1
|
Francois D, Charles-Belzie MD, Belzie LR, Clerisme JR, Jean-Noel P, Francois PL, Galanter CA. From Stigma to Empowerment: Teaching Advocacy to Child and Adolescent Psychiatry Fellows. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:298-299. [PMID: 37369958 DOI: 10.1007/s40596-023-01817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Dimitry Francois
- Weill Cornell Medicine, NewYork-Presbyterian Westchester Behavioral Health Center, White Plains, NY, USA.
| | | | - Louis R Belzie
- One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | | | - Pierre Jean-Noel
- One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | | | - Cathryn A Galanter
- SUNY Downstate/New York City Health and Hospitals/Kings, Brooklyn, NY, USA
| |
Collapse
|
2
|
Abarca-Brown G. Structuralizing Culture: Multicultural Neoliberalism, Migration, and Mental Health in Santiago, Chile. Cult Med Psychiatry 2024:10.1007/s11013-024-09858-4. [PMID: 38782866 DOI: 10.1007/s11013-024-09858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
The arrival of Afro-descendant migrants, mainly from Haiti and the Dominican Republic, has led to the emergence of new discourses on migration, multiculturalism, and mental health in health services in Chile since 2010. In this article, I explore how mental health institutions, experts, and practitioners have taken a cultural turn in working with migrant communities in this new multicultural scenario. Based on a multisited ethnography conducted over 14 months in a neighbourhood of northern Santiago, I focus on the Migrant Program-a primary health care initiative implemented since 2013. I argue that health practitioners have tended to redefine cultural approaches in structural terms focusing mainly on class aspects such poverty, social stratification, and socioeconomic inequalities. I affirm that this structural-based approach finds its historical roots in a political and ideological context that provided the conditions for the development of community psychiatry experiences during the 1960s and 1970s, as well as in multicultural and gender policies promoted by the state since the 1990s. This case reveals how health institutions and practitioners have recently engaged in debates on migration and intersectionality from a structural approach in Chile.
Collapse
Affiliation(s)
- Gabriel Abarca-Brown
- Center for Culture and the Mind (CULTMIND), Department of English, Germanic and Romance Studies (ENGEROM), University of Copenhagen, Emil Holms Kanal 6, 2300, Copenhagen, Denmark.
- Universidad Diego Portales, Santiago, Chile.
| |
Collapse
|
3
|
Lee K, Kronick R, Miconi D, Rousseau C. Moving Forward in Mental Health Care for Refugee, Asylum-Seeking, and Undocumented Children: Social Determinants, Phased Approach to Care, and Advocacy. Child Adolesc Psychiatr Clin N Am 2024; 33:237-250. [PMID: 38395508 DOI: 10.1016/j.chc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Given the current political and climate crisis, the number of forcedly displaced individuals continues to rise, posing new challenges to host societies aiming to support and respond to the needs of those fleeing war or persecution. In this article, we turn our attention to current and historical sociopolitical contexts influencing the mental health of forcedly displaced children (ie, refugee, asylum-seeking, and undocumented) during their resettlement in high-income countries, proposing timely ways to respond to evolving needs and recommendations to redress ubiquitous structural inequities that act as barriers to education and care for the children, youth, and families seeking sanctuary.
Collapse
Affiliation(s)
- Keven Lee
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue, Montreal, Quebec, Canada; Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec.
| | - Rachel Kronick
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue, Montreal, Quebec, Canada; Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec
| | - Diana Miconi
- Department of Educational Psychology and Adult Education, Université de Montréal, 90 Vincent D'Indy Avenue, Outremont, Montréal, QC, Canada
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Hubbard A, Sudler A, Alves-Bradford JME, Trinh NH, Emmerich AD, Mangurian C. Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors. Child Adolesc Psychiatr Clin N Am 2024; 33:57-69. [PMID: 37981337 DOI: 10.1016/j.chc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.
Collapse
Affiliation(s)
- Asale Hubbard
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA; San Francisco VA Health Care System
| | - Andrew Sudler
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA
| | | | - Nhi-Ha Trinh
- Massachusetts General Hospital Department of Psychiatry
| | | | - Christina Mangurian
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA.
| |
Collapse
|
5
|
Oluwoye O, Nagendra A, Kriegel LS, Anglin DM, Santos MM, López SR. Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States. SSM - MENTAL HEALTH 2023; 3:100209. [PMID: 37475775 PMCID: PMC10355221 DOI: 10.1016/j.ssmmh.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to 'recovery.' In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches.
Collapse
Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Arundati Nagendra
- Center of Excellence in Psychosocial and Systemic Research, Massachusetts General Hospital/Harvard Medical School, 151 Merrimac Street, Floor 6, Boston, MA, 02114, USA
| | - Liat S. Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Deidre M. Anglin
- City University of New York, Department of Psychology, 160 Convent Ave, NAC Building, Room 7/120, New York, NY, 10031, USA
| | - Maria M. Santos
- Department of Psychology, California State University, San Bernardino, 5500 University Parkway, San Bernardino, CA, 92407, USA
| | - Steven R. López
- Department of Psychology, University of Southern California, Seeley G. Mudd Room 501, 3620 S. McClintock, Los Angeles, CA, 90089, USA
| |
Collapse
|
6
|
Bhugra D, Smith A, Ventriglio A, Hermans MHM, Ng R, Javed A, Chumakov E, Kar A, Ruiz R, Oquendo M, Chisolm MS, Werneke U, Suryadevara U, Jibson M, Hobbs J, Castaldelli-Maia J, Nair M, Seshadri S, Subramanyam A, Patil N, Chandra P, Liebrenz M. World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century. Asian J Psychiatr 2023; 88:103739. [PMID: 37619422 DOI: 10.1016/j.ajp.2023.103739] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.
Collapse
Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London SE5 8AF, UK.
| | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Roger Ng
- Secretary for Education, WPA, Geneva, Switzerland
| | - Afzal Javed
- World Psychiatric Association, Geneva. Switzerland. Fountain House, Lahore. Pakistan
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Roxanna Ruiz
- University of Francisco Moaroquin, Guatemala City, Guatemala
| | - Maria Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | | | - Ursula Werneke
- Department of Clinical Sciences, Psychiatry, Umeå University, Sunderby Research Unit, Umeå, Sweden
| | - Uma Suryadevara
- Geriatric Division, Department of Psychiatry, University of Florida, Gainesville, United States
| | - Michael Jibson
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Jacqueline Hobbs
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
| | | | - Muralidharan Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Shekhar Seshadri
- Department of Child Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka 560029, India
| | - Alka Subramanyam
- Department of Psychiatry, Topiwala Nair Medical College, Mumbai, Maharashtra 400008, India
| | - Nanasaheb Patil
- Department of Psychiatry, J.N. Medical College, Belgavi, Karnataka 590010, India
| | - Prabha Chandra
- Behavioral Sciences, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| |
Collapse
|
7
|
Jarvis GE, Andermann L, Ayonrinde OA, Beder M, Cénat JM, Ben-Cheikh I, Fung K, Gajaria A, Gómez-Carrillo A, Guzder J, Hanafi S, Kassam A, Kronick R, Lashley M, Lewis-Fernández R, McMahon A, Measham T, Nadeau L, Rousseau C, Sadek J, Schouler-Ocak M, Wieman C, Kirmayer LJ. Taking Action on Racism and Structural Violence in Psychiatric Training and Clinical Practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:780-808. [PMID: 37198904 PMCID: PMC10517653 DOI: 10.1177/07067437231166985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- G Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada; Cultural Consultation Service and Culture and Psychosis Working Group, Jewish General Hospital, Montréal, QC, Canada
| | - Lisa Andermann
- Equity and Inclusion Council; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Oyedeji A Ayonrinde
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Community Psychiatry, Providence Care, Kingston, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON, Canada
| | - Imen Ben-Cheikh
- Department of Psychiatry, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Kenneth Fung
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Asian Initiative in Mental Health, University Health Network, Toronto, ON, Canada; Society for the Study of Psychiatry and Culture, Beverly Hills, CA, USA
| | - Amy Gajaria
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ana Gómez-Carrillo
- Montréal Children's Hospital (MCH), McGill University Health Centre (MUHC), Montréal, QC, Canada; Inuulitsivik Health Centre, Puvirnituq, QC, Canada; Ungava Tulattavik Health Centre, Kuujjuaq, QC, Canada
| | | | - Sarah Hanafi
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Ottawa Newcomer Health Centre, Ottawa, ON, Canada; Wholistic Health and Wellness, Mohawk Council of Akwesasne, Akwesasne, QC, Canada
| | - Rachel Kronick
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montréal, QC, Canada; Lady Davis Institute and Sherpa Research Institute, Montréal, QC, Canada
| | - Myrna Lashley
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Research Ethics Board, CIUSSS du Centre-Ouest-de-l'île-de-Montréal, Sir B. Mortimer Jewish General Hospital, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Sir B. Mortimer Jewish General Hospital, Montréal, QC, Canada
| | - Roberto Lewis-Fernández
- Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence and Research Area Leader, Anxiety, Mood, Eating and Related Disorders, New York State Psychiatric Institute, New York, NY, USA
| | | | - Toby Measham
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Divisions of Child Psychiatry and Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Lucie Nadeau
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Montréal University Health Centre, Montréal, QC, Canada; Inuulitsivik Health Centre, Puvirnituq, QC, Canada
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Meryam Schouler-Ocak
- Social Psychiatry, Charité - Universitätsmedizin, Berlin, Germany; Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Cornelia Wieman
- Indigenous Physicians Association of Canada (IPAC), Vancouver, BC, Canada; First Nations Health Authority (FNHA), Vancouver, BC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| |
Collapse
|
8
|
Davoren N, McEleney A, Corcoran S, Tierney P, Fortune DG. Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations. Clin Psychol Psychother 2023. [PMID: 37658701 DOI: 10.1002/cpp.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Therapeutic boundaries are limits to appropriate behaviours within a therapist-client relationship (e.g. related to accepting gifts, self-disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions. METHOD Six databases were searched. Following full-text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis. RESULTS Three major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re-Conceptualisation of Therapy as 'Clinical Political' and Re-Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries-Not becoming 'Hardened' or 'Haunted'. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist-client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re-conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn-out. CONCLUSIONS Boundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well-being and training needs for therapists supporting this population.
Collapse
Affiliation(s)
- Niamh Davoren
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Alice McEleney
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Santhi Corcoran
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
| | - Phelim Tierney
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Service Executive, Mid-West Region, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
9
|
Essay topic - What is the role of psychiatry in recovery from severe trauma? Australas Psychiatry 2023; 31:567-569. [PMID: 37583106 DOI: 10.1177/10398562231190829f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
|
10
|
Bhugra D, Smith A, Liebrenz M, Ventriglio A, Gnanapragasam SN, Buadze A, Pemberton M, Poulter D. "Otherness", otherism, discrimination, and health inequalities: entrenched challenges for modern psychiatric disciplines. Int Rev Psychiatry 2023; 35:234-241. [PMID: 37267034 DOI: 10.1080/09540261.2023.2192275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 06/03/2023]
Abstract
Identity is a complex concept that can be informed by various factors, involving biological, psychological, experiential, and social influences. Specifically, one's social identity refers to the ways in which individuals can adopt attributes from established collective categories, like cultural identities, ethnic identities, gender identities, and class identities, amongst others. Social identity can encompass unique and diverse interactions at an individual level, known as micro-identities, that may be selectively expressed, hidden, or downplayed, contingent on distinct sociocultural settings. However, the formation of social identity is recurrently defined in opposition to perceptions of the Other, which can entail adverse paradigms of marginalisation, stigma, and discrimination. Although this theory of Otherness has been developed across different fields, particularly sociology, it may be important in psychiatric contexts as it can engender inherent risk factors and mental health inequalities. Consequently, this paper seeks to bring attention towards these issues, exploring the construction of Otherness and its detrimental outcomes for psychiatry, such as systemic discrimination and disparities in therapeutic support, alongside recommended initiatives to mitigate against the effects of Otherness. This may require multifactorial approaches that include cultural competency training, interventions informed by micro-identities and intersectionality, patient advocacy, and structural changes to mental health policy.
Collapse
Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London, UK
| | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Ana Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, Specialized Outpatient Clinic for ADHD, University of Zurich, Zurich, Switzerland
| | - Max Pemberton
- Specialist Registrar, Camden and Islington NHS Foundation Trust, London
| | - Daniel Poulter
- South London and Maudsley Foundation NHS Trust, London, UK
| |
Collapse
|
11
|
Gómez-Carrillo A, Kirmayer LJ. A cultural-ecosocial systems view for psychiatry. Front Psychiatry 2023; 14:1031390. [PMID: 37124258 PMCID: PMC10133725 DOI: 10.3389/fpsyt.2023.1031390] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/08/2023] [Indexed: 05/02/2023] Open
Abstract
While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully characterized in terms of brain function but require a larger social-ecological view. Causal processes that result in mental health problems can begin anywhere within the extended system of body-person-environment. In particular, individuals' narrative self-construal, culturally mediated interpretations of symptoms and coping strategies as well as the responses of others in the social world contribute to the mechanisms of mental disorders, illness experience, and recovery. In this paper, we outline the conceptual basis and practical implications of a hierarchical ecosocial systems view for an integrative approach to psychiatric theory and practice. The cultural-ecosocial systems view we propose understands mind, brain and person as situated in the social world and as constituted by cultural and self-reflexive processes. This view can be incorporated into a pragmatic approach to clinical assessment and case formulation that characterizes mechanisms of pathology and identifies targets for intervention.
Collapse
Affiliation(s)
- Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Laurence J. Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| |
Collapse
|
12
|
Mizumoto J, Mitsuyama T, Kondo S, Izumiya M, Horita S, Eto M. Defining the observable processes of patient care related to social determinants of health. MEDICAL EDUCATION 2023; 57:57-65. [PMID: 35953461 DOI: 10.1111/medu.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) METHODS: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications. RESULTS Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient-physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care. DISCUSSION This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication-Practice-Maintenance-Advocacy framework could affect medical education, quality of patient care, and patient outcomes.
Collapse
Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshichika Mitsuyama
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kondo
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoko Horita
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
13
|
A Concept Analysis of Structural Competency. ANS Adv Nurs Sci 2022; 46:188-198. [PMID: 36036684 PMCID: PMC10153664 DOI: 10.1097/ans.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Structural competency is a concept that offers a way to understand and respond to health inequities and work toward antiracism in health care. This article undertakes a concept analysis of structural competency using Rodgers' evolutionary method. Based on this analysis, structural competency refers to the ability to recognize and act on structural inequities, skill development, multidisciplinary collaboration, and the reproduction of inequity over time. The meanings and use of this concept differ among disciplines. Multidisciplinary applications of structural competency offer insight into how this concept can foster health equity and antiracism in nursing care, education, research, and health services delivery.
Collapse
|
14
|
Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors. Psychiatr Clin North Am 2022; 45:283-295. [PMID: 35680244 PMCID: PMC9399901 DOI: 10.1016/j.psc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.
Collapse
|
15
|
Salhi BA, Zeidan A, Stehman CR, Kleinschmidt S, Liu EL, Bascombe K, Preston‐Suni K, White MH, Druck J, Lopez BL, Samuels‐Kalow ME. Structural competency in emergency medical education: A scoping review and operational framework. AEM EDUCATION AND TRAINING 2022; 6:S13-S22. [PMID: 35783075 PMCID: PMC9222890 DOI: 10.1002/aet2.10754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. METHODS A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. RESULTS A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. CONCLUSIONS Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.
Collapse
Affiliation(s)
- Bisan A. Salhi
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of AnthropologyEmory UniversityAtlantaGeorgiaUSA
| | - Amy Zeidan
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Christine R. Stehman
- Department of Emergency MedicineUniversity of Illinois College of MedicinePeoriaIllinoisUSA
| | - Sarah Kleinschmidt
- Department of Emergency MedicineUniversity of Massachusetts Medical School—BaystateSpringfieldMassachusettsUSA
| | - E. Liang Liu
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Kristen Bascombe
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Kian Preston‐Suni
- Department of Emergency MedicineVA Greater Los Angeles Healthcare SystemUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Jeff Druck
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Bernard L. Lopez
- Department of Emergency MedicineSidney Kimmel Medical CollegePhiladelphiaPennsylvaniaUSA
| | | |
Collapse
|
16
|
Bäärnhielm S, Schouler-Ocak M. Training in cultural psychiatry: Translating research into improvements in mental health care for migrants. Transcult Psychiatry 2022; 59:111-115. [PMID: 35442116 DOI: 10.1177/13634615221089384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This special issue of Transcultural Psychiatry on training in cultural psychiatry discusses translating research into improvements in mental health care for refugees and migrants. This topic is timely because, in addition to a global increase in migration, the number of forcibly displaced people is growing rapidly due to war and conflicts. We know that migrants, particularly refugees, are at increased risk of psychiatric disorders, including psychotic disorders and post-traumatic stress. Despite this, there is evidence of major disparities in care for minorities, migrants, and refugees. The gap between needs related to mental health care for migrants, refugees, and minority groups and available services points to the need to improve accessibility and adapt systems, services, and interventions. Health professionals have a key role in ensuring the quality of care. Their capacity to cope with new challenges depends on their competence, knowledge, skills, and attitudes toward their patients' needs. Mental health professionals need training in working with cultural diversity and structural competence to understand, treat, and support migrant and refugee patients-and to respond to racial discrimination. Mental health care services need to reduce barriers to providing adequate resources, including supporting skills training for mental health professionals. Hopefully, this thematic special issue will motivate further research, discussion, and sharing of local experience and pedagogical methods in this vital field.
Collapse
|
17
|
Bergen S. "The kind of doctor who doesn't believe doctor knows best": Doctors for Choice and the medical voice in Irish abortion politics, 2002-2018. Soc Sci Med 2022; 297:114817. [PMID: 35247770 PMCID: PMC8939907 DOI: 10.1016/j.socscimed.2022.114817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/08/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
This article examines how the physician advocacy organization Doctors for Choice articulated a collective pro-choice "medical voice" over the course of sixteen years. This voice was central to the successful 2018 campaign to repeal Ireland's Eighth Amendment, which had imposed a virtual ban on abortion in the Republic of Ireland since 1983. I examine how DfC set itself in opposition to the powerful cadre of anti-abortion Catholic physicians who had dominated Irish public discourse on abortion for decades. DfC not only had to provide a strong alternative argument, but also had to distance itself from a legacy of physicians as gatekeepers to abortion. Based on oral histories and documentary sources, I argue that DfC developed a collective pro-choice "medical voice" and a politics of physician advocacy by leveraging the cultural authority of physicians and using discourses of medical expertise and patient autonomy. Doctors have been called upon to use their social position to fight health-related social inequality. By providing a detailed case study based on individual experiences of and perspectives on physician advocacy, this article examines the framework of "physician advocacy" in practice. It identifies affective and structural barriers to physician engagement in abortion politics across medical specialties. Finally, it considers how, in the face of these barriers, a small group of physicians helped to set the terms of a movement for accessible and equitable abortion care in Ireland.
Collapse
Affiliation(s)
- Sadie Bergen
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, USA.
| |
Collapse
|
18
|
Sukhera J, Knaak S, Ungar T, Rehman M. Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:175-181. [PMID: 34647920 DOI: 10.1097/acm.0000000000004451] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.
Collapse
Affiliation(s)
- Javeed Sukhera
- J. Sukhera is chair of psychiatry, Institute of Living, and chief of psychiatry, Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Stephanie Knaak
- S. Knaak is research consultant, Mental Health Commission of Canada, and assistant professor, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-7663-3451
| | - Thomas Ungar
- T. Ungar is psychiatrist in chief, St. Michael's Hospital, Unity Health Toronto, and associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-9627-0421
| | - Maham Rehman
- M. Rehman is research associate, Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
19
|
Burson RC, Familusi OO, Clapp JT. Imagining the 'structural' in medical education and practice in the United States: A curricular investigation. Soc Sci Med 2021; 300:114453. [PMID: 34663541 PMCID: PMC9035321 DOI: 10.1016/j.socscimed.2021.114453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
A number of conceptual frameworks have emerged with the goal of helping clinicians understand and navigate the intersections of the health system and broader political, economic, and cultural processes when they care for patients. In this study, we analyze the impact that one emerging framework, "structural competency," had on medical students' and physicians' understanding of societal problems affecting patient health and the practices of health systems. In this sub-analysis of a longitudinal qualitative study conducted between August and December 2020, we analyzed 19 semi-structured interviews with 7 first-year medical students, 7 upper-level medical students, and 5 physician course facilitators who participated in a course called Introduction to Medicine and Society at an medical school in the United States affiliated with a large urban academic medical center. This paper focuses on three main findings: how medical students and faculty describe "structures" and their effects on patients and patient care; how they use or imagine using structural competency to improve patient-physician communication and work interprofessionally to address social needs; and the emotional and personal reactions that confronting societal challenges provokes. We conclude that structural competency enhances existing efforts to improve patient-physician communication and to address patients' social needs. However, we highlight how structural competency efforts might fall short of their goal to shift physicians' perspectives "upstream" to the determinants of health due to both critical ambiguities in the concept and inattention to the emotional and personal impacts of addressing societal problems in the clinic. These findings have practical implications for how clinicians are trained to act on societal issues from within the health system and conceptual implications for refining how existing frameworks and curricula conceive of the intersection between healthcare and broader processes.
Collapse
Affiliation(s)
- Randall C Burson
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd. 6th Floor, Philadelphia, PA, 19104, USA; Department of Anthropology, University of Pennsylvania, 3260 South St., Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA.
| | - Olivia O Familusi
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd. 6th Floor, Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
| | - Justin T Clapp
- Department of Anthropology, University of Pennsylvania, 3260 South St., Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| |
Collapse
|
20
|
Jones N, Kamens S, Oluwoye O, Mascayano F, Perry C, Manseau M, Compton MT. Structural Disadvantage and Culture, Race, and Ethnicity in Early Psychosis Services: International Provider Survey. Psychiatr Serv 2021; 72:254-263. [PMID: 33430649 PMCID: PMC9119303 DOI: 10.1176/appi.ps.202000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about provider perspectives on programmatic responses to structural disadvantage and cultural differences within early intervention in psychosis (EIP) services, programs, and models. The primary objective of this study was to investigate providers' perspectives on the impacts of disadvantage and minority race, ethnicity, and culture and to describe current practices and perceived gaps and concerns. METHODS An online survey of specialized EIP providers was disseminated in the United Kingdom, United States, Canada, Australia, and Chile. A total of 164 providers, representing 110 unique sites, completed the survey. Closed-ended questions gathered demographic and program data, including information on formal assessment of trauma or adversity, integration of trauma-informed care, integration of formal cultural assessment tools, training focused on culture, programmatic changes to address culture-related issues, and consultation with cultural insiders. Open-ended questions addressed the demographic mix of the program's client population; the perceived role and influence of trauma, structural disadvantage, and cultural differences; and concerns and needs related to these topics. Frequencies were examined for closed-ended items; open-ended responses were systematically coded. RESULTS Overall, survey findings suggested low levels of implementation of a variety of assessment and support practices related to cultural diversity in EIP programs. Coding of open-ended responses revealed numerous concerns regarding the impacts of disadvantage and cultural difference on clients and perceived gaps in policy and implementation. CONCLUSIONS An expansion of research and service development aimed at better meeting the disadvantage- and culture-related needs of young people with early psychosis and their families should be a priority for the field.
Collapse
Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Sarah Kamens
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Oladunni Oluwoye
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Franco Mascayano
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Chris Perry
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Marc Manseau
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Michael T Compton
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| |
Collapse
|
21
|
|
22
|
Xavier SM, Jarvis GE, Ouellet-Plamondon C, Gagné G, Abdel-Baki A, Iyer SN. Comment les services d’intervention précoce pour la psychose peuvent-ils mieux servir les migrants, les minorités ethniques et les populations autochtones ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088188ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
23
|
Orr Z, Unger S. The TOLERance Model for Promoting Structural Competency in Nursing. J Nurs Educ 2020; 59:425-432. [PMID: 32757005 DOI: 10.3928/01484834-20200723-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Structural competency is the trained ability to recognize how social, political, economic, and legal structures shape diseases and symptoms. Although structural competency has become an increasingly accepted framework for training and teaching, it usually has not addressed nursing students and has not included marginalized patients as trainers. METHOD This article analyzes a structural competency training model for nursing students that includes five components: Theory, Observations, Learning from patients, Engagement, and Research (the TOLERance model). RESULTS The TOLERance model increases the understanding of the interrelation between the individual clinical level and the sociopolitical structural level. It encourages nursing students to actively engage in social, political, and policy issues that affect their patients' health and to advocate for policy change. CONCLUSION The moral and professional commitment of nurses to their patients demands that they do not ignore the structural forces that are detrimental to their patients' health. The TOLERance model provides nursing students with skills and competencies that help them to fulfill this commitment. [J Nurs Educ. 2020;59(8):425-432.].
Collapse
|
24
|
de Freitas Girardi J, Miconi D, Lyke C, Rousseau C. Creative expression workshops as Psychological First Aid (PFA) for asylum-seeking children: An exploratory study in temporary shelters in Montreal. Clin Child Psychol Psychiatry 2020; 25:483-493. [PMID: 31814432 DOI: 10.1177/1359104519891760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Considering the growing number of asylum-seeking children worldwide, research on interventions which may buffer the effects of early resettlement conditions on asylum-seeking children's adjustment is warranted. In Canada, creative expressive workshops for asylum-seeking children and adolescents were implemented as a Psychological First Aid (PFA) intervention in temporary shelters. The present exploratory study aims to describe the implementation of these workshops to assess whether the intervention met core elements of PFA and explore its potential in supporting the diverse needs of asylum-seeking youth in temporary shelters, adopting a process-evaluation research approach. METHOD The intervention was evaluated via a qualitative thematic analysis of extensive field and supervision notes and focus groups with facilitators. RESULTS Preliminary results suggest that the intervention contributed to fostering emotional safety and a sense of normalcy in children and supported the creation of connections among both children and parents. Children's expression of past and present experiences during the workshops was seen as a way to promote self-efficacy in children and was reported as a potential way to provide some comfort and hope in a time of high instability. However, the high needs of children and the lack of resources in the temporary shelters represented significant challenges and barriers. CONCLUSIONS PFA using creative expression may be a promising youth mental health prevention intervention in temporary shelters.
Collapse
Affiliation(s)
- Júlia de Freitas Girardi
- Laboratoire Cliniques Pathologique et Interculturelle (LCPI), Université de Toulouse II-Jean Jaurès, France
| | - Diana Miconi
- Division of Social and Transcultural Psychiatry, McGill University, Canada
| | | | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, Canada
| |
Collapse
|
25
|
Purtle J, Lê-Scherban F, Nelson KL, Shattuck PT, Proctor EK, Brownson RC. State mental health agency officials' preferences for and sources of behavioral health research. Psychol Serv 2020; 17:93-97. [PMID: 31192673 PMCID: PMC6908783 DOI: 10.1037/ser0000364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
State mental health agencies (SMHAs) are integral to public behavioral health service systems. As such, senior-level officials within SMHAs are important targets for advocacy and dissemination of behavioral health research findings. Evidence-informed decision making in SMHAs can potentially be enhanced by developing summaries of behavioral health research (e.g., policy briefs) that reflect SMHA officials' information preferences, but knowledge about these preferences is lacking. An exploratory study was conducted with the aims of characterizing senior-level SMHA officials' preferences for behavioral health research and describing where they turn for this research when making policy decisions. A cross-sectional, web-based survey of senior-level SMHA officials (1 per state) was conducted in March-May 2017 (n = 43, response rate = 84%). The features of behavioral health research that SMHA officials identified as "very important" most frequently were research being relevant to state residents (93.0%), providing data on cost-effectiveness (86.0%) and budget impact (81.4%), and being presented concisely (81.0%). The primary sources that SMHA officials turned to for behavioral research when making policy decisions were professional organizations (79.1%), SMHA agency staff (60.5%), and university researchers (55.8%). Compared with state legislators' responses to the same survey questions, results suggest that senior-level SMHA officials and legislators have similar preferences for behavioral health research but turn to different sources for this research. Advocates and researchers who seek to promote evidence-informed decision making in SMHAs should consider developing policy briefs that are concise, provide state-level prevalence data about behavioral conditions, and contain economic evaluation data, and they should disseminate these materials to multiple sources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
26
|
Gajaria A, Izenberg JM, Nguyen V, Rimal P, Acharya B, Hansen H. Moving the Global Mental Health Debate Forward: How a Structural Competency Framework Can Apply to Global Mental Health Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:617-620. [PMID: 31161574 DOI: 10.1007/s40596-019-01073-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
| | | | - Viet Nguyen
- University of California, San Francisco, San Francisco, USA
| | | | - Bibhav Acharya
- University of California, San Francisco, San Francisco, USA
- Possible, Nyaya Health Nepal, Achham, Nepal
| | | |
Collapse
|
27
|
Willging C, Gunderson L, Shattuck D, Sturm R, Lawyer A, Crandall C. Structural competency in emergency medicine services for transgender and gender non-conforming patients. Soc Sci Med 2018; 222:67-75. [PMID: 30605801 DOI: 10.1016/j.socscimed.2018.12.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
Abstract
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6), nurses (n = 7), and non-clinical staff (n = 7) in four community-based EDs in New Mexico. Our iterative coding and analysis process resulted in eight sets of findings: (1) reasons why TGGNC patients seek care from EDs; (2) perceptions about and experiences of TGGNC patients; (3) relevance of gender identity and sex at birth; (4) bureaucracy and communication; (5) spatial considerations; (6) preparing providers and staff to care for TGGNC patients; (7) the lack of resources for structural prescriptions; and (8) respect, humanity, and sameness. Findings suggest that structural issues adversely impact the health and wellbeing of TGGNC patients and service-delivery practices in the ED. We describe study implications for training ED personnel and modifying this practice setting to prevent delayed care and ensure appropriate services for TGGNC patients in need of structurally competent emergency medicine.
Collapse
Affiliation(s)
- Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Daniel Shattuck
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Robert Sturm
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; New Mexico Community AIDS Partnership, 903 West Alameda #764, Santa Fe, NM, 87501, USA.
| | - Adrien Lawyer
- Transgender Resource Center of New Mexico, 149 Jackson Street, NE, Albuquerque, NM, 87108, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, MSC11-6025, 700 Camino de Salud, Albuquerque, NM, 87131, USA.
| |
Collapse
|
28
|
Audience segmentation to disseminate behavioral health evidence to legislators: an empirical clustering analysis. Implement Sci 2018; 13:121. [PMID: 30231934 PMCID: PMC6148796 DOI: 10.1186/s13012-018-0816-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Elected officials (e.g., legislators) are an important but understudied population in dissemination research. Audience segmentation is essential in developing dissemination strategies that are tailored for legislators with different characteristics, but sophisticated audience segmentation analyses have not been conducted with this population. An empirical clustering audience segmentation study was conducted to (1) identify behavioral health (i.e., mental health and substance abuse) audience segments among US state legislators, (2) identify legislator characteristics that are predictive of segment membership, and (3) determine whether segment membership is predictive of support for state behavioral health parity laws. Methods Latent class analysis (LCA) was used. Data were from a multi-modal (post-mail, e-mail, telephone) survey of state legislators fielded in 2017 (N = 475). Nine variables were included in the LCA (e.g., perceptions of behavioral health treatment effectiveness, mental illness stigma). Binary logistic regression tested associations between legislator characteristics (e.g., political party, gender, ideology) and segment membership. Multi-level logistic regression assessed the predictive validity of segment membership on support for parity laws. A name was developed for each segment that captured its most salient features. Results Three audience segments were identified. Budget-oriented skeptics with stigma (47% of legislators) had the least faith in behavioral health treatment effectiveness, had the most mental illness stigma, and were most influenced by budget impact. This segment was predominantly male, Republican, and ideologically conservative. Action-oriented supporters (24%) were most likely to have introduced a behavioral health bill, most likely to identify behavioral health issues as policy priorities, and most influenced by research evidence. This was the most politically and ideologically diverse segment. Passive supporters (29%) had the greatest faith in treatment effectiveness and the least stigma, but were also least likely to have introduced a behavioral health bill. Segment membership was a stronger predictor of support for parity laws than almost all other legislator characteristics. Conclusions State legislators are a heterogeneous audience when it comes to behavioral health. There is a need to develop and test behavioral health evidence dissemination strategies that are tailored for legislators in different audience segments. Empirical clustering approaches to audience segmentation are a potentially valuable tool for dissemination science. Electronic supplementary material The online version of this article (10.1186/s13012-018-0816-8) contains supplementary material, which is available to authorized users.
Collapse
|
29
|
Kronick R. Mental Health of Refugees and Asylum Seekers: Assessment and Intervention. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:290-296. [PMID: 29207884 PMCID: PMC5912300 DOI: 10.1177/0706743717746665] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With unprecedented numbers of displaced persons worldwide, mental health clinicians in high-income countries will increasingly encounter refugee and asylum-seeking patients, many of whom have experienced significant adversity before and after their migration. This paper presents a summary of the recent evidence on the assessment and treatment of refugees across the lifespan to inform clinicians' approaches to care of refugee patients in mental health care settings. Assessment and interventions for refugees are grounded in an ecosystemic approach which considers not only pre-migratory trauma, but social, familial, and cultural determinants of mental health in the host country. Evidence for psychotherapy and pharmacological treatments are reviewed, highlighting promising interventions while acknowledging that further research is needed. Ultimately, serving refugees necessitates a biopsychosocial approach that engages clinicians as medical experts, therapists, and advocates.
Collapse
Affiliation(s)
- Rachel Kronick
- Centre for Child Development and Mental Health, Jewish General Hospital, Lady Davis Institute, Montréal, Quebec, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, Quebec, Canada
| |
Collapse
|