lecture 10 Flashcards
Race
Biological basis
Visible, physical differences
Often externally-classified
Distinguish between large groups of people
Highlight commonalities ‘human race’
May also be self-ascribed
Ethnicity
intersect between race and culture
Social characteristics of a group
Faith/religion
Language
Traditions
Common ancestry
May share a distinctive culture
Some overlap with nationality
Culture
Acquired/learned
Non-biological/social aspects of human life
Norms, Values, Beliefs, Symbols
‘Fluid’
Multi-cultural at individual level
Culture & Mental Health
Cultural formulation highlights the effect of culture on:
Symptom expression
Cultural Explanations ‘Models’ of mental Illness
Definition of illness
Cultural factors related to the psychosocial environment
Treatment
What is acceptable?
Impact of culture/cultural identity on the clinician patient relationship
In UK, Black African & Caribbean worse experience at every level of service
More negative, coercive care pathways
More compulsory detention (Mental Health Act)
Higher doses psychotropic medication
More seclusion, control & restraint
Less psychological therapy
Longer length of hospital stay
More Community Treatment Orders (CTOs)
Lack of psychological interventions
AESOP
Aetiology & Epidemiology of Schizophrenia and Other Psychoses
Murray, Fearon, Morgan et al: First episode study of schizophrenia and other psychoses
AESOP Study aims
Elucidate the overall rates of psychotic disorder in 3 UK cities
Confirm and extend previous findings of raised rates of psychosis in certain migrant groups in the UK
Explore biological and social risk factors in these populations and their possible interactions
AESOP findings:
Compared with the baseline White British population
Incidence all psychoses higher in Black populations
explanations of AESOP study
Misdiagnosis
- Institutional racism in diagnosis?
- ‘Atypical psychosis’
Biological hypotheses
- Genetic predisposition
- ‘Migration hypothesis’
- Cannabis
Psycho-social hypotheses
- ‘Urbanicity’, social deprivation
- Impact of racism
- Attributional style
- Life events and childhood risk
Family Intervention (FI) - benefits and issues
NICE recommends FI for schizophrenia and psychoses:
Clinically- & cost-effective
Reduces family tension
Facilitates engagement & improved clinical care
Reduces relapse/readmission rates
Decreases lengths of stay in hospital
However:
Organisational and professional barriers prevent FI being offered
African Caribbeans are doubly-disadvantaged due to high levels of estrangement from their families
Family Intervention should:
Family intervention should:
Include the person with psychosis or schizophrenia if practical
Be carried out for between 3months and 1year
Include at least 10 planned sessions
Take account of the relationship between the main carer and the person with psychosis or schizophrenia
Have a specific supportive, educational or treatment function and include negotiated problem solving or crisis management work
CaFI Study: Feasibility Pilot
(culturally adapted family intervention)
Culturally-acceptable Family Intervention (CaFI), a 3-year NIHR (HS&DR) funded study to:
Assess the feasibility of culturally-adapting, implementing and evaluating Family Intervention (FI) for African Caribbean .
To test the feasibility and acceptability of delivering CaFI via ‘proxy families’ where biological families are not available.
Phase 1
Culturally-adapting Family Intervention
phase 2
Manual Development & Training
Family therapists & co-therapists
‘Proxy families’
Cultural competency for NHS staff & services
Phase 3: Method
\Feasibility Study (Proof of Concept): Delivering & Evaluating CaFI
Primary outcomes: Recruitment, Retention, Completion
Delivered 10 x 1 hour long CaFI sessions
‘Shared learning’, stress management, problem-solving
