Exploring issues of cultural difference for professionals working with psychosis

Abstract

This study aimed to explore professionals’ experiences of working with cultural differences within Early Intervention in Psychosis Services (EIPSs), to develop insights that will support professionals in working effectively and appropriately with diverse service users experiencing psychosis. Semi-structured interviews were conducted with ten professionals undertaking the role of a Care-Coordinator within EIPSs, and thematic analysis was conducted to generate a broad range of themes. Care-Coordinators experienced cultural factors as both useful and obstructive within their work. It appeared that their efforts to be culturally-competent were constrained by the limits of the service, with regard to the service culture and service demands and priorities. Their own cultural backgrounds also posed challenges for how service users engaged with them, and how they, in turn, engaged with service users. Care-Coordinators experienced a range of communication challenges that impacted on their sense of control and inhibited their ability to assess psychotic symptomology accurately, and therefore their understanding of the service user’s presentation. What Care-Coordinators appeared to value was the importance of gaining cultural knowledge and developing links with the community to support them in providing culturally-competent care. While EIPSs are not cultural services, the results have placed an emphasis on the various challenges experienced in working with cultural differences, including challenges in disentangling psychotic symptomology from cultural phenomena. This suggests that culture is not something that simply needs to be attended to, but something that is crucial to the role of Care-Coordinators within EIPSs, in supporting their ability to make accurate interpretations of service users’ presentations, and support their mental health needs most effectively. The findings highlight a range of suggestions for developing culturally-appropriate practices within EIPSs.