Transcultural Mental Health Research Articles

Building resilience in transcultural adults: investigating the effect of a strength-based programme

ABSTRACT Objective: The current study used a mixed-method approach to evaluate the effect of Building Resilience in Transcultural Adults programme (BRiTA), a strength-based preventative intervention developed by Queensland Transcultural Mental Health Centre (QTMHC), on the acculturation and resilience of culturally and linguistically diverse (CALD) adults from migrant background. QTMHC, as a part of their services, train facilitators to execute this programme in a range of community settings. Method: CALD individuals, from migrant background, attended the programme at community centres and organisations. They completed a demographic form, scale that measured their acculturation and resilience pre and post intervention and open-ended questions about each session at the end of the sessions. Facilitators of the programme also recorded their observations. Results: Quantitative data and qualitative feedback, were collected from every BRiTA programme run from 2012 to 2017. Paired T-Test indicated that the CALD migrant sample (N = 192) showed a significant self-reported increase in their acculturation and resilience levels after completing the BRiTA futures programme. Thematic analysis of the participants’ comments after every session indicated that they found the programme relevant, helpful, and enjoyable. Conclusions: The findings illustrate the benefits of the preventative BRiTA programme and the role it can play in promoting CALD migrant’s wellbeing and integration in Australia. Implications and future directions are discussed. Key Points What is already known about this topic: (1) Migrants have to acculturate to their new relocated country, which can be stressful. (2) Preventative programmes can promote the acculturation and wellbeing of migrants. (3) Building resilience in transcultural adults and parents (BRiTA) is one of the preventative group programmes. What this paper adds: (1) BRiTA can positively affect the acculturation and resilience of those who attend this programme. (2) It can be delivered in different languages to different ethnic groups. (3) It can be used successfully in community settings.

Using the Cultural Formulation Interview in Denmark: Acceptability and clinical utility for medical doctors and migrant patients.

Previous studies have shown the importance of focusing on the cultural background of migrant patients in the psychiatric assessment. The Cultural Formulation Interview (CFI) offers a patient-focused approach to foreground the cultural context of the patient in the clinical encounter. Our objective was to explore the acceptability and clinical utility of the CFI for physicians and its acceptability for migrant patients seen at a transcultural mental health clinic in Denmark. In this study, the CFI was used in a second session following the standard clinical assessment to explore what additional information was gained from the CFI. Data on the use of the CFI data were collected immediately after the interview with questionnaires for medical doctors (MDs) (N = 12) and patients (N = 71). The findings showed that the CFI, in addition to standard assessment, was useful to the MDs for planning the treatment (60.0%) and for exploring the patients' view on their cultural and social context (74.7%), but less so for the diagnostic process (9.9%). Patients reported high overall satisfaction with the CFI (93.0%) and viewed it as a welcome opportunity to tell their story. The findings add to existing knowledge on the CFI in terms of acceptability for patients of a primarily Middle Eastern origin and patients using an interpreter during the CFI session. Based on the findings of this study, the CFI is recommended to clinicians for treatment planning purposes and for exploring the cultural and social context of the patient.

Finding ways together: Researching with Aboriginal women in a mental health setting

IntroductionThis paper describes the collaborative development of a method and process for transcultural qualitative enquiry, undertaken as the second phase of a mixed methods PhD research project. AimTo develop an ethical, sensitive and culturally secure research method and process with which to explore the experiences of Aboriginal women in an acute mental health inpatient unit, a potentially vulnerable research population. To invite Aboriginal women to share their stories and their experiences as current inpatients, or as carers, visitors and health service providers. MethodA local Aboriginal Reference Group (ARG) was constituted and collaborated with the first author in developing working strategies and tools. Members of the ARG guided all aspects of the research process, acted as primary agents for information-giving, informed consent and interview processes, and were co-authors of relevant publications. ResultsThe method described here fostered trust and cultural respect, and embedded informed consent as an ongoing process. Eleven Aboriginal women inpatients undertook a single semi-structured interview prior to discharge from the inpatient unit. Five ARG members also gave interviews, adding insights from their ‘insider-outsider’ perspectives. A rich dataset of personal experience was made available for analysis. ConclusionsThe process devised for this study integrated principles of cultural respect and collaboration with an ongoing process of informed consent. By integrating these principles into research initiatives and evidence-based practice, and by ensuring familiarity with local Aboriginal and Torres Strait Island cultures, non-Aboriginal mental health nurses can enhance transcultural mental health service delivery in an acute setting.

Bilingual and Multilingual Psychologists Practising in Australia: An Exploratory Study of Their Skills, Training Needs and Experiences

ObjectiveAs Australia becomes more diverse it is essential for the psychology profession to examine training, cultural competency, and professional development needs of psychologists working in languages other than English. In this exploratory study of bilingual/multilingual psychologists in Australia, we aimed to investigate their self‐perceived language skills, multicultural counselling competency, and professional development needs; understand their training and practice experiences; and seek recommendations for policy and practice.MethodAn online survey including demographic and practice information, the Multicultural Counselling Inventory and open‐ended text questions was completed by 38 bilingual/multilingual psychologists working in Australia in 2015. Eleven participants undertook supplementary telephone interviews which along with survey responses were transcribed for qualitative thematic analysis.ResultsMost participants trained in English. They expressed concerns about their application of psychological concepts in other languages, despite good conversational fluency. Participants highlighted language barriers to entering the profession; limited multicultural and multilingual training and supervision in Australia; and the need for more transcultural mental health resources, particularly for small/new migrant communities and people outside large cities.ConclusionTo effectively serve clients, significant changes are required to psychology training in Australia, including but not limited to bilingual and multilingual psychologists. These include enhanced training and competency standards in MCC and using interpreters. The profession must actively support supervision, professional development, and practice in community languages. The Psychology Board of Australia and the universities need to examine policies operating as barriers to the admission of culturally and linguistically diverse people to the psychology profession in Australia.

The Current State of Transcultural Mental Health Nursing: A Synthesis of the Literature.

The Current State of Transcultural Mental Health Nursing: A Synthesis of the Literature.

‘My husband is possessed by a jinn’: a case study in transcultural mental health

Objectives The objective of this study was to discuss jinn possession in Muslim culture, and the importance of understanding cultural differences in mental health. Conclusion It is important to understand cultural and religious differences in psychiatry, as it affects the way patients perceive and attribute symptoms. It also helps clinicians to reach an accurate diagnosis and provide appropriate treatments. Beliefs about jinn possession should not automatically be regarded as delusional. In alleged cases of jinn possession, clinicians should consider all the biopsychosocial, cultural and spiritual factors that are unique to the individual. Further research is still needed in this area.

The trainee perspective

In Asia, while the postgraduate training in psychiatry employs the World Psychiatric Association (WPA) core training curriculum for psychiatry as a standard course, some adjustment to the course is required for the unique demographic and sociocultural characteristics of its region.From the small group work in the 14th course for the academic development of psychiatrists (CAD), organized by the Japan Young Psychiatrists Organization (JYPO) in 2015, young psychiatrists form Indonesia, Japan, Philippines, South Korea, Taiwan and Thailand agreed that the core psychiatric curriculum must include both general and psychiatric knowledge which are fundamental to clinical practice and continuous learning. General knowledge consists of knowledge management, academic skills, epidemiology, research methodology and statistics, evidence-based medicine, bio-ethic and medicolegal issues, professionalism, and medical anthropology, while psychiatric knowledge incorporates basic science, diagnostic assessment skills, etiopathogenesis, pharmacological and non-pharmacological treatments, disease prognosis, and mental health promotion and prevention. Moreover, the curriculum for junior psychiatric residents has to be composed of courses from various departments that encourage them practice in holistic care and multidisciplinary approach including emergency medicine, internal medicine, neurology, pediatrics, community based medicine, anesthesiology, radiology and palliative care. For senior psychiatric residents, the training program should consist of in-depth psychiatric knowledge, general psychotherapy concept and basic skills, and free elective subjects.Since Asia is different from Europe in terms of large population, shortage of psychiatrists, aging society, racial and cultural diversity, and high risk of natural disasters; the postgraduate training in psychiatry in Asia should focus on the subjects regarding health economy, geriatric psychiatry, cultural and trans-cultural psychiatry, ethnopsychopharmacology, disaster psychiatry and mental health. Furthermore, the cooperation among Asian countries should be promoted in order to initiate knowledge exchange and research collaboration. These could contribute to the sustainable advancement of Asian psychiatry and mental health in the future.Disclosure of interestThe author has not supplied his declaration of competing interest.

The Application of Problem Based Learning in Undergraduate Nursing Education: A Strategy for Curriculum Reform

Background: Problem based learning (PBL) is an innovative way of delivering instruction in which problems are used as the basis of learning. Problem based learning was developed in the 1960s by Harold Barrows at McMaster University Medical School in Canada. Since then, PBL had been im-plemented as a teaching method in other reputable education institutions internationally, includ-ing nursing education. Curriculum reform is proposed through PBL in conjunction with patient simulation in undergraduate nursing education. The first author, Tan Kan Ku, PhD Candidate, MHS (Transcultural Mental Health—by Research) worked as a Registered Nurse for more than two decades internationally in England, New Zealand, Saudi Arabia and Australia, where she worked as a Case Manager in Community Mental Health Rehabilitation Program. Since 2001, she focused on nurse education and research into the stigma of mental illness from a cross-cultural perspective. Currently, she teaches Mental Health, Cultural Diversity and Research in the Diploma of Nursing course at Victoria University in Melbourne, Australia, while completing her PhD thesis for examination at Charisma University. The second author, Dr. Michael Ha, FSA, MAAA, CFA, CPA (Australia) FRM, PRM, LLM, is the Founding Director of the MSc Financial Mathematics programme at Xian Jiaotong-Liverpool University. He was previously Vice President of Strategic Business In-itiatives Units at ING Life Insurance in its Taiwan operation. Ninety percent of his students are enrolled in the Financial Mathematics programme. They learn not only mathematics and statistics theories but also their applications in the Finance and Investment areas, especially Portfolio Con-struction and Financial Risk Management. Creating a real-world Finance work environment in university lecture-halls embracing theories and practice, Dr. Ha strongly believes the PBL method can be employed in the Financial Mathematics training agenda so students can be better-prepared for work. Students are no longer instructed-learners but active thinkers and problem-solvers. Conclusion: Educators in fields such as Medical, Nursing, Engineering, Financial Mathematics, Ac-counting, Computing, etc., need to be prepared to change their teaching philosophy from didactic to problem solving for PBL to be implemented. Constructive alignment is recommended for curri-culum reform.

Language, culture and mental health: a study exploring the role of the transcultural mental health worker in Sheffield, UK

This paper aims to explore the role of the transcultural mental health worker as an alternative to the use of interpreters in an attempt to identify the communication barriers and improve the mental health care for Black and minority ethnic patients in the Sheffield area of the UK. A qualitative approach was conducted using a questionnaire, focus groups and semi-structured interviews, with 92 health and social care participants taking part. All participants apart from seven found working with transcultural mental health workers either more effective than or as effective as working with interpreters due to their holistic approach in understanding the various mental health aspects and cultural boundaries. The study highlights the importance of addressing the cultural issues since different cultural meanings can sometimes cause more difficulties in understanding between health and social care professionals and Black and minority ethnic patients than does language. It also highlights the complexities involved in interpreting in mental health settings and the need to tailor practical training sessions and educational programmes for interpreters in this field.

Perinatal mental health cultural responsiveness training – an evaluation

Purpose – Women from culturally and linguistically diverse communities face barriers to accessing perinatal mental health care. Victorian Transcultural Mental Health (VTMH) is a state-wide service in Victoria, Australia, that supports specialist mental health service providers to improve cultural responsiveness. VTMH provided training for perinatal health professionals in cultural responsiveness. The paper aims to discuss these issues. Design/methodology/approach – A curriculum was specifically developed based on a literature review, consultation forum, and input from members of an industry-based reference group. An Evaluation Tool was designed to collect participants’ feedback regarding the perceived relevance of the training content and its impact on practice. Responses were analysed using quantitative techniques and thematic analysis. Findings – Nine face-to-face training sessions were provided, in metropolitan and rural regions. In all, 174 professionals of various backgrounds (including midwives, mental health professionals, and maternal child health nurses) attended. In all, 161 completed evaluations were received and responses indicated that the training was of high relevance to the target workforce, that the training would have implications for their practice, and support was given for further training to be delivered using online methods. Research limitations/implications – First, an assessment of the cultural competence of participants prior to enrolment in the course was not conducted, and no matched control group was available for comparison with the participants. Second, generalisability of these findings to other settings requires further investigation. Third, the sustainability of the project is an area for further study in the future. Fourth, other methods including direct interviews of focus groups with participants may have yielded more detailed qualitative feedback regarding the effectiveness of the programme. Practical implications – To facilitate the sustainability of the project, following the face-to-face training, an online training module and a resource portal were developed, offering links to relevant web sites and resources for health professionals working in this field. Originality/value – The training addressed a significant unmet need for cultural responsiveness training for a diverse range of practitioners in the field of perinatal mental health. Online training can be adapted from face-to-face training and it is anticipated that online training will facilitate the sustainability of this initiative.

Enhancing cultural responsiveness: the development of a pilot transcultural secondary consultation program

This paper describes the development of a pilot secondary consultation program by a state-wide transcultural psychiatry unit, Victorian Transcultural Mental Health (VTMH), in partnership with a rural mental health service, Goulburn Valley Area Mental Health Service (GVAMHS), and the responses of the clinicians who participated. A series of eight consultations were facilitated by the VTMH in 2010 and attended by a total of 57 GVAMHS clinicians; five sessions were conducted face-to-face and three by videoconference. Facilitators recorded the details of discussions at each session. Participants and facilitators offered feedback that was analysed to improve the quality of cultural responsiveness at GVAMHS. Participants from a range of disciplines provided consistently positive feedback. The sessions provided an effective forum for discussing cultural formulations and culturally sensitive approaches to working with individuals and their families. This pilot secondary consultation program provided clinicians in a rural area with a forum in which to reflect on cross-cultural mental health issues. This pilot has informed the development of subsequent VTMH cultural consultation services.

Characteristics of culturally and linguistically diverse mental health clients

The present study examined Queensland Transcultural Mental Health Centre (QTMHC) client characteristics in order to provide a better understanding for development of future health service delivery models. Archived data that was collected for 1499 clients over a two year period (2007–2009) was analysed using descriptive statistics and x2. The results indicated that clients were referred from a range of sources and were generally adults. There were more women than men, who sought services. At least half of the clients had language barriers and relied on bilingual workers. Most frequently expressed mental health issues were mood disorder symptoms, followed by symptoms of schizophrenia and psychosis and anxiety. Acculturation strains and stressors were described as the most common psychosocial issues. Mental health and psychosocial issues differed for age, gender and world regions from which the CALD clients originated. The findings provided an understanding of clients who seek services at QTMHC. Various ways in which transcultural services and data bases can be further improved are discussed.

Characteristics of Culturally and Linguistically Diverse Mental Health Clients

The present study examined Queensland Transcultural Mental Health Centre (QTMHC) client characteristics in order to provide a better understanding for development of future health service delivery models. Archived data that was collected for 1499 clients over two years period (2007-2009) was analysed using descriptive statistics and Chi squares. The results indicated that clients were referred from a range of sources and were generally adults. There were more women than men, who sought services. At least half of the clients had language barriers and relied on bilingual workers. Most frequently expressed mental health issues were mood disorder symptoms, followed by symptoms of schizophrenia and psychosis and anxiety. Acculturation strains and stressors were described as the most common psychosocial issues. Mental health and psychosocial issues differed for age, gender and world regions from which the CALD clients originated. The findings provided an understanding of clients who seek services at QTMHC. Various ways in which transcultural services and data bases can be further improved are discussed.

Mental health, service use and social capital among Indian-Australians: findings of a wellbeing survey

Indian-Australians represent a distinct immigrant group both demographically and culturally. Yet, despite an expanding body of research on transcultural mental health in Australia, there is a paucity of studies regarding mental health of Indian-Australians. This paper explores the extent of psychological morbidity and related service use in a representative sample of Indian-Australians. It further examines the association of mental health with social participation and networking in this ethnic community. Measures to assess current levels of psychological distress, functional disability, service use, and social capital were administered in a random sample of 71 Indian-Australian family groups living in Sydney. Amongst participants, 15% reported high to very high levels of psychological distress. Psychological distress was associated with increased days of functional disability and higher levels of functional impairment, and an increased likelihood of a GP consultation. However, 91% of participants with identifiable mental health needs did not seek any mental health consultation. Social capital was not found to be a significant predictor of psychological health or service use in this sample. Psychological morbidity in the Indian-Australian community is associated with high levels of functional disability, both in number of days and extent of severity, but only a small proportion seeks mental health help.

Repatriation of a Patient Under a Forensic Order from Australia to Thailand

A person who develops a serious mental illness whilst visiting Australia may encounter substantial barriers to treatment, rehabilitation and eventual repatriation to his home country. Particularly when English is not the person's first language and there are no supports in Australia, the person will have special needs whilst recovering from his or her illness. Further difficulties arise if the person has been charged with a serious offence. We present the case of a 23 year old single Thai citizen who had been living in Australia on an overseas student visa before he was charged with a serious violent offence in the context of a mental illness. Following an assessment at the watch-house, the patient was diagnosed with an untreated psychotic illness. The patient was subsequently admitted from a remand prison to a secure mental hospital and became subject to the involuntary treatment provisions of the Queensland Mental Health Act. With a detailed multi-disciplinary rehabilitation plan and the assistance of a transcultural mental health service, a patient with a serious mental illness may be rehabilitated to enable negotiations with multiple government and non-government agencies to facilitate the patient's return to his country of origin.

Transcultural mental health care issues of Ethiopian immigration to Israel

In Western societies abnormal behaviour is permitted and encouraged on specific occasions, such as Carnival and Halloween. However, in many parts in the world people are possessed by supernatural forces that speak through them, or have dreams and hallucinations that convey important messages to the community, including health perceptions and behaviours. What is an acceptable conduct for African immigrants in a Western community such as Israel and how is this interpreted?To illustrate the cultural component in mental health care and link this to mental health prevalence and patterns of mental disease, two patients who immigrated from Ethiopia are presented: (1) a young woman who tried to commit suicide, and who, on arrival at the hospital informed the physician that her situation was the result of possession by an evil spirit, the ‘Zar’; (2) a 19-year-old student, who was brought by his older brother to the primary physician due to ‘sensations in his head’.This article also presents unique causes and patterns for immigration of Ethiopian Jews to Israel that could have an imprint on the wellbeing of the newcomers. The conclusion is that marked sociocultural differences between immigrants and the host society and the lack of awareness of these differences by mental health professionals may influence rates and patterns of psychiatric hospitalisation even more than the immigration hardship itself. It is therefore essential that health providers make every effort to familiarise themselves with the cultural backgrounds and identities of their patients and equip themselves with the competences to engage actively and in the spirit of partnership with their patients, in order to provide them with appropriate and acceptable care.

Perception That “Everything Requires a Lot of Effort”

This brief report illustrates how the migration context can affect specific item validity of mental health measures. The SCL-25 was administered to 432 recently settled immigrants (220 Haitian and 212 Arabs). We performed descriptive analyses, as well as Infit and Outfit statistics analyses using WINSTEPS Rasch Measurement Software based on Item Response Theory. The participants' comments about the item You feel everything requires a lot of effort in the SCL-25 were also qualitatively analyzed. Results revealed that the item You feel everything requires a lot of effort is an outlier and does not adjust in an expected and valid fashion with its cluster items, as it is over-endorsed by Haitian and Arab healthy participants. Our study thus shows that, in transcultural mental health research, the cultural and migratory contexts may interact and significantly influence the meaning of some symptom items and consequently, the validity of symptom scales.

Development of the Multicultural Mental Health Awareness Scale

The present study describes the development of an instrument to assess the multicultural competencies of mental health professionals in Australia. The scale was developed to assess the effectiveness of a multicultural mental health training program. Mental health professionals from Queensland, Australia (N = 268) participated in the study by completing a questionnaire battery. Items on the new scale were generated to parallel the Queensland Transcultural Mental Health Centre (QTMHC) training program's objectives. The results describe a 35-item Multicultural Mental Health Awareness Scale. Factor analysis of the scale indicated three factors of multicultural counselling competencies: Awareness, Knowledge, and Skills. These factors were in line with the Sue et al. (1982) multicultural counselling competencies. The scale has satisfactory internal consistency, test–retest reliability, concurrent validity, and discriminant validity and can be used to evaluate the effectiveness of the multicultural competency training programs in mental health.

Multiple-Family Group Treatment for English- and Vietnamese-Speaking Families Living With Schizophrenia

Multiple-Family Group Treatment for English- and Vietnamese-Speaking Families Living With Schizophrenia

What CALD consumers say about mental illness prevention

This article discusses what consumers from culturally and linguistically diverse (CALD) backgrounds said about mental illness prevention in a consultation conducted by the Queensland Transcultural Mental Health Centre (QTMHC). The consultative process was organised by two CALD consumer workers and involved a total of 28 CALD consumers, as well as eight consumer facilitators who received training from the QTMHC on interviewing and conducting focus group discussions with consumers from their own cultural background in their own language on mental illness prevention. CALD consumers drew on their personal experiences with mental illness to identify what may have made a difference to them personally in terms of prevention. They also discussed what service providers can do in both the multicultural and mental health sectors; the key issues they currently perceive as stressors for mental illness in their cultural communities (including for specific sub groups in communities at greatest risk); unmet needs and gaps in programs and services; existing activities within their communities that can further be supported or built upon to facilitate mental illness prevention; and what they as consumers would like to become involved in as part of a prevention strategy within their communities.