Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
4.6 cultural competence and multicultural mental health care
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來自 University of Toronto 的課程
The Social Context of Mental Health and Illness
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Culture, mental health and mental illness
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Charmaine WilliamsAssociate Professor
Faculty of Social Work
>> Okay, I know that many of you will remember meeting Caroline Kwak in the
first lecture. And, during the interview that I had with
her, we actually talked about culture and mental health and cultural confidence,
which is what's going to be introduced next.
So I'm going to turn it over to that interview, and I'll be back at the end.
. >> Now the thing is, you know, these, the,
the dose of a medication is lowered. >> Mm-hm.
>> Than the normal, quote unquote, Canadian folks, you know?
Because I think that's for the Caucasian folks, right?
Only we depend so much on the, on the, on the illness.
>> Mm-hm. >> Because at one time, the doctor, the
psychiatrist, who, caused me to coma, he said, Caroline, you speak fast.
I'm going to increase the dose to 102, 1,200 milligram, of[INAUDIBLE].
So, of course I didn't believe in him, [laugh] after the coma that he had done
for me. >> Um-hm.
>> And then I went to see Doctor Wong, my GP.
And then he gave me 600 milligrams of Epidal.
>> Um-hm. >> Well, little research shows, this is
very important, because research shows that Asians and American and Canadian
native people. They, because the body's intake is
different one should be given a lesser dose of neuroleptic medications.
>> Mm-hm.. >> That is not my words it comes from
research. >> Well, part of what I think I, I'm
hearing in your story is, one, that he should have appreciated that you might
need a lower dose because of your, who you are.
But also, that his feeling that you were talking too fast, ...
>> Hm, am I talking too fast? >> I, well, I mean it's, do you think
that, that reflected his I don't know, his, his, his, his stereotypes about how a
woman, an Asian woman should speak, or, I, like, it makes me wonder if he was
diagnosing something. He, he saw your talking fast as a symptom
of an illness but, but really that's a very subjective judgement, whether it's.
>> Yeah, I think so. It also maybe it has to do with the
cultural stereotype. You're right.
As I mention in the book, you know, even at the in the days when I was first
diagnosed, well, did the doctor really understand that I am an individual.
Or do they just love me? >> Mm-hm.
>> All at once, oh, this is an Asian woman.
She should. The stereotype thinking.
We'll be quiet,[LAUGH] slow. >> Mm-hm.
>> And the, and the, and the communication, the non-verbal and the
verbal communication should be lower ones eyes, and that kind of stuff.
>> Mm-hmm. >> Maybe I'm different because I, maybe at
one time I was educated at the University of Minnesota, and later at Yale.
Which, you know, with all this connections and all.
And also, even when I was young, young, in high school [laugh], I was supposed to be
the rebellious type. So, you know, so this is what I hope that
the mental health professionals will not lump a person because that person is
Asian, [unknown] that person is black. >> Mm-hm.
>> Lump them. You know, I think that, you know, for a
lot of these black folks, that have been misdiagnosed as schizophrenic.
>> Mm-hm. There is a research literature that speaks
to that, yes. >> Yeah, so.
>> I know that you know, this is one of the areas that you've actually been a very
active advocate on. Having mental health professionals more
culturally sensitive in their approaches. >> Yeah.
>> Yeah. So, could you, could you talk a bit about,
you know, what your hopes would be for how we could be bringing culture into the way
that we think about mental health? >> Well, first of all is to develop some
competent cultural competence causes. >> Mm-hm.
>> That might involve people like me or whoever that have experienced this kind of
cultural issue. >> Mm-hm, You know what I, I'm going to
ask you to, to say, can you say what cultural competence is because I'm going
to guess that the people who are watching this will not necessarily have heard that
term. >> Cultural competence, that is, if I'm
correct, if you ask any other people. >> No, as you define it.
>> As I define it, is that you know, like a person, a psychiatrist, they have this
medical competence, but a lot of them, they don't seem to have the cultural
competence, the wisdom, to understand what the culture of this, of the clients come
from. And then derive some of the, the, the
diagnosis has to be derived both from the medical competence, as well as the, from
the cultural competence. A lot of the time, a lot of the time,
right, in the DSM-IV. >> Mm-hm.
>> Do they understand what's in the DSM-IV?
>> And, by the time they see this, they should have seen yeah, the definition of
the DSM. >> Yeah, in the DSM four, right, there's
little mention of this cultural, cultural formulation of it.
And it was only at the very end, I seen they only got 6 pages.
>> Yeah, it's an appendix. >> Yeah, an appendeix.
So, you know, even a trained psychiatrist almost like here to resident.
Would I be able to really look into this kind of appendix to apply into my
situations? >> Mm-hm.
>> So what I, another thing of, so this is why I hope that you're like a maybe, I
think, DSM-V will be coming in May 2013. >> That's what they say.
>> It is, because when I went to take a course at the university, at Boston, you
know, like, they said that the person said that it's going to be out in May 2013.
>> Mm-hm. >> So I hope that there will add more of
these cultural issues. There's a lot, the world is headed to be
so diversed culturally. >> Well I can tell you actually what they
proposed. Are you interested?
>> Yeah, sure. >> Yeah?
So. They have something called the cultural
formulation interview. And it's, I don't think it's in an
appendix. But it is presented as if you do your
normal interview, and then you do the cultural formulation interview.
Now one of the things that they've said is it's quite clearly not supposed to be
something that's only triggered when you think you have something, somebody in
front of you who represents some sort of exotic cultural experience.
The questions are, are quite deliberately written so that they should apply to
anyone, because we all have culture. We all have things in our cultural
background that influence the way that we think about illness or whether we feel
will or what should be done about it and all this sort of thing.
But I'm not sure how much improvement it is because it's still a separate
interview. >> Yeah.
>> So I think it will be, it will be all in how they communicate to people about
how important it is to actually do an interview that tries to understand how,
how culture has impact on people's experience of illness and healing.
>> You know, when you talk about cult, as cultural in, aspect, one of the things I
think of would be communication. >> Mm-hm.
>> The verbal or the non-verbal communication of a client that comes from
a different culture. Mm-hm.
>> You know when we talk about stereotyping and that, it, also, what if
an immigrant cannot speak English. So they depend so much on the
interpreters. You know I read a lot of this literature
from the library. They talk about all these wonderful ideas
of having this interpreter[UNKNOWN], all this kind of training, but in reality as
far as I'm concerned, actually on my way to, St George here.
>> Mm-hm. >> I just ran into a friend of mine.
She does she's an interpreter. She just had two years, one year of
training. >> Mm-hm.
>> And that's about it, you know? >> You don't think it's enough?
>> The training doesn't really concentrate on the psychiatric items.
>> Yes. >> It concentrate on not every one of
these illnesses. >> Yes.
>> So I think that there should be some special, special training, to be done.
Because look, immigrants, whether people like it or not, are all over the world.
There's lot of immigrants in Canada, in the states, in Australia, in the United
Kingdom and in New Zealand. >> Mm-hm.
>> All of these English speaking countries.
>> Yes, Mm-hm. You're quite right.
So we're, many of us are living in multicultural environments.
We know that there are all of these stressors that are associated with
immigration and settlement that can provoke mental illness.
>> You're right. >> So, I mean, and, and people are
citizens in our community, so they're going to become ill just like anybody else
can become ill. We do need to understand.
>> Yeah, and I think that we should develop some strategies.
>> Mm-hm. >> Rather than all those big words in
books. Strategies.
>> Mm-hm, Mm-hm. >> Practical strategies.
>> Mm-hm. .
So, cultural competence and multicultural mental health care.
I don't know that I can add much more to what Caroline said.
She spoke to it so well. But just to wrap this up, I'll just say,
cultural competence is something that's being identified as a priority for mental
health care systems across the world. And as Caroline said, we're all living in
multicultural environments now. And what cultural competence often asks of
us is that we are able to demonstrate behaviors, and have service systems, and
have policies and ways of working, that mean that we are effective in
cross-cultural situations. If a system is culturally competent, then
no matter who you are, no matter what language you speak, no matter what gender
you present with, no matter what sexuality you have, you should be able to get
effective mental health care. And culture should not be a barrier to
that. And we often see culture competence being
broken down into these areas that we see here.
Cultural awareness, cultural knowledge, skills and then policies and practices.
Some of the things that have been introduced as strategies from
multicultural mental health care include things like having language-skilled staff,
so Caroline refers to interpreters. And there are lot of people who work with
interpreters, but there's a lot of ambivalence and, in some places,
negativity about interpreters for the reasons that she mentioned.
Certainly having a staff group and service providers that are skilled in different
languages strengthens the cultural competence of a mental health care system.
Another thing is diversity of service providers.
So that, if you have a workforce that it represents all kinds of languages,
cultural backgrounds, ethnic backgrounds, sexualities.
All kinds of things that mirror the community.
I mean, often what we are trying to do is be representative of the community around
us. And certainly in my research around
cultural competence I found that, while there are some people who really only want
to meet with or be served by somebody who's from their own language, or culture,
or ethnic, or racial group, many more will say it's not so much that they need to see
that. They need to be in environments where they
see that there is diversity. And that, that, that environment
communicates that it welcomes diversity. The ability to illicit patient beliefs and
experiences is recognized as a skill for cultural competence.
Rather than us assuming or imposing our own understandings of mental health, being
able to have conversations with our clients and our patients.
But give them the space, the space to talk about how they experience mental health.
Knowledge of and provision of culturally accessible services, so that either within
the institutions we're working there are services available to meet the needs of
different cultural groups, or, and or, we have relationships with other
organizations and institutions that ensure people have choices in terms of receiving
services that are culturally appropriate. And then collaboration with trusted
community services for all the same reasons.
So that people have choice, and so that people feel that they're in environments
where they are safe and they're going to receive effective services.
So, I'm going to move to the summary and conclusions next.
