Cultural competency training in psychiatry

Abstract

Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.

EPA guidance on cultural competence training

“…Global migration and the increasing number of immigrants to Europe imply that psychiatrists and patients may come from different cultures. The inclusion of cultural competence into psychiatric-psychotherapeutic training and practice is therefore a matter of growing relevance [2,6,8,12,16,23,27,28,39,50,57,62,91,111,112,126], just as ''hyperdiversity'' and migration are essentially global issues, but have a particular ''local'' shape nonetheless [68]. It is inevitable that in clinical settings, patients will present with differing clinical needs, and it has to be kept in mind that immigrants are a heterogeneous group in a number of ways [8,42,98].…”

“…We know that culture plays an important role in the symptom presentation of distress and illness and, moreover, that cultural factors have quite an impact on the diagnostic process and the treatment strategies in all populations [3,39,77,101,108,122]. Cultural competence is one concept that has been advanced as a way of capturing the capacity to provide appropriate care for diverse patients, overcoming socio-cultural differences and other systemic challenges to reduce disparities with regard to mental health care provision [6,16,79,91,117,129]. Cultural competence is defined as the ability to understand and be aware of cultural factors in the therapeutic interaction between the therapist and the patient [6,8,13,39,71,111,112].…”

Fifty years after Frantz Fanon: beyond diversity

“…Fanon's advocacy of culturally relevant treatments is partly addressed through these changes and European psychiatric training now includes mandatory training in cultural competencies (Quereshi 2008). Dogra & Karim (2005) highlighted in this journal the need for the recognition of diversity issues, although they observed that teaching in UK medical schools is 'fragmented' (Dogra 2005: p. 162).…”

“…In addition, there are debates over what exactly a 'culturally competent clinician' means (Ferns 1995;Dogra 2005;Quereshi 2008). Fanon's work may be being taken a step further than he had intended.…”

Medical faculty members' perspectives on the components of cross-cultural competence in the Islamic Republic of Iran: a qualitative study

“…Faculty members act as role models and prepare their students to deliver culturally competent care (6). Yet cultural diversity poses a pedagogical and social challenge to educators (18); at all levels, they must develop cultural knowledge, awareness and sensitivity to help diverse learners (19).…”