Worlds apart: Social inequalities and psychological care

Culture and Psychopathology: New Perspectives on Research, Practice, and Clinical Training in a Globalized World

“…For instance, lesbian, gay, bisexual and transgender (LGBT) populations have been found to present increased risk for suicide ( 19 , 20 ), traumatic stress reactions ( 21 ), major depression disorders ( 22 , 23 ), anxiety disorders ( 24 , 25 ), among others [e.g., ( 26 )]. Also, socio-economic adversities, including poverty and environmental risk factors, have been associated with the onset and maintenance of psychopathological symptoms and low life satisfaction ( 27 ). This relationship has been explained through material deprivation but also increased adverse life events (such as unemployment, abuse and neglect), with consequences for treatment outcomes, including among children and adolescents [e.g., ( 28 )].…”

“…These authors discuss the relevance and applicability of “Western” psychotherapies in different populations, considering distinct cultural, religious, political, social, familial, and individual features, with implications not only for treatment outcomes, but also the clinical therapeutic relationship. Another relevant, recent example is a special issue of Counseling and Psychotherapy Research ( 27 ), which brings light to the role of social inequalities in psychotherapy research and practice, acknowledging that, for a long time, psychotherapy was seen as an endeavor for the middle- and upper-class of educated and psychologically minded clients.…”

“…That is, issues of stereotyping and discrimination may be as real in the clinician-patient relationship as in any other interpersonal relationship. Indeed, social, educational and economic disparities between patients and clinicians are often evident ( 27 ). Moreover, there is evidence of stereotyping and bias among healthcare providers [e.g., ( 39 , 66 , 67 )], and diverse micro-aggressions in the health care systems ( 42 ).…”

“…However, research is still needed on the processes of implementation, clinical effectiveness, clinical communication, wider social impact, and outcomes of culturally competent services and interventions ( 11 , 39 ). Indeed, Delgadillo ( 27 ) argues for a better integration of the literature on social inequalities, power imbalance, and cultural competence into clinical training programmes. The recent aforementioned understandings of culture and of psychopathology in a social and cultural context, rather than an (exclusively) intra-individual process, provide a possible route to develop these clinical competences.…”

Medicine and meaning—How experienced therapists describe the role of medication in recovery processes in bipolar disorder

“…While local authorities are responsible for providing primary care, public health trusts run secondary and tertiary mental health care in a designated catchment area. This system aims to meet the challenges stemming from the fact that mental health problems are disproportionately experienced by people in lower socioeconomic groups (Delgadillo, ). However, a person in the community may also receive psychotherapy and counselling from specialised professionals in private practice, some of whom receive substantial funding from the local public health trust.…”