Culture-Diversity: Global Mental Health

Culture and Diversity in Global Mental Health/Member Care

This section highlights materials that promote understanding, respect, and competency regarding human diversity and multicultural settings. These materials complement the practical knowledge we acquire from connecting with others from different backgrounds and cultures. We have also found it invaluable to learn from multicultural mentors/friends and to stay in regular touch with international media/issues (examples are in the Media that Matters section of this web site). For us, developing competency in human diversity and multicultural settings, at its core, involves first-hand experience, a mindset, and a lifestyle.

1. Mental Health in a Changing World: The Impact of Culture and Diversity (World Mental Health Day 2007, World Federation of Mental Heath; click on the title/link for the full version--Chinese, English, French, Japanese, Russian, and Spanish). "There are approximately 6.5 billion people living on planet Earth. Within that number, there are more people living outside their country of origin than at any other time in history. One person out of 35 is an international migrant — 3% of the global population. If we look at our world to­day, is there any single culture, race or religion that is 100% contained in one single country? We can find dramatically different languages, religions, family relationships and values, as well as views on health care and treatment wherever we go, including in our own respective countries. A female mental health professional born and trained in India may have moved to the United Kingdom and is seeing a male client born and raised in Ecuador — how do they communicate and how do each view the same mental illness?

Culture may influence many aspects of mental health, including how individuals from a given culture communicate and manifest their symptoms, their style of coping, their family and com­munity supports, and their willingness to seek treatment. Likewise, the cultures of the clinician and the service system influence diagnosis, treatment, and service delivery. Cultural and social influences are not the only determinants of mental illness and patterns of service use, but they do play important roles.

In the mental health care setting, culture impacts how people:

• Label and communicate distress

• Explain the causes of mental health problems

• Perceive mental health providers

• Utilize and respond to mental health treatment."

2. Where There Is No Psychiatrist: A Mental Health Care Manual (by Vikram Patel, Royal College of Psychiatrists, 2003) Summary below and purchase information is from Teaching-Aids at Low Cost (TALC). You can also preview this book at Google Books). After giving the reader a basic understanding of mental illness, the book goes on to describe more than 30 clinical problems associated with mental illness, and uses a problem-solving approach to guide readers through their assessment and management. There is also a section which contains quick reference information for common problems. The manual is divided into four sections with the first giving an overview of mental illness and dealing with the different types of mental disorders using a simple classification; the second deals with clinical problems including a chapter on the most disturbing and worrying clinical problems that you will encounter, the third covers integrating mental health and considers how mental health can be promoted in the community, the fourth discusses localising the manual for your area and accessing resources. Note: second edition published in 2018.

3. Culture and the Clinical Encounter: An Intercultural Sensitizer for the Health Professions (1996, Rena Groper, Intercultural Press; You can also preview this book on Google Books). This book provides dozens of brief cases (called "cultural sensitizers") in a USA-oriented medical context. In each case cultural factors have a significant impact on how health problems are perceived and treated--by both the patients and the health professionals. Each case includes a choice of four possible responses for dealing with the situation, with an explanation in a separate section as to the appropriateness of each response. The book concludes with 10 pages of helpful principles for for working with those from different cultures, including the awareness of the influence of our own culture on our perceptions of others (Section Four). Note march 2021: This book continues to be practical, challenging, and very relevant!

4. Resolution on Culture and Gender Awareness in International Psychology (American Psychological Association, 2004; excerpt below--click on the title/link above for the full version). "WHEREAS an estimated 60 percent (or more) of the world's psychologists now live outside the US... WHEREAS psychologists outside of the US have generated perspectives, methods and practices that correspond to the needs of the people in their societies and data that are relevant to the development of a more complete psychology of people... THEREFORE LET IT BE RESOLVED that the American Psychological Association will:

(4) encourage more attention to a critical examination of international cultural, gender, gender identity, age, and disability perspectives in psychological theory, practice, and research at all levels of psychological education and training curricula.

(5) encourage psychologists to gain an understanding of the experiences of individuals in diverse cultures, and their points of view and to value pluralistic world views, ways of knowing, organizing, functioning, and standpoints. (6) encourage psychologists to become aware of and understand how systems of power hierarchies may influence the privileges, advantages, and rewards that usually accrue by virtue of placement and power..."

Note march 2021: See the APA's Multicultural Guidelines: An Ecological Approach to Context, identity, and Intersectionality 2017.

5. World Health Organization--Department of Mental Health. For more information see the entry from 20 March 2010 at: www.COREmembercare.blogspot.com

a. Begin with these two multimedia items:

**A “photo fact file" which includes 10 pictures and some core statistics.

http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index.html

**Watch the five minute video about WHO’s 2008 mhGap program. This video gives a good overview of international mental health needs and makes a plea to work together to help people to promote mental health for all. There is no health without mental health! http://www.who.int/mental_health/mhgap/en/

b. Then have a look at some short summaries:

**The Bare Facts is a fact sheet on mental health statistics (e.g., an estimated 877,000 people commit suicide each year). http://www.who.int/mental_health/en/index.html**Some core reflections on human rights, law, and mental health. http://www.who.int/mental_health/policy/fact_sheet_mnh_hr_leg_2105.pdf

c. For more detailed reviews and information:

**Links to special articles that review global mental health in the Lancet journal from the UK (2007).

http://www.thelancet.com/series/global-mental-health

**The Mental Health Atlas from 2005 which “provides essential information on mental health for 192 countries includes including epidemiology, mental health policy, substance abuse policy, national mental health programme…mental health facilities…and other relevant information.”

http://www.who.int/mental_health/evidence/atlas/

One need not be a mental health professional to benefit from the information and resources listed on the WHO site! You will likely find the material to be practical for your own life and work in member care and mission/aid. Remember: an important part of respecting human diversity involves respecting people from all cultures who struggle with mental disorders. They especially are vulnerable and have rights to adequate care, opportunities, and well-being.

6. Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition TR (DSM IV-TR). (American Psychiatric Association, 2000). This is the most widely used diagnostic manual for psychological disorders. The fourth edition was published in 1994, revised in 2000, and the next version is due in 2013 (DSM-V). One of its most helpful contributions regarding the role of culture is found in the appendix "Outline for Cultural Formulation and Glossary of Culture Bound Syndromes". It consists of two parts:

• a. Part one is a short outline to evaluate the cultural context as it relates to diagnosis and treatment (e.g., cultural identity/connection, cultural explanations of a person's problems, cultural understanding of social stressors and supports, cultural factors influencing the client-clinician relationship, and the overall impact of cultural factors on diagnosis and care).
• b. Part two provides a fascinating list of some of the more common "afflictions and illnesses" that are found in different cultures and which can be encountered in clinical practice. Some of these conditions overlap with DSM-IV diagnoses although often the types of symptoms, course, explanations, and social responses are influenced by the local cultural perspectives. Unfortunately we have not found an online source for viewing this material (please let us know if you find one) and hence one has to get a hard copy of the book.

Note: For more information on culture bound syndromes, go to : Curious Mental Illnesses Around the World and read the short descriptions of koro, latah., brain fag, anorexia, and amok. For an overview of culture bound syndromes, go to:

http://homepage.mac.com/mccajor/cbs_intro.html

7. Diagnostics and Statistics Manual IV-TR Casebook. (American Psychiatric Association, 2000). The very helpful casebook includes 70 pages of various examples of diagnoses and problems in different countries and cultures. These examples are included in the section called "International Cases." This section offers the local cultural/indigenous views of afflictions/illnesses along with DSM IV diagnostic considerations. You will note that in many of these cases there is the attribution and complaint some sort of spirit possession/influence. Unfortunately we have not found an online source for viewing this material (please let us know if you find one) although the above site provides a preview of some of the book's contents including parts of some international cases.

8. Global Health TV. This media organization covers health conferences, offers the short interviews done with international researchers and practitioners in mental health and related areas. Have a look at some of these video links below from Global Health TV. Each one is about three minutes long.

Conference Preview for Geneva Health Forum 2010—Movement for Global Mental Health. Dr. Vikram Patel (author of Where There Is No Psychiatrist and editor of the Lancet journal series on Global Mental Health) gives a short update on some of the issues for mental health internationally and a preview of what he will share at the Geneva Health Forum next week.

http://www.globalhealthtv.com/#/news/preview_geneva_health_forum_2010/

The Global Burden of Depression. According to the World Health Organization, depression will be the leading cause of illness around the globe. Dr Ian McPherson from the National Mental Health Unit in England shares about the relationship between employment and mental health and the need to prioritise mental health in the global health agenda.

http://www.globalhealthtv.com/#/news/the_global_burden_of_depression/

Overcoming Global Oppression Against Women. Sheryl WuDunn is a Pulitzer prize-winning author. She shares about her new book, Half the Sky: Turning Oppression Into Opportunity for Women Worldwide. The material in the book can be used as a toolkit to take action against oppression.

http://www.globalhealthtv.com/#/news/overcoming_global_oppression_against_women/

Stress in the Womb. Prenatal stress can have a long-term consequences. Here is a snippet from Vivette Glover, a researcher at Imperial College London, who advocates that reducing stress during pregnancy could help prevent emotional and behavioural problems in children.

http://www.globalhealthtv.com/#/news/stress_in_the_womb/

Global Mental Health. The Movement for Global Mental Health was launched in 2009 in Athens. Its purpose is to improve services for people with mental health conditions worldwide, promote human rights/protection of those affected, and for more research in low-middle income countries. Psychiatrist Professor Vikram Patel explains that mental health deserves an equal footing with other major health problems such as HIV/AIDS, TB, malaria and maternal health.

http://www.globalhealthtv.com/#/news/global_mental_health/

9. See also:

**Movement for Global Mental Health. "The Movement for Global Mental Health aims to improve services for people with mental disorders worldwide. In so doing, two principles are fundamental: first, the action should be informed by the best available scientific evidence; and, second, it should be in accordance with principles of human rights. The Movement is a global network of individuals and institutions who support this mission."

** "The Banyan is a not for profit organization based in Chennai, India. It works for the cause of homeless persons with mental illness. Over the last 13 years, The Banyan has rescued over 1500 women and enabled close to 1000 women, not just recover from the illness but to also trace their lost steps back to their families and communities." See the short, inspiring/artistic video: http://www.youtube.com/watch?v=THdLdJDc6go

**Click here for a short review of Patrick Lencioni's Five Dysfunctions of a Team ( 2002), with an emphasis on cross-cultural applications, by Kelly O'Donnell (Note: a version of this review was published in the Journal of Psychology and Theology, Spring 2011).