Cultural Diversity, Mental Health and Psychiatry: The Struggle against Racism

By Suman Fernando | Go to book overview

Chapter 5

Moving forward

The need for change in psychiatric practice and delivery of mental health services is now acknowledged widely. Confronting ethnic issues (Chapter 1) is acknowledged as a priority, if only by implication, in the National Service Framework for Mental Health (Department of Health 1999) referred to in Chapter 2. I believe that the long-term answers to the problem of addressing cultural diversity and counteracting racism in psychiatry and mental health services are in making fundamental changes in psychiatry and psychology in conjunction with changes in society at large. In the case of psychiatry, it has to move away from its adherence to the narrow biological model, 'Kraepelinian' or 'neo-Krapelinian' psychiatry' (Chapter 3), that it has slipped back into recently. Indeed, there has been a shift of the biomedical model in general medicine towards a biopsychosocial model (Engel 1977) and some doctors, including some psychiatrists, have already moved towards this. But that is not enough. As Harari (2001) points out, psychiatry must be practised in a way that appreciates 'the clinical and ethical limitations of concepts derived from simple empiricism' (2001:729). This means that, in a multicultural world, the discipline has to be opened up to concepts of mental health from all cultures and it has to identify and counteract racism in its practices, its theories and its research.

Notwithstanding the above, I believe that it is unrealistic to expect-or even try to achieve-a sudden revolutionary change in the practice of psychiatry and thence to the training of psychiatrists. Yet change must come and so consideration must be given to strategies to achieve change. I suggest that in the short term, the struggle is to enable services to be more 'culture sensitive' and minimise the effects of institutional racism. On the face of it

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Cultural Diversity, Mental Health and Psychiatry: The Struggle against Racism
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Figure, Tables and Boxes x
  • Acknowledgements xi
  • Introduction 1
  • Part I - Background 9
  • Chapter 1 - Racism and Cultural Diversity 11
  • Chapter 2 - Responding to Racism, Addressing Culture 46
  • Part II - Underlying Themes 87
  • Chapter 3 - Psychiatry and Mental Health from a Transcultural Perspective 89
  • Chapter 4 - Psychiatric Stigma and Racism 146
  • Part III - Changing Practice 169
  • Chapter 5 - Moving Forward 171
  • Chapter 6 - Future Prospects 208
  • References 218
  • Index 243
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