Responding to Client’s Mental Health Issues

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 Vancouver Community Mental Health Services Physician Leader RVH

2. Service Barriers • Frequent misdiagnosis • Inappropriate use of interpreters and paraprofessionals • Culturally inappropriate treatment methods • NOT AVAILABLE • NOT ACCESSIBLE • NOT ACCEPTABLE

3. 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 Cross Cultural Formulation

4. Periods of Elevated Risk • First period • 3 to 18 months after arrival • Second period • 3 to 5 years after migration

5. Relationship Between Complaint & Positive Findings

6. 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?

7. 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

8. 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

9. 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