developing culturally appropriate psycho-social interventions Flashcards
what is race
Race • Biological basis • Visible, physical diferences • Often externally-classified • Disinguish between large groups of people • Highlight commonalities ‘human race’ • May also be self-ascribed
what is ethnicity
Ethnicity • Social characterisics of a group • Faith/religion • Language • Traditions • Common ancestry • May share a disinctive culture • Some overlap with naionality
what is culture
- Acquired/learned
- Non-biological/social aspects of human life
- Norms, Values, Beliefs, Symbols
- ‘Fluid’
- Muli-cultural at individual level
why is culture important in mental health
Culture and social contexts shape individuals' mental health • Symptoms, Presentation and Meaning • Coping styles • Family inluences • Help-seeking behaviours • Stigma • Trust
what does culture effect with mental health
- Symptom expression
- Cultural Explanaions ‘Models’ of mental Illness
• Definition of illness
• Cultural factors related to the psychosocial environment
e.g. believe spiritually posessed
l • Treatment
• What is acceptable?
• Impact of culture/cultural idenity on the clinician patient relationship
In UK, Black African & Caribbean worse experience at every level of service
give examples
– More negaive, coercive care pathways
– More compulsory detenion (Mental Health Act)
– Higher doses psychotropic medicaion
– More seclusion, control & restraint
– Less psychological therapy
– Longer length of hospital stay
– More Community Treatment Orders (CTOs) Lack of psychological intervenions
what does AESOP stand for
Aeiology & Epidemiology of Schizophrenia and Other Psychoses (Murray, Fearon, Morgan et al)
is psychosis higher in Black populations
all psychosis higher in black populations
what are the potential explanations of the higher rate of diagnosis
• Misdiagnosis
– Insituional racism in diagnosis?
– ‘Atypical psychosis’
• Biological hypotheses – Geneic predisposiion – ‘Migration hypothesis’ – Perinatal/obstetric factors – Cannabis
• Psycho-social hypotheses – ‘Urbanicity’, social deprivaion – Impact of racism – Atribuional style – Life events and childhood risk
why does NICE reccommend FI for schizophrenia and psychosis
- Clinically- & cost-efecive
- Reduces family tension
- Facilitates engagement & improved clinical care
- Reduces relapse/readmission rates
- Decreases lengths of stay in hospital
“Offer family intervenion to all families of people with psychosis or schizophrenia who live with or are in close contact with the service user” (NICE, 2014)
why are Black people less likely to be given family therapy
- Organisaional and professional barriers prevent FI being ofered
- African Caribbeans are doubly-disadvantaged due to high levels of estrangement from their families
what should family therapy do
– Include the person with psychosis or schizophrenia if practical
– Be carried out for between 3 months and 1 year
– Include at least 10 planned sessions
– Take account of the whole family’s preference for either single-family intervenion or multi-family group intervention
– Take account of the relaionship between the main carer and the person with psychosis or schizophrenia
– Have a specivic supportive, educational or treatment function and include negotiated problem solving or crisis management work
what is the feasability plot for CAFI studies
Culturally-acceptable Family Intervenion (CaFI), a 3-year NIHR (HS&DR) funded study to:
1. Assess the feasibility of culturally-adaping, implemening and evaluating Family
Intervenion (FI) for African Caribbean service users diagnosed with schizophrenia and their
families across a range of clinical settings.
- To test the feasibility and acceptability of delivering CaFI via ‘proxy families’ where
biological families are not available.
what happened in phase 1 of culturally acceptable family intervention
literature review
focus group
consensus conference
what happened in phase 2 of CAFI
manual development
training
family support workers recruited
