Cultural diversity is a global challenge for mental health services. The changing demography of communities requires rethinking approaches to cultural competence for health professionals and institutions. Cultural consultation is a way to improve the quality of mental health care by providing a nuanced understanding of the predicaments that prompt diverse clients to seek help, and the social contexts of their mental health problems, to guide clinical assessment and intervention.

Cultural Consultation explores the practice of cultural consultation as a strategy to improve the quality of mental health care for diverse populations. The contributors, who have worked together at an innovative clinical service, frame best practices in psychiatry clinical psychology, and social work in relation to empathy, human rights, and culturally responsive and ethically sound care. A detailed model of the process of cultural consultation, from initial intake, through assessment, to recommendations and referrals, provides guidelines for clinical practice. Expert contributors examine specialized settings (medical, psychiatric emergency, inpatient, social/legal services), populations (remote, indigenous, child and youth), and contextual issues in the care of people with a wide range of mental health problems. Numerous case examples, charts, and tools add depth for readers interested in developing similar services or enhancing existing practice. Among the key areas covered:

• Working with interpreters and culture brokers.
• Family systems in cultural consultation.
• Gender, power, and ethnicity in cultural consultation.
• Consultation and mediation with racialized and marginalized communities.Collaborative care and primary care consultation.

• Cultural consultation with refugees. A unique guide to challenges and opportunities in contemporary practice, Cultural Consultation will be immediately useful for health careprofessionals, clinical psychologists, and cultural consultants and provide a versatile knowledge source for years to come.

  Autorentext

Laurence J. Kirmayer, M.D. is James McGill Professor and Director, Division of Social and Transcultural Psychiatry, McGill University and Editor-in-Chief of Transcultural Psychiatry. He directs the Culture & Mental Health Research Unit at the Jewish General Hospital where he conducts research on the mental health of Aboriginal peoples; mental health services for immigrants and refugees and the cultural basis of psychiatric theory and practice. He was founding director of the Cultural Consultation Service.

Jaswant Guzder, M.D. is Associate Professor of Psychiatry and of Social Work, McGill University, and Head of Child Psychiatry and Director of the Childhood Disorders Day Hospital at the Jewish General Hospital. She was Co-Director of the Cultural Consultation Service from its inception. From 1980 to 1984, she worked in Mumbai, India as a psychiatric consultant and psychoanalyst and continues to consult in India for Ummeed, Angaan and Tata Instituteof Social Services. Her current academic activities include cross-cultural training, family therapy training, and and child trauma projects in Canada, India, Nepal, Sri Lanka, Turkey, Israel and Jamaica.

Cécile Rousseau, M.D., M.Sc. is Associate Professor, Department of Psychiatry & Director, Transcultural Psychiatry Service, CSSS de la Montagne, where she has built a team addressing refugee and immigrant children's mental health, with particular interest in children of war. She has conducted epidemiological and ethnographic research on the personal, family and cultural determinants of refugee children's mental health. She has developed innovative school prevention programs for refugee and immigrant children and adolescents using creative expression workshops. In partnership with researchers in international law and community organizations, she has analyzed the cultural and psychological construction of immigration policies and their consequences for the mental health of refugees.

Zusammenfassung

Based on a recently completed project of cultural consultation in Montreal, Cultural Consultation presents a model of multicultural and applicable health care. This model used clinicians and consultants to provide in-depth assessment, treatment planning, and limited interventions in consultation with frontline primary care and mental health practitioners working with immigrants, refugees, and members of indigenous and ethnocultural communities. Evaluation of the service has demonstrated that focused interventions by consultants familiar with patients' cultural backgrounds could improve the relationship between the patient and the primary clinician.

This volume presents models for intercultural work in psychiatry and psychology in primary care, general hospital and specialty mental health settings. The editors highlight crucial topics such as:

• Discussing the social context of intercultural mental health care, conceptual models of the role of culture in psychopathology and healing, and the development of a cultural consultation service and a specialized cultural psychiatric service

• Examining the process of intercultural work more closely with particular emphasis oto strategies of consultation, the identity of the clinician, the ways in which gender and culture position the clinician, and interaction of the consultant with family systems and larger institutions

• Highlighting special situations that may place specific demands on the clinician: working with refugees and survivors of torture or political violence, with separated families, and with patients with psychotic episodes

This book is of valuable use to mental health practitioners who are working in multidisciplinary settings who seek to understand cultural difference in complex cases. Psychiatrists, psychologists, social workers, nurse practitioners, primary care providers and trainees in these disciplines will make thorough use of the material covered in this text.

Inhalt
Introduction: The Place of Culture in Mental Health Services.- Development and Evaluation of the Cultural Consultation Service.- The Process of Cultural Consultation.- Cultural Consultation in Child Psychiatry.- Working with Interpreters.- Culture Brokers, Clinically Applied Ethnography and Cultural Mediation.- Family Systems in Cultural Consultation.- Gender, Power & Ethnicity in Cultural Consultation.- Community Consultation and Mediation with Racialized and Marginalized Minorities.- Addressing Cultural Diversity Through Collaborative Care.- Consultation to Remote and Indigenous Communities.- Cultural Consultation for Refugees.- Consultation to Youth Protection and Legal Settings.- Cultural Consultation in General Hospital Psychiatry.- Cultural Consultations in Medical Settings.- Conclusion: The Future of Cultural Consultation.