Cultural Competence Is Not Optional

Article excerpt

Increasingly, we are becoming aware of the prevalence of mental health problems around the globe. Depression--a major public health issue--has reached alarming proportions, and other mental illnesses are taking a toll on our patients in terms of morbidity and mortality.

Quoting a study published by the Bulletin of the World Health Organization, the Lancet points out that each year, "up to 30% of the population worldwide has some form of mental disorder, and at least two-thirds of those people receive no treatment" (Lancet 2007 Sept. 3 [Epub doi:10.1016/S0140-6736(07)61242-2]).

Given this, it seems to me that World Mental Health Day--which is aimed at raising awareness about mental health issues around the world and is commemorated in October by the World Federation for Mental Health--has added significance. This year's theme is related to the effects of culture and diversity on mental health.

Culture, which encompasses belief systems, ethnicity, language, and expressions, plays an important role in mental health. A behavior deemed abnormal in one culture may not be so in another.

All of our patients have a vocabulary for expressing different symptoms. However, that language might not be interpreted properly if the treating psychiatrist is not well versed with the individual's background. There are many culture-bound syndromes, for example, some of which are mentioned in the classification systems, and more new ones are fast emerging. Recent migration trends, mainly from the developing to the developed countries, have presented a huge challenge for the host countries when it comes to addressing mental health problems.

Migration often is associated with many social problems, such as a decrease in socioeconomic status; lack of recognition of overseas qualifications, including educational and employment experiences; low levels of language learning and proficiency; social isolation and support; prejudice and discrimination by the host population; stress prior to or during migration; and culture shock and nostalgia. The data show that such problems more seriously affect women and younger individuals, and that the stress associated with these problems can result in mental illness. It is becoming more imperative that the health authorities deal with and understand these cultural issues and their undercurrents. …