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Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director Vancouver Community Mental Health Services Physician Leader RVH

Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

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Page 1: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Responding to Client’s Mental Health Issues

Soma Ganesan MD FRCPClinical Professor of Psychiatry UBC

Medical Director of Psychiatry VGH/UBCH Medical Director Vancouver Community Mental Health

ServicesPhysician Leader RVH

Page 2: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Service Barriers

Frequent misdiagnosis Inappropriate use of

interpreters and paraprofessionals

Culturally inappropriate treatment methods

NOT AVAILABLE NOT ACCESSIBLE NOT ACCEPTABLE

Page 3: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Cross Cultural Formulation

Pre-Post migration factors which increase risk

Impact of socio-political & cultural factors on diagnosis

How culture affects perceptions of the cause of illness

Socio-cultural factors affecting the development & onset

Effects of culture on help-seeking patterns, treatment & response to care

Service needs of “high-risk” groups such as torture victims, the elderly, children, adolescents & women

Differentiating between immigrants & refugees & their respective problems

Page 4: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Periods of Elevated Risk

First period 3 to 18 months after arrival

Second period 3 to 5 years after migration

Page 5: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Relationship Between Complaint & Positive Findings

Complaints Positive Findings

Neurological 86% 22%

Cardiopulmonary 74% 14%

Gastrointestinal 68% 28%

Urology 34% 4%

Sex Organ 54% 16%

Musculoskeletal 92% 92%

Page 6: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Questions to Elicit Client’s Explanatory Model

What do you think has caused the problem? Why do you think it started when it did? What do you think your illness (or injury) does to you?

How does it work? How severe is your illness? Will it have a long or short

course? What kind of treatment do you think you should receive? What are the most important results you hope to receive

from this treatment? What are the chief problems your illness has caused for

you? What do you fear most about your illness?

Page 7: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Tips for Negotiating an Agreement Between Explanatory Models

Approach this negotiation with an open mind, with an expectation of mutual learning

Explore their understanding of the problem Explain your background and your

understanding Utilize the metaphors of distress that they have

used Acknowledge their model as an important source

of understanding Work to identify areas of agreement, and to

stress the strengths in the client’s situation Where discrepancies remain, discuss these

Page 8: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Important Factors in Planning Collaborative Primary/Mental Health Services for Ethnocultural

Population Appropriate interpretation services Ongoing training for organizations and front-line staff Role of community for Immigrant settlement services Development of cultural competency training curriculum

in professional training programs at academic centers Inclusion of Immigrant agencies in Federal, Provincial

and Municipal as partners in service delivery system Explore role of diversity coordinator in community health

centers No “cook book” model “bottom up research” and collaborative research should

be encouraged

Page 9: Responding to Client’s Mental Health Issues Soma Ganesan MD FRCP Clinical Professor of Psychiatry UBC Medical Director of Psychiatry VGH/UBCH Medical Director

Key Lessons From The Literature

Primary needs first (food, clothing, shelter, job) met prior to meeting Mental Health needs

Safety and Trust Cultural competence of service providers Role of interpreters Lack of awareness of services by consumers

and service providers Role of informal Mental Health system Population at risk = elderly, youth, single parent,

victim of torture