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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
Service Barriers
Frequent misdiagnosis Inappropriate use of
interpreters and paraprofessionals
Culturally inappropriate treatment methods
NOT AVAILABLE NOT ACCESSIBLE NOT ACCEPTABLE
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
Periods of Elevated Risk
First period 3 to 18 months after arrival
Second period 3 to 5 years after migration
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%
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?
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
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
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