTSD. A postmigratory factor, comprised of items associated with isolation, restrictive policies and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile