Kirmayer & Eric Jarvis (2019): Culturally Responsive Services as a Path to Equity in Mental Healthcare

Question 1

4 policies necessary to support culturally responsive services in mental healthcare

Answer 1

1. train practitioners anti-racism
2. proper use of language interpreters.
3. culture brokers
4. cultural considerations into the design

Question 2

unfair differences in mental health care are linked to social challenges like:

Answer 2

• poverty
• violence
• racism
• discrimination

Question 3

Culture shapes various aspects of individuals’ experiences, including:

Answer 3

• symptoms
• coping mechanisms
• help-seeking behavior
• treatment response
• social stigma
• recovery

Question 4

Social determinants of culture (how can cultures differ):

Answer 4

• Meaning about income and social status
• Meaning of social support networks (status, power and obligations)
• Meaning of education and literacy (language, modes of knowledge transmission and authority
• Meaning of employment (conditions)
• Meaning of social environments (institutions and definitions in-group, out-group)
• Meaning of physical environments (relationship to environment aesthetics)
• Personal health practices and coping skills (and what is available)
• Healthy child development (expectations, rituals and ceremonies, parenting arrangements and practices
• Biology and genetics (gene x person x environment)
• Racism and discrimination
• Health services (accessibility, acceptibily an appropriateness)
• Gender (roles, attitudes toward sexuality, orientation and identity)
• Culture itself

Question 5

colour-blind ethnocentrism=

Answer 5

a common response to cultural difference is to take the background framework of the dominant society as “culturally neutral” and assume that it simply represents the normal, accepted or practical way to arrange services. Sometimes this is coupled with a deliberate decision to ignore differences in the name of neutrality and inclusion. In practice, this results in “colour-blind” ethnocentrism.

Question 6

culturally responsive strategies:

Answer 6

1. mental health literacy (enhancing public awareness about mental health)
2. language interpreters
3. culture brokers, mediators or link workers
4. ethnic matching
5. cultural adaptation of intervention
6. cultural competence of clinician
7. cultural competence of institution and health care system
8. cultural humility
9. cultural safety
10. structural competence

Question 7

mental health literacy strengths and limitations:

Answer 7

strengths: teaches people, reduces stigma
limitations: simply providing info may not be enough, does not consider local meanings or healting practices, does not address barrieres to care, does not question cultural assumptions of standard care

Question 8

language interpreters:

Answer 8

strengths: communication is key, interpreters are trained, collaborative
limitations: does not go beyond linguistics therefore no culture, often non-professionals

Question 9

culture brokers, mediators or link workers:

Answer 9

strengths: focus on cultural translation
limitations: roles and funding not well established, lay helpers (have own agenda), might make a patient feel less in control of their own cultural understanding

Question 10

ethnic matching:

Answer 10

strengths: welcoming face, knowledge, can be targeted at level of intervention
limitations: imprecise matching, may not able to find match, stigmatizing, variation

Question 11

cultural adaptation of intervention

Answer 11

strengths: intervention can be tailored
limitations: time, costs, effectiveness uncertain

Question 12

cultural competence of clinician:

Answer 12

strengths: knowledge, skills can be used on diverse populations
limitations: emphasizes knowledge ipv. empathy, may accentuate power imbalance in clinical setting, may not pay attention to inequality in healthcare systems

Question 13

cultural competence of institution and healthcare system

Answer 13

strengths: open and responsive organisations
limitations: may emphasize form rather than substance, resources

Question 14

cultural humility

Answer 14

strengths: emphasis on clinicians limited knowledge
limitations: may undermine clinician, shift responsibility to patient

Question 15

cultural safety:

Answer 15

strengths: addresses power and inequality, focuses on safety, emphasis on power sharing
limitations: may frame culture in terms in vulnerability

Question 16

structural competence:

Answer 16

strengths: emphasis on issues of power
limitations: risks losing sight of personal and cultural meanings

Question 17

A broad approach to culture does not begin with specific groups or populations identified as the “cultural other” but with recognition of the developmental, social and political facts of our cultural being. Ideas that emerge in response to the concerns of one group (e.g., cultural safety for Indigenous peoples) have potential implications for other groups. These approaches need to consider regional variations in demography and resources, which may require different models.

Answer 17

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