Guidelines for Training in Cultural Psychiatry
Kirmayer, Laurence J., Fung, Kenneth, Rousseau, Cécile, Lo, Hung Tat, Menzies, Peter, Guzder, Jaswant, Ganesan, Soma, Andermann, Lisa, McKenzie, Kwame, Canadian Journal of Psychiatry
A position paper developed by the Canadian Psychiatric Association 's Section on Transcultural Psychiatry and the Standing Committee on Education and approved by the CPA 's Board of Directors on September 28, 2011.
Canada is a highly diverse society and Canadian scholars and clinicians have been world leaders in efforts to understand the impact of culture on mental health. However, to date, there have been no national guidelines for the integration of culture in psychiatric education and practice. This paper, prepared by the Section on Transcultural Psychiatry of the Canadian Psychiatric Association (CPA) for the Standing Committee on Education, sets out the rationale, content and pedagogical strategies for training in cultural psychiatry. It is based on a review of literature, experiences with existing training programs and expert consensus. This paper addresses issues relevant to general psychiatry as well as specific populations, including immigrants, refugees and ethnocultural communities as well as First Nations, Inuit and Métis.
There is a large literature demonstrating the many ways that cultural variations affect the symptomatic manifestations and clinical presentation of the entire range of mental health problems, including common mental disorders, such as depression, anxiety and trauma-related problems, as well as psychosis and organic mental disorders.1·2 These cultural variations have been shown to influence physicians' ability to detect, diagnose and appropriately treat mental health problems. Cultural differences in health practices are also major determinants of illness behaviour, coping, treatment response and adherence, rehabilitation and recovery. There is strong evidence that cultural differences contribute to health disparities and unequal access to care and that cultural knowledge and identity are important determinants of treatment outcome.3-8 Any mental health care system that aims to achieve equity must therefore address issues of cultural diversity.9 This has been recognized by governmental and professional organizations in the United States, the United Kingdom, Canada and other countries.3,10,11
The Mental Health Commission of Canada, in its framework for a mental health strategy, included addressing the diverse needs of Canadians as the third of seven basic principles of a reformed mental health care system.12 These diverse needs include those arising from culture and ethnicity, as well as from gender, sexual orientation, disability and other aspects of experience that interact with cultural values.
Cultural diversity is conceptualized in different ways in different countries based on local histories of migration, policies and ideologies of citizenship, and patterns of ethnic identity and social stratification.'317 The Canadian context is distinctive in many ways. Since 1976, Canada has had an official policy of multiculturalism.18 This formally acknowledges and promotes recognition of the diversity of Canadian society as a shared feature of collective identity.19 It reflects and contributes to a social milieu in which attention to culture is positively valued and, indeed, required to respect and respond to individuals and ethnocultural communities. However, this explicit commitment to diversity is relatively recent, and the education of professionals generally has ignored the history of Eurocentric and racist policies and exclusionary practices that continue to have impact on individuals and communities.20"22 Recent years have seen greater recognition of the history of colonization and the devastating impact of the policies of forced assimilation on Aboriginal Peoples in Canada, along with appreciation of the resilience and vitality of First Nations, Inuit and Métis cultures, languages and traditions as resources for mental health and well-being.
Although Canada has been a culturally diverse nation from its inception, the geographic origin of newcomers to Canada has changed. …